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PHARM 2-EXAM 1 (kinetics/dynamics/renal) > IV dyes > Flashcards

IV dyes Flashcards

1
Q

The higher the osmolarity of a ICM, the

A

Higher the risk of adverse events such as N/V

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2
Q

Which ICM agents are of choice?

A

Low-Osmolality

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3
Q

What are the 3 osmotic effects?

A

Transient decrease in RBF & GFR

Osmotically induced diuresis (dehydrating effect)

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4
Q

What are the 3 classifications of ICM reactions?

A

Idiosyncratic

Non-idiosyncratic

Contrast-induced nephropathy

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5
Q

Idiosyncratic reactions will happen within

A

20 min of injection

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6
Q

Idiosyncratic reactions can be _______ & _________

A

Anaphylactoid (not a true hypersensitivity)

Independent of dose administration

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7
Q

When is a Idiosyncratic reaction more likely to occur?

A

In a previous ICM reaction

Asthma

Food/drug/environmental allergy

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8
Q

What are significant symptoms of an Idiosyncratic reaction?

A

Hives

N/V

Diaphoresis

Facial & laryngeal edema

Bronchospasm

Pulmonary Edema

Syncope

Seizures

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9
Q

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

A

Peak Airway Pressures will increase

HOTN

Bradycardia

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10
Q

What is the onset of a Non-idiosyncratic reaction?

A

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

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11
Q

Non-idiosyncratic reactions resemble

A

Flu-like symptoms

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12
Q

Caution in the pregnant population with which ICM reaction?

A

Non-idiosyncratic reaction since it can cross the placenta

May be mutagenic to human cells

Nonionic agents PREFERRED if administered

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13
Q

What is the non-idiosyncratic cardiovascular reaction?

A

Direct NEGATIVE isotrope

Peripheral vasodilation

HOTN

Lowered threshold for v-arrhythmias

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14
Q

Which fluid should be avoided with ICM?

A

Hyperosmolar, since it can cause HTN & pulmonary edema

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15
Q

A direct negative isotrope effect can cause

A

A vasovagal reaction

Precipitation of angina

Risk of syncope

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16
Q

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

A

Cardiac arrest

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17
Q

Non-idiosyncratic reactions can cause this tissues abnormality

A

Extravasation

Tissue damage/compartment syndrome

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18
Q

Contrast- Induced Nephropathy happens when

A

Creatinine is elevated >50% of baseline

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19
Q

Contrast- induced Nephropathy will increase

A

O2 free radicals

O2 consumption

Blood Viscosity

Endothelin

20
Q

Contrast induced nephropathy will decrease

A

Nitric Oxide

21
Q

Contrast- induced nephropathy will cause

A

Renal ischemia

Cellular Toxicity

22
Q

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

A

Preexisting renal insufficiency

DM Nephropathy

CHF IV

NSAID & aminoglycoside use

Elderly

Repeated, large doses

23
Q

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

A

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

IVF- use Iso-osmolar (NS or LR)

24
Q

How can CIN be managed?

A

IVF

N-acetylcysteine (600mg x2 daily)

Theophylline

Sodium Bicarb

Diuretics- NOT mannitol or lasix!!!!

25
Q

When managing CIN, what should not be held?

A

Diuretics or ACE-Inhibitors

26
Q

How can ICM reactions be prevented?

A

Corticosteroids (methylprednisolone & prednisolone)

H2 blockers (famotidine & Pepcid)

H1 blocker (Benadryl)

27
Q

What is the absorption & emission of indocyanine green?

A

800-850

28
Q

IcG should be reconstituted with

A

Sterile water & used within 6 hours

29
Q

IcG visualization time range?

A

1-30 min

30
Q

IcG dose for Adults?
PEDS?

What is MAX dose?

A

Adults: 5 mg

PEDS: 2.5mg

MAX: 2mg/kg

31
Q

Absorption & excitation of Indigo Carmine?

A

615

32
Q

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

A

5mL

33
Q

indigo Carmine may cause

A

Alpha- adrenergic stimulation (transient HTN)

Pregnancy C

34
Q

Absorption & excitation of Methylene Blue (MB)?

A

700

35
Q

MB is incompatible with

A

NS

36
Q

MB can be diluted with

A

50mL D5W

37
Q

MB is a pregnancy category

A

X

38
Q

When should MB be avoided?

A

G6PD deficiency (hemolytic anemia)

Hepatic/Renal impairment

Antidepressant drugs

39
Q

MB is used to treat

A

Methemoglobinemia by reducing iron

40
Q

MB is sometimes used as a

A

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

41
Q

What is the dose of MB?

A

0.25-2mg/kg IV

Infusion up to 3mg/kg/hr

Give slowly over 5-30 min

42
Q

Adverse effects of MB?

A

Potent MAOI (serotonin toxicity–> HTN crisis)

Hemolysis

HTN

Angina

Hypersensitivity reaction

Reduced mesenteric & cutaneous perfusion

43
Q

MAO helps break down

A

Catecholamines

44
Q

Oxyhemoglobin absorbs more ______, emitting______

A

More Infrared

940

45
Q

Deoxyhemoglobiin absorbs more_______, emitting______

A

More Red

660

46
Q

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

A

Decrease

False LOW

PHARM 2-EXAM 1 (kinetics/dynamics/renal) (4 decks)

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