5.2 Contrast Agents Part 2

Question 1

a very small percentage less than ____ of the iodinated CM given to a mother will be excreted into breast milk and absorbed by the infant

Answer 1

1%

Question 2

one of the most widely used and one of the safest of all medications

Answer 2

Iodinated contrast agents

Question 3

are extremely rare in both HOCM and LOCM estimated at 0.9 per 100,000 (<0.001%)

Answer 3

Fatal reactions

Question 4

Mechanisms of Adverse Reactions

Answer 4

• Contrast Reaction

- Subjective Effects

Question 5

all undesired effects including the many subjective side effects experienced to some degree by most patients to whom contrast is administered

Answer 5

Contrast Reaction

Question 6

feeling of heat, nausea and mild flushing

Answer 6

Subjective Effects

Question 7

2 Categories of Reactions

Answer 7

1. Chemotoxic Reactions

2. Idiosyncratic Reactions

Question 8

result from the physiochemical properties of the contrast media, the dose, and speed of infection

Answer 8

Chemotoxic Reactions

Question 9

all hemodynamic (blood circulation) disturbances and injuries to organs

Answer 9

Chemotoxic Reactions

Question 10

Chemotoxic Reactions examples

Answer 10

Contrast-induced nephropathy

Question 11

includes all other reactions

Answer 11

Idiosyncratic Reactions

Question 12

largely unpredictable

Answer 12

Idiosyncratic Reactions

Question 13

most often occur within 1 hour of CM administration and are not related to the dose

Answer 13

Idiosyncratic Reactions

Question 14

symptoms resemble allergic (or anaphylactic) and are therefore, often called “allergic-like” or “anaphylactoid” reactions

Answer 14

Idiosyncratic Reactions

Question 15

risk of recurrent reaction in a patient with a prior reaction:

Answer 15

HOCM - 16% to 35%

LOCM - 7%

Question 16

Common side effects:

“Less common when LOCM is used”

Answer 16

1. Nausea
2. Vomiting
3. Altered taste (often described as metallic)
4. Perspiration
5. Warmth
6. Flushing
7. Anxiety

Question 17

Classifications of Idiosyncratic Reactions

Answer 17

• Mild
• Moderate
• Severe

Question 18

short duration and self-limiting

Answer 18

Mild

Question 19

monitor patient at least 20-30 mins (M-S)

Answer 19

Mild

Question 20

• Cough
• Itching
• Pallor (pale)
• Rash (hives)
• Nasal stiffness
• Minimal swelling in the eyes and face
• Facial rash

Answer 20

Mild

Question 21

not immediately life threatening

Answer 21

Moderate

Question 22

• Respiratory difficulties (bronchospasm, dyspnea, wheezing, laryngeal edema)
• Pulse change
• Hypertension
• Hypotension (leg elevation)

Answer 22

Moderate

Question 23

potentially/immediately life-threatening

Answer 23

Severe

Question 24

• Substantial respiratory distress
• Unresponsiveness
• Convulsions
• Clinically-manifested arrhythmias
• Cardiopulmonary arrest

Answer 24

Severe

Question 25

Treatment

Answer 25

ABC | Airway Assessment, Breathing and Circulation

Question 26

Treatment is Followed by

Answer 26

ACLS | Advanced Cardiac Life Support Treatment

Question 27

Majority of idiosyncratic adverse side effects are mild, non-life-threatening events that require only ____

Answer 27

observation, reassurance and support

Question 28

HOCM percentage of side effects

Answer 28

5 to 12% (Mild-98% to 99%)

Question 29

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

Answer 29

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

Question 30

Patient Assessment Prior to Administration of Contrast Medium (1)

Answer 30

1. Patient's age 2. History of impaired hepatic function 3. History of impaired renal function 4. History of allergic or anaphylactic reactions 5. History of thyroid disease 6. Last menstrual period and possible pregnancy 7. Nursing mother 8. Sensitivity to aspirin

Question 31

Patient Assessment Prior to Administration of Contrast Medium (2)

Answer 31

9. History of diabetes mellitus 10. History of sickle cell disease 11. History of hypertension 12. History of pheochromocytoma 13. History of seizures 14. Medication history 15. History of previous reactions to medications or contrast agents 16. Allergy to seafood

Question 32

Incidence and Risk Factors for Idiosyncratic Reactions

Answer 32

1. Previous contrast medium reaction 2. Asthma 3. Allergies 4. Drugs

Question 33

Prevention of Acute Idiosyncratic Reactions

Answer 33

1. Use LOCM 2. Role of premedication 3. Documentation 4. Renal anatomy and physiology

Question 34

most important method of reducing the risk of idiosyncratic CM reaction

Answer 34

Use LOCM

Question 35

pretreatment with steroids will reduce the rate of idiosyncratic CM

Answer 35

Role of premedication

Question 36

adverse reaction to CM administration must be appropriately documented

Answer 36

Documentation

Question 37

Elements that must be captured:

Answer 37

1. Amount and type of contrast injected 2. Signs and symptoms of the reaction 3. Interventions or medications given during the reaction and patients response to treatment 4. Final outcome (discharged or admitted)

Question 38

paired organs that lie behind the parietal peritoneum

Answer 38

Renal anatomy and physiology

Question 39

level of T12-L3

Answer 39

Renal anatomy and physiology

Question 40

0.5% of total body weight, receives ____ of total arterial blood

Answer 40

20-25%

Question 41

contains _____ nephrons per kidney

Answer 41

1-2M

Question 42

the ability of the kidney to remove a substance from the blood

Answer 42

Clearance

Question 43

volume of plasma that is cleared of a specific substance in a given time

Answer 43

Clearance

Question 44

GFR

Answer 44

Glomerular Filtration Rate

Question 45

Glomerular Filtration Rate (GFR)

Answer 45

60-120 mL/min (normal), 16-59 mL/min (kidney disease), 0-15 mL/min (kidney failure)

Question 46

ERPF

Answer 46

Effective Renal Plasma Flow

Question 47

Effective Renal Plasma Flow (ERPF)

Answer 47

500 mL/min

Question 48

used for the estimation of GFR

Answer 48

Inulin

Question 49

ideal filtration marker

Answer 49

Inulin

Question 50

metabolically inert (not digested or absorbed in the stomach)

Answer 50

Inulin

Question 51

cleared only by kidney

Answer 51

Inulin

Question 52

demanding and time-consuming

Answer 52

Inulin

Question 53

index of GFR

Answer 53

Serum Creatinine

Question 54

a by-product of muscle protein metabolism generated by the body at a fairly steady rate and excreted entirely in the urine

Answer 54

Creatinine

Question 55

Female Creatinine level

Answer 55

0.5 - 1.1

Question 56

Male Creatinine level

Answer 56

0.6 - 1.0

Question 57

Creatinine clearance test can be done using samples from _________ & _______

Answer 57

blood, urine

Question 58

Methods to measure creatinine or kidney function

Answer 58

Effective Renal Plasma Flow, | Glomerular Filtration Rate

Question 59

produces urine by filtering out from the blood small molecule and ions and then reclaiming the needed amount of useful materials

Answer 59

Nephron