Drugs and CM Flashcards
(98 cards)
1
Q
what drugs are found on the emergency trolley
A
adrenaline, atropine, diazepam, morphine
2
Q
purpose of adrenaline
A
- vasoconstriction
- bronchodilation
- increased HR & myocardial contraction
3
Q
purpose of atropine
A
- treat symptomatic bradycardia by blocking vagus nerve to increase HR & CO
- reduce secretions to minimize aspiration
4
Q
purpose of diazepam
A
- acute seizures
- anxiety / agitation
- muscle relaxant
- sedative
5
Q
purpose of morphine
A
- pain management
- reduces anxiety
6
Q
most popular form of fleet for rectal use
A
fleet enema
7
Q
PEG
A
polyethylene glycol electrolyte
8
Q
mechanism of fleet enema
A
bowel evacuation by increasing bulk volume & water content of stool
9
Q
effectiveness of fleet enema
A
2-5 mins; relieves constipation & cleanses lower bowels
10
Q
indications of fleet enema
A
- relieve occasional constipation
- bowel cleaning before rectal exams
11
Q
mechanism of bisacodyl
A
irritates smooth muscle of intestines (colonic intramural plexus) to stimulate peristalsis
12
Q
effectiveness of bisacodyl
A
6-12 hrs (oral)
15 - 60 mins (suppository)
5 - 20 mins (enema)
13
Q
indications of bisacodyl
A
relieve occasional constipation & prep for diagnostic procedures
14
Q
active components of PICOPREP
A
sodium picosulfate & magnesium citrate
15
Q
function of sodium picosulfate
A
locally acting stimulant cathartic
16
Q
function of magnesium citrate
A
osmotic laxative by retaining moisture in colon
17
Q
effectiveness of PICOPREP
A
bowel movement 2-3 hrs after 1st dose
18
Q
indications of PICOPREP
A
cleanses bowel prior to XR & endoscopy
19
Q
mechanism of PEG
A
osmotic laxative by retaining moisture in colon
20
Q
effectiveness of PEG
A
Bowel movements 1 to 2 hours after taking the first dose.
21
Q
indications of PEG
A
Clearing of bowels in prep for endoscopic & radiologic exam & colonic surgery
22
Q
drugs used for patient prep
A
- steroid / hydrocortisone
- water / saline
- antiseptic solution
- 70% alcohol
23
Q
steroid purpose
A
treat inflammation and overactive immune
responses
24
Q
steroids can be administered
A
IV or IM
25
steroid mimics __`
cortisol
26
methylcellulose is used as __
negative CM to improve visualization of GI tract by distending stomach & intestines
27
baros tablets are used to __
provides negative contrast by expanding the stomach and intestines = delineating the mucosal lining and improving the visibility of the GI tract
28
buscopan is an __
antispasmodic
29
function of buscopan
- reduces peristalsis & relaxes smooth muscles to distend GI tract = less motion
30
function of glucagon
smooth muscle relaxant = reduces peristalsis
31
lidocaine / lignocaine function
local anesthetic to prevent pain during and after procedure
32
onset time of lidocaine
45 - 90s (IV) / 4hrs (transdermal)
33
duration of lidocaine
10 - 20 mins (IV)
34
heparin function
prevent blood clot for catheters and guidewire placement
35
glycerin trinitrate function
vasodilator to prevent vasospasm for vascular intervention
36
routes of drug administration
oral, inhalation, topical, parenteral, intradermal, subcutaneous/hypodermic, intramuscular, intravenous, intra-arterial, intra-thecal
37
where is intra-dermal injected into
just below skin surface
38
where is subcutaneous injected into
into loose connective tissue under skin
39
subcutaneous drugs have ___ effect than intramuscular
slower and more sustained
40
parenteral is used only when __
emergency / oral route not tolerable
41
intramuscular is injected into __
deltoid / glutes
42
intra-thecal injection is into __
thecal surrounding spinal cord by taking out CSF and injecting contrast
43
common sites for intravenous
basilic vein, median cubital vein, cephalic vein, median antebrachial vein
44
intra-arterial is injected commonly at __
femoral artery
45
what are the 5 rights before drug adminsitration
dose, drug, patient, time, route
46
iodinated CM work by __
iodine absorbs x-rays to enhance contrast in vessels, urinary tract, etc
47
Barium based CM works by __
barium sulfate outlines stomach and intestines
48
gadolinium CM works by __
altering magnetic properties of water molecules to enhance visibility of internal structures
49
US CM works by __
using microbubbles to enhance reflection of US waves and improve visualization of blood flow & organ structures
50
iopamiro and omnipaque are ___
non-ionic, low osmolar, water soluble iodine compounds that are positive CM
51
common iodinated CM are
iohexol, iopamidol, iodixanol
52
gadolinium shortens ___
relaxation time of protons in tissues where it accumulates and results in brighter images in tissues
53
negative CM works by __
appearing darker compared to surrounding tissues
54
how does CO2 work as negative CM
displaces tissue / fluid in area of interest to create clear delineation between gas-filled space and tissues
55
how is co2 safer than iodinated CM
less nephrotoxic and naturally absorbed by the body
56
caution of using positive CM
must careful consider
- medical history
- allergies
- renal function
- hydration
- premedication
57
caution of using negative CM
proper technique to avoid
- air embolism
- excess pressure to cause discomfort / injury
58
all ICAs share similar function group which is __
tri-iodinated benzene ring
59
atomic radius of covalently bonded iodine atom is __
133 picometers; falls within wavelength of xrays
60
what has the weakest ability to attenuate xrays and must be administered in high concentrations that are hyperosmolar
ionic monomers
61
nonionic dimers are __
iso-osmolar with blood
62
low osmolarity agents are __
ionic dimers & nonionic monomers
63
LOCM ionicity are __
non-ionic / ionic but fewer particles
64
alll ICAs demonstrate __ protein binding
low
65
distribution of CM from IV methods are __
faster to highly perfused organs but slower for less perfused organs
66
IOCM are ___
not metabolized and remain unchanged in the body, excreted in urine
67
direct contrast injection can be done via __
percutaneous needle access, indwelling catheter / tube
68
mild reactions of CM are __
warmth, flushing, metallic taste
69
moderate reactions of CM are __
vomitting, moderate allergic reaction, brief hypotension
70
side effects of ionic contrast agents are due to __
ionic charge, hypertonicity, hyperosmolarity, chemical toxicity
71
what barium CM should be used for upper GI series
barium sulfate orally to examine from pharynx down to duodenum
72
Ba swallow mainly focuses on __
pharynx and esophagus for diagnosing swallowing disorders
73
small bowel follow through is used to___
track barium progress through small intestine to identify blockages, tumors and abnormalities
74
ba enema is used to examine __
colon by introducing ba sulfate rectally for polyps, tumors and diverticulosis
75
what is EZHD used for
Ba swallow and meal
76
what is EZ paque used for
Ba follow through & SBE
77
what is polibar used for
Ba enema
78
where is barium sulphate distributed to
remains within lumen of GI tract from ingestion till excretion as it is not metabolized or absorbed
79
how long does it take for barium sulphate to be excreted
24 - 72 hours after administration
80
common reactions of ba sulphate
constipation & abdominal cramping
81
serious reactions of ba sulphate
aspiration, barium impaction and hypersensitivity reactions
82
contraindication of ba sulphate
suspected or known perforation of GI tract, hypersensitivity to CM
83
precautions of ba sulphate
avoid aspirations as it can lead to pneumonitis esp in patients with swallowing disorders
84
what property of gadolinium based contrast agents increases contrast
unpaired electrons which make them highly paramagnetic
85
how are GBCAs distributed
rapidly within extracellular fluid space and do not cross BBB or cell membranes
86
half life of GBCAs are ___
1.5 - 2.5 hours in patients with normal renal function
87
NSF
nephrogenic systemic fibrosis; rare but serious adverse result
88
what increases the risk of NSF
high doses or repeated doses of GBCAs
89
why is iodinated CM risky for mothers and fetus
crosses placenta and enters fetal circulation = thyroid disorder
90
how long should patients taking metformin abstain from it
48 hours
91
what eGFR indicates discontinuation of metformin
< 30 mL/min
92
what is the issue of administering iodinated CM for patients with diabetes who take metformin
risk of lactic acidosis = contrast induced nephropathy
93
what pre medication should be adminstered to reduce allergic reactions from CM
systemic corticosteroids (prenisolone) & H1 blockers (antihistamines)
94
what type of contrast should be given to minimize allergic reaction
non-ionic, low osmolar, iso osmolar CM with slower infusion rates
95
what strategies should be employed for reducing allergic reactions due to CM
pre-procedure assessment
pre-medication
CM administration & choice
post-procedure monitoring
documenting & reporting
96
anaphylactic shock is __
unpredictable & not dose dependent
97
anaphylactic shock occurs due to __
fluid shift, contraction of smooth muscles and vascular collapse
98
