Pharmacology

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Pharmacology Contrast Media

• RTEC 93

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Pharmacology for the Radiologic Technologist
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Drug Classifications

• Name generic or brand
• Action
• Method of legal purchase (prescription or
  non-prescription)

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Classification by Name

• Chemical name actual chemical structure
• Generic name when it becomes commercially
  available (never capitalized) nonproprietary
  name
• Brand name give by a drug manufacture
  trademark, trade name, proprietary name

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Example

• Chemical name 7 chloro-1,3-dihydro-1-methyl-5-ph
  enyl-H-1,4-benzodiazepin-2-one
• Generic name diazepam
• Brand name - Valium

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Drug Reactions

• Anaphylaxis
• VS
• Anaphylactoid

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Principles of Drug Administration

• The golden rules of drug administration
• The five rights of drug administration
• Right drug Right amount
• Right patient Right time
• Right route

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Drug Routes

• Oral by mouth
• Sublingual under the tongue
• Topical directly onto the skin
• transdermal
• Parenteral by injection or other than oral -
  intramuscular, subcutaneous, intravenous,
  intrathecal

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Charting Drug Information

• Any time a drug is administered to an inpatient
  it must be charted
• Information includes
• Drug name
• Dose of the drug
• Route of administration (if parenterally, then
  the side of injection)
• Date Time

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Legal Considerations

• Errors with drug administration is the most
  common legal problems for radiologic
  technologists
• Techs must follow charting protocols and document
  all errors in drug administration

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CONTRAST MEDIA

• CONTRAST
• X-RAY DYE
• IODINE

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Contrast Media

• Negative contrast
• (AIR OR CO2)
• Radiolucent
• Low atomic material
• Black on film

• Positive contrast
• (all others)
• Radiopaque
• High atomic material
• White on film

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2 BASIC TYPES OF CONTRAST

• BARIUM Z 56
• NON WATER SOLUABLE
• GI TRACT ONLY INGESTED OR RECTALLY
• KVP 90 120

• IODINE Z 53
• WATER SOLUABLE
• POWDER
• LIQUID
• INTRAVENOUS OR
• GI TRACT
• KVP BELOW 90

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Water Soluble Iodine

• High atomic 53
• Radiopaque
• Used to radiograph
• Vessels
• Arteries
• Veins
• Function of internal organs

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KVP TYPE OF CONTRAST USED DETERMINES KVP RANGE

• IODINES 70 80 kVp
• (Ionic / Nonionic Water or Oil)

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IONDINATED CONTRAST

• WATER BASED
• INJECTED
• VESSELS/DUCTS
• INGESTED
• OPEN WOUNDS
• ISOVUE 200(41), 300(61) or 370 (76)

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Ionic Iodine Contrast
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Non-ionic Contrast
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Non-ionic Contrast Isosmolar
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ISOVUE-M 200 OR 300 (iopamidol)

• Intrathecal Injection
• Myelography
• Pediatric Myelography
• Enhancement of CT spine images

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IODINE WATER BASED CONTRAST

• IONIC
• LESS
• MORE REACTIONS

• NON-IONIC
• MORE
• LESS REACTIONS
• NON-IONIC PART 2
• ISOMOLAR
• EVEN LESS REACTIONS

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IODINATED Contrast Agents

• NON-IONIC
• Low Osmolality (Lower risk of complications)
• Gadodiamide (Omniscan)
• Iodixanol (Visipaque)
• Iopamidol (Isovue)
• Iopromide (Ultravist)
• Ioversol (Optiray)

• IONIC
• High Osmolality (Higher risk of complications)
• Diatrizoate sodium (Hypaque)
• Iothalamate meglumine (Conray)

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Adverse Reactions

• Caused By Osmolality of the Media
• Osmolality The number of particles when in a
  solution form.
• The more particles in solution the more water is
  drawn toward the molecule. This causes a change
  in the electrolyte balance in the body beginning
  the adverse reaction

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Iodine Contrast Material

• Ionic Iodine Contrast
• Anion -
• Cation
• More patient allergic reactions
• Non-Ionic Contrast
• Less patient allergic reactions

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Visipaque (iodixanol)

• Isosmolar, Non-ionic
• Water-soluble
• Addition of electrolytes
• Not to be used for intrathecal injection
• 270 (49) or 320 (63)
• Better for patients with renal problems

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Dose standards for intravenous contrast agents

• Adults
• Typically 100ml to 150ml is used for all patients
  regardless of body weight
• 200 ml used for angiography or CT angiography
• Maximum of 200 ml can be used in one day must
  test BUN Creat again prior to next contrast
  injection.

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Dose standards for intravenous contrast agents

• Pediatrics
• Standard of 2.0 ml/kg for pediatrics
• Sometimes a simpler division of patients into 2
  or 3 categories is used.  (eg. small/medium/large.
  )

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Converting Pounds to Kilograms

• 1 pound (lbs) 0.45 kilograms
• 1 kg 2.2 lbs (pounds)
• Patient wt 35 lbs
• How much contrast do you give?

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Contrast Dose Calculation

• 35 lbs X 0.45 15.75 kg
• 15.75 X 2 31.5ml of contrast

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Patient Education Assessment

• RTEC 93 Venipuncture

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Venipuncture

• Before venipuncture is performed, the
  technologist needs to be aware of
• Potential for an allergic reaction
• Contraindications for contrast material
• Site preparation for injection
• Adverse reaction to contrast
• How to deal with medical emergencies

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Question?

• The patients doctor ordered the exam, therefore
  the patient must be able to have contrast
  material

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Question?

• The patient must have been told by an ordering
  physician or nurse about what is going to happen
  during this examination in x-ray.

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Patient Education

• The way we are told is directly related to the
  way we will react to the information

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Patient Education

• Careful explanation and a confident,
  understanding attitude can help the patient
  relax.
• A relaxed patient makes venipuncture easier.
  
• Vasoconstriction

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Information

• A consent must be provided in terms the patient
  can understand. In a language they can
  understand.
• The patients questions must be answered in
  laymans language.

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Procedure

• Explain the steps in the procedure
• Expected duration
• Any limitations or restrictions

• Address any horror stories the patient may have
  heard
• Post care instructions
• Results of the Exam

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Be honest..

• Never tell the patient that inserting a needle
  for venipuncture does not hurt.
• Especially children, they may not trust medical
  staff again.

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Always be truthful

• The technologist must tell the truth and explain
  that the amount of pain experienced varies with
  each patient.
• You will do your best to keep the discomfort to a
  minimum and TRY to get it right the first time.

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Patient Assessment

• The patient must be assessed before any
  medication is administered.
• Information about a history of allergy must be
  obtained and documented.
• The patient must be screened thoroughly by the
  technologist for contraindications of contrast
  media.

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Patient Assessment

• You need to clear EVERY patient for contrast
  administration.
• Every time with no exceptions!

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Medications containing metformin

• Glucophage
• Glucovance
• Glyburide
• Glipizide
• Janumet

• Rosiglitazone
• Metaglip
• Avadment
• Fortamet
• Riomet

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Reactions to Contrast

• Let the patient know what is normal (expected)
  or abnormal reactions to contrast material
• Expected Flash of heat from head to toe
• Strange or metallic taste in the mouth
• Feeling like they have to urinate or are
  urinating
• Increased heart rate

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Check ListDo you have any allergies?
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Let me know if

• You have difficulty breathing
• You feel itchy
• You feel nauseous

• You feel faint
• Your arm starts to hurt or burn

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Shell fish allergies
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Contrast Reactions

• If a patient is going to have a contrast reaction
  it will happen within the first 1-5 minutes after
  injection.
• If the patient is going to have a life
  threatening reaction it will happen almost
  immediately

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Patient Assessment Check List
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BLOOD WORK LAB TESTS to check function of
kidneys prior to injection of contrast

• WATCH THE UPPER LIMITS
• BUN BLOOD UREA NITROGEN
• Merrills pg 214 range is 8 to 25
• pg 242 range is 10 - 20
• always check with RAD when level above 20
• CREATINE levels range
• pg 214 (0.6 - 1.5) pg 242 (0.05 - 1.2)
• always check with RAD when level above 1.2
• Indicates function of kidneys
• Diseases / dehydration / kidney failure

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BUN Creatinine

• BUN Blood urea nitrogen
• Measure the amount of urea nitrogen in the blood
• Could be elevated due to dehydration
• Normal 8-25 mg/dl
• Creatinine
• Measures the amount of creatine in the blood
• Normal 0.05-1.5 mg/dl (milligrams per deciliter)

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Creatinine clearance vs Creatinine

• In general, creatinine clearance is the removal
  of creatinine from the body.
• In renal physiology, creatinine clearance (CCr)
  is the volume of blood plasma that is cleared of
  creatinine per unit time.
• The result of this test is an important gauge
  used in assessing excretory function of the
  kidneys

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Creatinine clearance vs Glomerular filtration
rate (GFR)

• Clinically, creatinine clearance is a useful
  measure for estimating the glomerular filtration
  rate (GFR) of the kidneys.
• creatinine clearance overestimates actual GFR by
  10-20.
• This margin of error is acceptable considering
  the ease with which creatinine clearance is
  measured

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Normal ranges

• Normal reference ranges for creatinine clearance
  are
• Low High
• Male 55 146 ml/minute/1.73m2
• Female 52 134 ml/minute/1.73m2

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Normal ranges

• For most patients, a GFR over 60 ml/min is
  adequate. But, if the GFR has significantly
  declined from a previous test result, this can be
  an early indicator of kidney disease requiring
  medical intervention.

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Patient Assessment Check List

• Have you had an exam like this before?
• Have you had iodine before, x-ray dye, contrast,
  or an x-ray exam where they have put something in
  your vein?
• If Yes did have any difficulty with the
  injection?

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Allergic to Iodine

• General Rule No Contrast
• Pre medication is available

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Check List

• Check for Diabetes
• Glucophage or Metphormin
• Renal failure
• Renal Failure
• Diabetic
• Removal of Kidney

• Anyone over the age of 50 or anyone with a
  history of renal failure must have there BUN
  level and creatinine level evaluated. To
  determine renal function.

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Post Care

• Drink plenty of H20 for the rest of the day
• At least 8 glasses today
• Other types of fluids are good as well

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Take Good Care of Your Patients!
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Parenteral Injection Supplies

• Drugs are injected into the body with a plastic
  syringe. All of the supplies for drug injection
  are used only once.
• The tourniquet may be used again as long as it
  was not soiled.

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Supplies for Venipuncture

• Disposable gloves
• Alcohol Swabs
• Tourniquet
• Needle
• Butterfly or Angiocath
• Tape
• 2X2 or 4X4
• Contrast Syringes
• Saline

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3 parts of the syringe Plunger,
Barrel Tip
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Sizes

• General-purpose syringes
• 2, 2.5, 3, 5, 10, 20 50 ml
• Special design syringes
• TB insulin syringes
• Luer-Lock syringes (best for closed systems)

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3 parts of the needle Hub, Cannula or Shaft
Bevel
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Needle Sizes

• Length
• The measurement in inches of the shaft portion
• 0.25 to 5 inches
• Shorter subcutaneous, Longer IM, 1 1.5-inch
  IV

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Needle Sizes

• Gauge
• The thickness of diameter of the needle
• The smaller the diameter of the shaft the finer
  the needle, the larger the gauge number. Inverse
  relationship with size and (Ex 25-gauge very
  small diameter, 18-gauge used to draw contrast
  not start IVs)

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Examples Package labeled

• 20g/1.5
• 25g/1
• 22g/1/5

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Bevel Length

• Long bevels SC IM
• Short bevels IV

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Parenteral Drugs

• 2 different containers Ampule Vials
• Ampule sealed glass container holding one
  single dose

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Withdrawing a drug from a glass ampule
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Vial

• Small glass bottle with a sealed rubber cap
• Different sizes and may contain multiple doses of
  a drug

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Withdrawing a drug from a vial
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When you are done with your supplies where do
your dispose of them?
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New Skill for Lab Practice

• Drawing medications
• Sterile technique
• Expel excess air
• Safe way to recap needle

• Continue practice on vitals and locating veins.

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Questions?

• "The pessimist sees difficulty in every
  opportunity. The optimist sees the opportunity
  in every difficulty."
  Winston Churchill Demo filling a
  syringe
• Lab practice Vitals,
• drawing meds
• locating veins