21-23 book objectives

what is associated pharmacology nomenclature?

pharmacist (professionals), pharmacokinetics (study with emphasis of time on drugs), pharmacology (study of drugs)

classifications:

• classification name

• classification action

• legal classification

what are the various classifications of drugs?

name - chemical, generic, and brand (trade) names

action - function, drug family category

legal - prescription or non-prescription; professionals (pharmacists)

types: analgesics, anesthetics, antianemics, antianxiety, antiarrhythmics, antibiotics, anticholinergics, anticancer agents, anticoagulants, antidepressants, antidiabetics, antiemetics, antiepileptics, antifungals, antihistamines, antihyperlipidemics, antihypertensives, antiparkinson agents, and many more

what are actions, indications, and precautions for various drugs?

analgesics: none; nausea/vomiting if overdose

anesthetics: irregular heartbeat and breathing, seizures, and possibly death

antianemics: none; may affect view on MRI

antianxiety: if abused, can cause reverse affects

antiarrhythmics: hyperthyroidism, pulmonary fibrosis

antibiotics: allergic reactions (mild → severe or possibly fatal)

anticholinergics: delirium, dry mouth, rapid heart beat, coma

anticancer agents: toxic; alopecia, bone marrow suppression, nausea/vomiting

anticoagulants: hemorrhages - mostly associated with falls

antidepressants: nausea, drowsiness, sexual disfunction, diarrhea

antidiabetics: lactic acidosis (50% mortality rate), decreased renal function

there are more but these are the most important

precautions include: checking the patient history for allergies and previous disease or medical issues

what are the 5 rights of drug administration?

the right…

1. drug

2. amount

3. patient

4. time

5. route

what are common metric systems of measurement?

weight:

• microgram (mcg)

• milligram (mg)

• gram (g or gm)

• kilogram (kg)

volume

• milliliter (mL)

• cubic centimeter (cc)

• liter (L)

equivalents

• 1 mL = 1 cc

• 1000 mL = 1 L = 1000 cc

• 1000 mcg = 1 mg

• 1000 mg = 1 g

• 1000 g = 1 kg

• 100 mg = 0.1 g

• 10 mg = 0.01 g

what are methods of drug administration?

enteral:

• oral

• sublingual

• buccal

• rectal

topical

• applied to skin (transdermal)

parenteral:

• anywhere other than GI

• injection:

  • intravenous

  • intramuscular

  • intradermal

  • subcutaneous

what are documentation procedures for drug administration?

all information about drug administration, etc. to patient should be recorded in the patient’s medical record

what are common standard abbreviations for drug administration?

• (IV) intravenous

• (IM) intramuscular

• (ID) intradermal

• (SQ) subcutaneous

what is the purpose of contrast media?

it allows for visualized anatomic detail - usually at a localized area of interest - for differentiation in radiographic density from surrounding tissues

low vs high subject contrast

low:

• includes radiographic images

• few density differences

• without contrast media

high:

• high density differences

• with contrast media

negative vs positive contrast agents

negative:

• radiolucent

• photons appear dark

• increased density

• low anatomic numbers

positive:

• radiopaque

• photons appear light/visible

• decreased density

what are general contrast media (CM) types?

• ultrasound contrast agents (UCAs)

• negative CM

• positive CM

• MRI contrast agents

• CM for children

• radiopharmaceuticals

what are the complications of barium sulfate contrast media?

• can dry colon and cause residue buildup in colon

• extravasation

• perforation of colon

• barium peritonitis - inflammation of abdominal cavity

• atrophic tissues

• vaginal rupture

• water absorption from colon

• pulmonary edema - causes seizures, coma, and possibly death

• apathy, drowsiness, and hypervolemia are possible symptoms as well

what are some specific procedures and how do they associate with patient instruction?

• esophagram: supportive communication, tell patient to exhale, then swallow barium, and hol breath on exhale for exposure

• upper gastrointestinal: supportive communication, explain positioning

• small bowel: supportive communication, 1 hr barium sulfate suspension

• colon/barium enema: supportive communication, listen to patient, observe their mental status

• stomach CT: supportive communication, patient should believe radiographer is constantly watching the procedure

what is the importance of osmosis?

osmolality: determines osmotic pressure

this is important because of the plasma water displacement and movement of contrast to the vascular system - this could potentially cause hypervolemia and blood vessel dilation (pain and discomfort)

what are advantages of nonionic iodinated contrast media?

decreases side effects of ionic iodine CM; low osmolality CM; water soluble

what are adverse effects of various contrast agents?

• bronchospasm

• anaphylactoid

• histamine

• vasoconstriction

• dehydration

• increased BUN

• increased creatinine

• toxic renal effects

• alteration of blood-brain barrier

• increased blood pressure, bradycardia, tachycardia

• sickle cell anemia progression

• extravasation

• mild → severe reactions

what are clinical symptoms of adverse reactions to iodinated CM and level of treatment required?

mild - observation, reassurance, and resolution; usually does not require treatment; limited/no evidence of progression:

• urticaria/pruritis, cutaneous edema, itchy/scratchy throat, nasal congestion, sneezing/conjunctivitis/rhinorrhea, nausea/vomiting, flush/chills/warmth, headache/dizziness/anxiety/altered taste, mild hypertension, vasovagal reaction (resolves itself)

moderate - careful observation, check if symptoms are continually progressing/life threatening; pronounced/typically required prompt treatment

• urticaria/pruritis, erythema, facial edema without dyspnea , throat tightness/hoarse, wheezing/bronchospasm/mild-no hypoxia, protracted nausea/vomiting, hypertensive urgency, isolated chest pain, vasovagal reaction (needs responsive treatment)

severe - medical emergency, life threatening; aggressive treatment needed immediately, hospitalization

• diffuse edema/facial edema with dyspnea, diffuse erythema with hypotension, laryngeal edema with stridor and/or hypoxia, wheezing/bronchospasm/significant hypoxia, anaphylactic shock (hypotension + tachycardia), vasovagal reaction (resists treatment), arrhythmia, convulsions/seizures, hypertensive emergency (all of these can cause cardiopulmonary arrest or pulmonary edema in severe cases)

how do patient history and adverse reactions relate?

ex: if patient has sickle cell anemia or renal failure, etc. it can cause the adverse effects, so they need to be monitored and radiographer needs to carefully review the patient’s medical history

what are concerns for contrast media for children?

small volumes used, small-gauge angiocaths, and unusual vascular access sites are common factors for the cause of extravasation, kidney stones, sensitivity to CM, and abnormal kidney function

what is the concept of radiopharmaceuticals?

attaches pharmaceuticals to radioisotope to get radiation out of the body through excretion