RT208 Pharmacology for the Radiographer

By mouth

PO

Intramuscular

IM

Intravenous

IV

At once

STAT

Verbal order

VO

Subcutaneous

SC or SQ

Intradermal

ID

Twice a day

bid

Drop

gtt

Cubic centimeter

cc

Before meals

ac

After meals

pc

At bedtime

hs

As necessary

PRN

Every

q

Every day

qd

Three times a day

tid

Every 2 hours

q2hrs

milliliter

mL

American Society or Radiologic Technologists (ASRT)

Who cited "Venipuncture falls within the profession's scope of practice and practice standards and that it shall be

included in the didactic and clinical curriculum with demonstrated competencies of all appropriate disciplines

regardless of the state or institution where such curriculum is taught."

30%

... of all imaging examinations involve the use of a form of contrast media to aid in the visualization of a body

part or body system

contrast media

30% of all imaging examinations involve the use of a form of ... to aid in the visualization of a body

part or body system

Contrast agents

Categorized as drugs because they can be absorbed into the systemic circulation and may produce a

physiologic response on the body

Contrast agents

Required to visualize areas of the body when the organ or system of interest is too similar to the surrounding area

Barium

Most common type of contrast; GI system

Barium

Metal, does not dissolve; suspended in solution

barium

All positive contrast agents used in diagnostic imaging contain iodine, except ...

Angiography

Invasive imaging test that uses CM to visualize the arteries

Iodine

able to absorb the x-ray photons, allowing an area of interest to be seen on the image as white area

53

Atomic number of Iodine

Barium

able to accomplish the same absorption of x-ray photons and the same radiopaque image

56

Atomic number of Barium

1. GI Tract

2. Kidneys

3. Gallbladder

4. Pancreas

5. Heart

6. Brain

7. Uterus

8. Spinal column

9. Arteries

10. Veins

11. Joints

Iodinated contrast agents used in the following examinations:

1. Ability to mix with the body fluids

2. The viscosity

3. The ionic strength

4. Its persistence in the body

5. The osmolality

6. The iodine content

7. The potential for toxicity

Variables to consider when selecting a contrast agent:

● Oral, Vaginal, Intravenous & Intra-arterial Routes

● Directly instilled into the organ through a retrograde procedure

● Directly into the joints or cavities

Iodinated contrast agents, mode of administrations:

33.2 keV

K-shell binding energy of Iodine

photoelectric absorption

When the incident x-ray energy is closer to

the k-edge of the atom it encounters, ... is more likely to occur

Iodine

Similar to the average energy of x-rays used in diagnostic radiography

8, 0.5 keV

Atomic number (Z) and keV: Oxygen

20, 4.0 keV

Atomic number (Z) and keV: Calcium

42, 20 keV

Atomic number (Z) and keV: Molybdenum

53, 33 keV

Atomic number (Z) and keV: Iodine

56, 37 keV

Atomic number (Z) and keV: Barium

74, 70 keV

Atomic number (Z) and keV: Tungsten

82, 88 keV

Atomic number (Z) and keV: Lead

hysterosalpingography (HSG)

Oil based contrast can be used in ...

480 mg I/mL

240 - 300 mg I/mL

Organs

Oil based contrast agent is instilled in ... - not vessels

Oil based contrast agent

• Made from fatty acids

• Not ingested

1. Patients with a history of previous adverse reaction to CM

2. Patients with asthmatic conditions

3. Patients with known cardiac conditions

4. Patients who are severely debilitated

5. Patients at high risk for contrast extravasation

6. Patients for whom the physician feels there is an indication for its use

Patients for LOCM:

1. Assessment of the patient's understanding of the procedure.

2. Informing the patient in detail concerning how the examination will proceed.

3. Explanation of the expected side effects and assurance that these are not unusual.

4. Allowing the patient to express feelings of anxiety and obtaining patient feedback to ascertain his complete

understanding of the procedure.

The radiographer may assist in reducing anxiety in the following ways:

1. A feeling of flushing or warmth

2. Nausea

3. Headache

4. Pain at the injection site

5. Altered taste, may be metallic

Clinical manifestations of expected side effects:

● Slow the rate of the contrast infusion

● Observe the patient closely and offer reassurance

Radiographers response to expected side effects:

1. Pallor

2. Cold sweats

3. Rapid pulse

4. Syncope or complaint of feeling faint

5. Bradycardia

6. Hypotension

Clinical manifestations of a Vasovagal reaction:

● Stop the infusion of contrast medium.

● Place the patient in flat or Trendelenburg position

● Notify the radiologist

● Remain with the patient and offer reassurance

Radiographers response to Vasovagal reactions:

1. Nausea, vomiting

2. Cough

3. Feeling of warmth

4. Headache

5. Dizziness

6. Shaking

7. Itching

8. Pallor

Clinical manifestations of a Mild Reaction:

● Stop the infusion and notify the radiologist or radiology nurse

● Remain with the patient and offer reassurance

● Prepare to assist in the administration of an antihistamine or subcutaneous epinephrine

Radiographers response to mild reactions:

● Tachycardia or bradycardia

● Hypertension or hypotension

● Dyspnea

● Broncospasm or wheezing

● Patient complains of feeling of throat closing (laryngeal edema)

Clinical manifestations of a Moderate Reaction:

● Stop the infusion

● Notify the radiologist and the radiology nurse

● Call for the emergency team if symptoms progress rapidly.

● Remain with the patient and offer reassurance

● Prepare to administer oxygen and intravenous medication

● If the patient is in respiratory distress, place him in semi-fowler's position

● Position patient who is vomiting in a position to prevent aspiration.

Radiographers response to Moderate Reactions:

1. Dyspnea related to laryngeal edema

2. Hypotension

3. Seizures

4. Cardiac arrhythmia

5. Lack of patient response

6. Cardiac arrest

Clinical manifestations of a Severe Reaction:

● Call for emergency response team (Code blue)

● Notify the radiologist and the radiology nurse

● Prepare to use AED (automated external defibrillator)

● Prepare to administer oxygen and intravenous medications.

Radiographers response to Severe reactions:

● All drugs (medications) are potentially harmful.

● All health care workers who administer drugs must understand the intended action, contraindications, side

effects and potential adverse effects of any drug they administer.

Universal precautions in drug administration:

1. The Right Patient

2. The Right Drug

3. The Right Amount or Dose

4. The Right Route

5. The Right Time

The radiographer must adhere to the 5 rights of drug administration at all times:

Above the knee amputation

AKA

Atrioventricular

AV

Atrial septal defect

ASD

Atrial fibrillation or afebrile

AF

Atherosclerotic heart disease

ASHD

Abdominal aortic aneurysm

AAA

As soon as possible

ASAP

as much as needed

ad lib

Arteriovenius oxygen

A-VO2

Arteriovenous

A-V

Arterial blood gas

ABG

Aortic stenosis

AS

Aortic insufficiency

AI

Antinuclear antibody

ANA

Bowel or breath sounds

BS

Bowel care

BC

bone marrow or bowel movement

BM

Body weight

BW

Blood urea nitrogen

BUN

Blood pressure

BP

Biopsy

BX

Bilateral otitis media

BOM

Bilateral

Bilat

Benign prostatic hypertrophy

BPH

Below the knee amputation

BKA

Beats per minute

BPM

Bathroom privileges

BRP

Basal metabolic rate

BMR

1. Signs and symptoms

2. Relevant history

3. Current diagnoses

4. Specific reason for the procedure requested (physician)

MEDICAL NECESSITY FOR THE EXAMINATION:

Medication errors

If a drug is incorrectly administered or an order is misinterpreted, the radiographer is legally liable.

1. The dosage of the drug administered

2. The name of the incorrect drug

3. Why it as administered

4. The patient's reaction

5. How the error was remedied

Medication error: Items to include in the report are as follows:

1. Enteral

2. Topical

3. Parenteral

Methods of drug administration:

Enteral

Used if the drug will not be destroyed by gastric secretions and when slower absorption and longer duration of drug

activity are desired

Topical

• Skin for local treatment of lesions or skin conditions

• Eyes, nose, and throat

• Respiratory mucosa by inhalation

• Vagina and in the rectum

• Skin for intended systemic effect (transdermal application)

Parenteral

• Subcutaneous, intramuscular, intradermal & intravenous

• Intralesional, intra-arterial, intracardiac, and intra-articular

• Used only by the physician or specialty nurses

1. Hub

2. Shaft

3. Lumen

4. Bevel

Needles are made of stainless steel and consists of the following parts: