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What is the most common method of drug administration?
Oral
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State why oral administration via a tablet or capsule takes longer for the body to process than other routes of administration?
Medication must go through disintegration and dissolution process.
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List 2 disadvantages of oral administration.
Taste, odor, irritate stomach, aspiration
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How is a medication absorbed in sublingual or buccal administration?
The thin epithelium and network of capillaries on the underside of the tongue permit drug absorption.
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Why would a medication be administered via the rectal route?
When the stomach is nonretentive or traumatized, when the medicine has an objectionable taste or odor, or when it can be changed by digestive enzymes.
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Define parenteral.
Done via injection through the skin.
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Define enteral.
Anything given via the GI tract.
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Define percutaneous.
Absorbed through the skin
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Describe intramuscular.
Deep injection made into the muscular tissue.
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Describe subcutaneous.
Small amounts of drug in solution are given beneath the layers of the skin, yet above the muscle.
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Describe intravenous.
Direct injection into a vien.
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State how antiarrythmics work.
They affect the electrical conduction of the heart. They block the SA and AV nodes, as well as the bundle of HIS. The ultimate goal for this class of medications is to suppress excess electrical conduction with the cardic system and thus decrease arrhythmia production.
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What is the main goal of an antihypertensive?
Lower blood pressure.
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What are some secondary effects of an antihypertensive medication?
Decrease the pressure the heart must pump against, vasodialation, drecreased heart rate.
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Describe what heart failure is.
Insuffient pumping of the heart.
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How do diuretics work?
These medications are designed to eliminate excess fluid and sodium from the bloodstream, thus decreasing the overall pressure within the vessels.
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List 2 signs or symptoms of stroke.
One-sided weakness, drooping of one side of face, slurring of speech.
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Differentiate between anticoagulants and antiplatelets.
Anticoagulants are given to patients with history of clots or have conditions that may increase potenial to develop clots. Antiplatelet are given to patients who have experienced a heart attack or stroke. Antiplatelet prevent platelets from sticking together or clotting.
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When is a thombolytic most effective?
Within 7 days.
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Which category of medications is prescribed more frequently than any other?
Analgesic medications
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What can occur if a patient takes too high of a narcotic dose?
May cause repiratory distress.
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What is a NSAIDS?
Nonsteroidal antiinflammatory drugs. Treats pain associated with inflammation.
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What is a concern with muscle relaxers?
The diaphragm is our main muscle of respiration. Muscle relaxants may cause respiratory depression.
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What are the dose requirements of acetaminophen and what can too high of a dose cause?
No more than 4000 mg/day because it is associated with severe liver damage at high doses.
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What is a common side effect of antihistamine medication?
Drowsiness
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Differentiate between a narcotic and non narcotic antitussive.
- Narcotic - suppresses the cough reflex by acting on the cough center of the brain.
- Non narcotic - Reduces the cough reflex at it's source.
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Define refractoriness- what type of medication is this commonly seen with?
Occurs when given to frequently, build up a resistance to medication. This is commonly seen with bronchodilators.
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How do decongestants work?
Vasoconstriction occurs, this limits blood flood and decrease fluid movement, this reduces blood/fluid flow to the nasal area.
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What to expectorants serve to do?
Liquify thick mucous so it is able to be coughed up.
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Name 1 concern a radiographer may consider when working with a diabetic patient.
Diabetic patients must with hold metformin (Glucophage) for 48 hours.
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What is a common medication used to treat type 2 diabetes that may also be a concern when administering contrast media.
metformin (Glucophage)
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Differentiate between, antiseizure, antipsychotics, antidepressants and antianxiety medications.
- Antiseizure - medications used to prevent and to trat seizure disorders.
- Antipsychotics - medications used to treat psychotic episodes and disorders such as schizophenia, paranoid behaviors and bipolar disorder.
- Antidepressants - medications used to treat clinical depression that results from neurotransmitter deficiencies.
- Antianxiety - medications used for treating acute and chronic anxiety states.
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Differentiate between antibiotics, antivirals and antifungals.
- Antibiotics - therapeutic agents used to kill or suppress pathologic microorganisms responsible for causing infectious diseases.
- Antivirals - used to suppress and limit the spread of viruses that invaded the human body.
- Antifungals - agents used to kill mycotic (fungal) organisms.
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List 2 effects the healthcare worker may be at risk for when dealing with chemotherapeutic agents.
Chemotherapeutic agents are very toxic. Mutagenic changes in DNA and teratogenic affects (effects to an unborn child)
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Why is it important to treat heart burn? What type of medication is used to do this? And how does it work?
It can effect the lining of the esophagus. Antacids are used to treat heart burn. Antacids are alkaline in nature (basic in nature), they neutralize the acid secretion in stomach.
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How does an antidiarrheal work?
Increases water absorption.
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How does a laxative work?
Draw fluid into the intestine
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When would an emetic be used?
To enduce vomiting.
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What is a microorganism?
Organisms that are too small to be seen without the aid of a microscope.
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List the 4 categories of microorganisms discussed in your book and their characteristics.
- Bacteria - unicellular microorganisms that can be spherical.
- Viruses - simplest form of life.
- Protozoa - unicellular and colonial organisms that exhibit characteristics typical of animal life. Classified according to their motility
- Fungi - found in live or decaying matter.
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List the 6 parts of the cycle of infection and describe each.
- Pathogen - microorganisms that are capaable of causing disease
- Reservoir - site where infectious organism can remain alive and from which transmition can occur.
- Portal of exit - the way the infection leaves one host before entering another.
- Mode of transport - direct contact, fomite (any object), vector (animal or insect), airborne.
- Portal of entry - path through which a pathogen can enter the body of a susceptible host.
- Susceptible host - persons who have reduced resistance to infection.
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What is the difference between HIV and AIDS?
HIV affects T cells (white blood cells). AIDS is the stage when a patient is HIV+ and has developed an additional illness.
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How is TB spread? What are some things we can do to protect ourselves when we come in contact with TB?
TB is spread through airborne particles. To protect ourselves we should wear a fitted mask.
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List the 5 types of hepatitis and compare and contrast each.
- Hepatitis A - transmitted via the oral/fecal route. Vaccine available.
- Hepatitis B -
- Hepatitis C - Blood born virus. No treatment.
- Hepatitis D - Blood born virus. No treatment.
- Hepatitis E - transmitted via the oral/fecal route. Vaccine available.
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List 3 items that are discussed in the standard precautions set forth by the CDC.
Hand washing, gloving, personal protective equipment and needle recapping.
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What types of items should be sterilized or disinfected?
Equipment, door knobs and keyboards.
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What are some guidelines or considerations to follow when using gloves.
Change gloves after contact with each patient. As soon as you are done with the patient, take your gloves off before touching other things.
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List 2 concerns with alcohol based rubs.
Should not replace hand washing and alcohol based rubs are flammable.
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What role does the technologist play in cleaning?
Keep area clean, stop spread of infection.
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Contaminated waste disposal is required by which two agencies?
OSHA and EPA
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Define contrast media.
Organic iodides with varying degrees of radiopacity depending on their iodine content. Contrast media provides an enhanced radiographic image and allows the study of areas of the body which normally have low contrast.
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State characteristics of a “perfect” contrast media.
Water soluble, chemical and heat stability, biologically inert, low viscosity, love osmolality, selective renal excretion, safe, cheap.
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Does a perfect contrast media exist?
No
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List 2 indications for CM.
CT (head and body), intravenous urography, coronary/pulmonary angiography, ERCP, cholangiography, venography (IVC, SVC)
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How many exams that use contrast media results in fatalities?
Fatal occurrences are estimated to be less than 1/10,000 test (about 500 deaths/yr.)
Fatal occurrences are estimated to be less than 1/10,000 test (about 500 deaths/yr.)
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List one example of ionic and one example of non ionic contrast with their osmolality.
- Ionic – Diatrizoate (1600-3000)
- Non ionic – iohexol (844)
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____% of all imaging studies in the US use contrast media.
10
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Non ionic contrast media was introduced in _____.
1984
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____% of all contrast studies use non ionic contrast media.
70
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Non ionic agents cost ___ to ___ times more than similar ionic agents.
10 to 15
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Selective use protocols _______ high risk patients who may be best served by using nonionic contrast media
Indentify
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What is the cost for 100cc of ionic contrast media?
6-20 dollars
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What is the incidence rate for adverse reactions due to contrast media?
5-8%
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Usually severe and fatal reactions occur within the 1st ___ minutes.
20
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What are the most common physiologic reactions(non idiosyncratic)seen with iodinated contrast media?
Warmth, flushing, nausea and vomiting, and metallic taste
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Name 2 non physiologic reactions (idiosyncratic) seen with iodinated contrast media.
Bronchospasm, airway edema, gastrointestinal distress, and urticaria (hives)
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The incidence of anaphylactic shock due to contrast media is ______, incidence for severe reactions is ____ and for fatal reactions is _______.
1-2%, 0.1%, 0.01-0.0025%
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What drug will be given to alleviate urticaria and what is the dose?
Diphenhydramine (Benadryl) 50mg PO/IV/IM
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Where will urticaria usually occur on the body?
Upper part of the trunk, either in the chest neck or face.
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What drug can be given to treat facial edema, what is the dose and route of administration?
Epinephrine (1:1000) 0.1-0.3ml SC
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What drugs can be given to treat bronchospasm?
Administer oxygen. SC epinephrine 0.1-0.3ml, B-agonist inhaler, Albuterol (Proventil) or metaproteranol (Alupent)
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List the risk factors for contrast reactions.
Previous reaction to CM, asthma, multiple drug or food allergies, co-existing disease states (especially cardiac or renal), doses containing 20gm or more of iodine, stress, fear and anxiety.
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What 2 groups of medications can be used to premedicate to prevent adverse reactions?
Antihistamines and corticosteroids
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When does an antihistamine work best against contrast reactions?
When they are given before the reaction occurs.
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List questions that should be included when assessing your patient prior to contrast administration.
- 1. Have you ever received CM?
- 2. Do you have any food or medication allergies?
- 3. Obtain medical history.
- 4. What medications is the patient taking?
- 5. Vital signs.
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What is extravasation?
The accidently leakage of the IV fluid from out the vein into the space around the vein.
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What are some methods of treating extravasation?
Initial use of cold compresses may help, warm compresses may be beneficial in some instances, the extremity should be raised about the level of the heart.
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What are the two main drugs that interact with contrast media according to the video?
Metformin (Glucophage) and Beta Blockers
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What is the incidence of lactic acidosis?
0.03/1000 cases
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A patient should stop taking Glucophage ____ hrs prior to contrast media use.
48
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What is lactic acidosis?
Lactic acidosis is when lactic acid builds up in the blood stream faster than it can be removed. Results from accumulation of lactate, which is normally eliminated in the kidneys.
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Beta blockers are commonly used to treat ___________ or ___________.
High blood pressure or angina (chest pain).
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Patients taking beta blockers have been shown to have a _____ times higher risk of having moderate to severe contrast reactions.
2.7
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Name 3 beta blockers.
Atenolol (Tenormin), Metoprolol (Lopressor), and Propranolol (Inderal)
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Why is contrast media needed to visualize certain structures in the body?
It is needed to visualize certain structures in the body because those structures have a low contrast and cannot be visualized. Contrast media has a high density and atomic number; it is nontoxic to the body, and easily excreted.
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What areas of body require contrast media to be visualized?
The area of body require contrast media to be visualized are those areas that have inherently low contrast and low tissue density. These areas can include vasculature, renal system, GI tract, and the biliary system.
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State the atomic # of iodine and barium.
- Atomic number of iodine: 53
- Atomic number of barium: 56
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State why barium and iodine are ideal for the use of contrast media.
They are ideal because they are both nontoxic to the body, have high atomic numbers, and are easily excreted.
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What interaction with matter predominates when contrast media is used?
Photoelectric absorption
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What is the name of the structure of iodinated contrast media?
Triiodinated benzoic acid or triiodinated benzene ring
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Define osmosis.
Movement of water across a semi-permeable membrane, from a high concentration to a low concentration.
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Define osmolality.
The number of milliosmoles per kilogram of water, or the concentration of molecules per weight of water.
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Define osmolarity.
The number of milliosmoles per liter of solution, or concentration per volume of solution.
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Define osmotic activity.
Action of osmolarity and osmolality together.
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Compare and contrast ionic and non ionic contrast media.
IONIC contrast media will dissociate into 2 particles, the positive cation, and the negative anion. It can have either a high or low osmolality. NON IONIC contrast media will not dissociate, is more expensive and much safer than ionic contrast, with low osmolality. Both IONIC and NON IONIC contrast media contain iodine and will cause a fluid shift inside the body.
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Describe high osmolar ionic contrast media.
High osmolar Ionic contrast media has an anion and cation of every iodine atom. With this type there are 3 iodine atoms to 2 osmotically active particles. Ratio of 3:2 which can be reduced to 1.5.
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Describe low osmolar nonionic contrast media.
Low osmolar nonionic contrast media does not dissociate into a negative/positively charged particle, therefore results in 3 iodine atoms to 1 osmotically active particle.
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Describe low osmolar ionic contrast media.
Low osmolar ionic contrast media consists of 6 iodine atoms per molecule and dissociates into two osmotically active particles. This results into a ration of 6:2 which can be reduced to 3.
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How is intravenous contrast media excreted (iodinated)?
It is primarily excreted via the kidneys and also a small percentage is also excreted into the intestines through the hepatic/biliary system
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How are oral/rectal contrast media is excreted (barium)?
Through the GI tract.
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What two main lab values are assessed prior to intravenous contrast media administration? What are the ranges for the lab values?
- BUN – 8-25 mg/dL
- Creatinine - .6-1.5 mg/dL
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What are microbubble agents generally used for?
To enhance ultrasound images.
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What can happen if iodinated contrast media is injected too slowly?
The cardiovascular system will dilute the iodine concentration before imaging; this prevents photoelectric absorption and ends up not being of diagnostic quality.
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List 3 examples of a mild, moderate, severe iodinated contrast media reaction.
- Mild: Metallic taste, warm, flush feeling, sweating, dizziness, rash
- Moderate: Tachycardia, systemic rashes/hives, and wheezing
- Severe: Convulsions, cardiopulmonary arrest, and arrhythmias
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What happens when iodinated contrast media has higher osmolality than that of blood?
If iodinated CM has a higher osmolality than blood there will be a rise in intravascular pressure. More fluid will be drawn into the blood stream, causing RBCs to shrink. This results in vasodilation, giving the patient that warm, flush feeling. The kidneys will also be bombarded with extra fluid.
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