IV dyes

Question 1

The higher the osmolarity of a ICM, the

Answer 1

Higher the risk of adverse events such as N/V

Question 2

Which ICM agents are of choice?

Answer 2

Low-Osmolality

Question 3

What are the 3 osmotic effects?

Answer 3

Transient decrease in RBF & GFR

Osmotically induced diuresis (dehydrating effect)

Question 4

What are the 3 classifications of ICM reactions?

Answer 4

Idiosyncratic

Non-idiosyncratic

Contrast-induced nephropathy

Question 5

Idiosyncratic reactions will happen within

Answer 5

20 min of injection

Question 6

Idiosyncratic reactions can be _______ & _________

Answer 6

Anaphylactoid (not a true hypersensitivity)

Independent of dose administration

Question 7

When is a Idiosyncratic reaction more likely to occur?

Answer 7

In a previous ICM reaction

Asthma

Food/drug/environmental allergy

Question 8

What are significant symptoms of an Idiosyncratic reaction?

Answer 8

Hives

N/V

Diaphoresis

Facial & laryngeal edema

Bronchospasm

Pulmonary Edema

Syncope

Seizures

Question 9

What will occur on the ventilator when a patient is having an allergic reaction?

Answer 9

Peak Airway Pressures will increase

HOTN

Bradycardia

Question 10

What is the onset of a Non-idiosyncratic reaction?

Answer 10

May be delayed 30 minutes to up to 7 days, with a variety of possible reactions

Question 11

Non-idiosyncratic reactions resemble

Answer 11

Flu-like symptoms

Question 12

Caution in the pregnant population with which ICM reaction?

Answer 12

Non-idiosyncratic reaction since it can cross the placenta

May be mutagenic to human cells

Nonionic agents PREFERRED if administered

Question 13

What is the non-idiosyncratic cardiovascular reaction?

Answer 13

Direct NEGATIVE isotrope

Peripheral vasodilation

HOTN

Lowered threshold for v-arrhythmias

Question 14

Which fluid should be avoided with ICM?

Answer 14

Hyperosmolar, since it can cause HTN & pulmonary edema

Question 15

A direct negative isotrope effect can cause

Answer 15

A vasovagal reaction

Precipitation of angina

Risk of syncope

Question 16

When the threshold for V-arrythmias is lowered, this places the patient at risk for

Answer 16

Cardiac arrest

Question 17

Non-idiosyncratic reactions can cause this tissues abnormality

Answer 17

Extravasation

Tissue damage/compartment syndrome

Question 18

Contrast- Induced Nephropathy happens when

Answer 18

Creatinine is elevated >50% of baseline

Question 19

Contrast- induced Nephropathy will increase

Answer 19

O2 free radicals

O2 consumption

Blood Viscosity

Endothelin

Question 20

Contrast induced nephropathy will decrease

Answer 20

Nitric Oxide

Question 21

Contrast- induced nephropathy will cause

Answer 21

Renal ischemia

Cellular Toxicity

Question 22

Contrast- induced Nephropathy will have an elevated risk in these patient populations

Answer 22

Preexisting renal insufficiency

DM Nephropathy

CHF IV

NSAID & aminoglycoside use

Elderly

Repeated, large doses

Question 23

What drugs can you give to help manage an allergic reaction?

Answer 23

Antihistaminies (H1 blockers, Benadryl, H2 blockers, Pepcid) can be given after EPI

IVF- use Iso-osmolar (NS or LR)

Question 24

How can CIN be managed?

Answer 24

IVF

N-acetylcysteine (600mg x2 daily)

Theophylline

Sodium Bicarb

Diuretics- NOT mannitol or lasix!!!!

Question 25

When managing CIN, what should not be held?

Answer 25

Diuretics or ACE-Inhibitors

Question 26

How can ICM reactions be prevented?

Answer 26

Corticosteroids (methylprednisolone & prednisolone) H2 blockers (famotidine & Pepcid) H1 blocker (Benadryl)

Question 27

What is the absorption & emission of indocyanine green?

Answer 27

800-850

Question 28

IcG should be reconstituted with

Answer 28

Sterile water & used within 6 hours

Question 29

IcG visualization time range?

Answer 29

1-30 min

Question 30

IcG dose for Adults? PEDS? What is MAX dose?

Answer 30

Adults: 5 mg PEDS: 2.5mg MAX: 2mg/kg

Question 31

Absorption & excitation of Indigo Carmine?

Answer 31

615

Question 32

Indigo Carmine can be given IV or IM with a dose of

Answer 32

5mL

Question 33

indigo Carmine may cause

Answer 33

Alpha- adrenergic stimulation (transient HTN) Pregnancy C

Question 34

Absorption & excitation of Methylene Blue (MB)?

Answer 34

700

Question 35

MB is incompatible with

Answer 35

NS

Question 36

MB can be diluted with

Answer 36

50mL D5W

Question 37

MB is a pregnancy category

Answer 37

X

Question 38

When should MB be avoided?

Answer 38

G6PD deficiency (hemolytic anemia) Hepatic/Renal impairment Antidepressant drugs

Question 39

MB is used to treat

Answer 39

Methemoglobinemia by reducing iron

Question 40

MB is sometimes used as a

Answer 40

Vasopressor by inhibiting nitric oxide synthase & gunnel cyclase, reducing the formation of cGMP

Question 41

What is the dose of MB?

Answer 41

0.25-2mg/kg IV Infusion up to 3mg/kg/hr Give slowly over 5-30 min

Question 42

Adverse effects of MB?

Answer 42

Potent MAOI (serotonin toxicity--> HTN crisis) Hemolysis HTN Angina Hypersensitivity reaction Reduced mesenteric & cutaneous perfusion

Question 43

MAO helps break down

Answer 43

Catecholamines

Question 44

Oxyhemoglobin absorbs more ______, emitting______

Answer 44

More Infrared 940

Question 45

Deoxyhemoglobiin absorbs more_______, emitting______

Answer 45

More Red 660

Question 46

IV dyes with lower absorption peaks _______the absorption ratio of red & infrared wavelengths, showing a false ______

Answer 46

Decrease False LOW