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SDF 2 > L15 - Radiopharmaceuticals and Nuclear Pharmacy > Flashcards

L15 - Radiopharmaceuticals and Nuclear Pharmacy Flashcards

1
Q

What is Nuclear Medicine used for?

A

Diagnostic and some therapeutic purposes of most body systems.

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2
Q

What source is involved in Nuclear Medicine?

A

Radiation source, gamma rays emitted from patient

Radiation dectector (gamma camera)

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3
Q

Define an Isoptope

A

Same element but different number of neutrons.

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4
Q

How is radiation measured?

A

Becquerel or megabecqueral

1Bq = 2.7 x 10-11 curie

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5
Q

What are the 3 main types of radiation decay?

A
  • Alpha Particles
  • Beta Particles
  • Gamma Rays
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6
Q

What is Radioactive Component responsible for.

A

Emission of radiation for detection or treatment of disease.

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7
Q

What is chemical component responsible for?

A

For Localisation in specific organ or tissue

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8
Q

What are the 6 types of administration routes?

A
  • Intravenous
  • Inhalation
  • Ingestion
  • Subcutaneous
  • Eye drops
  • Directly into shunts
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9
Q

Which administration route is used most often?

A

IV

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10
Q

How does the Ingestion route work?

A

mixed with food to assess gastric emptying rate of stomach or mixed with water to assess small and large bowel transit times

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11
Q

When are eye drops used?

A

Lacrimal Duct obstruction

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12
Q

When is subcutaneous used?

A

to assess lymphatic drainage from breast cancer and melanomas

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13
Q

When is inhalation used?

A

Blood Clots in lungs

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14
Q

Which radio-nucleotide is most commonly used?

A

Technetium-99m or 99MTc

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15
Q

99MTc is daughter isotope of which nucleotide?

A

Molybdenum 99

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16
Q

What is the short life of 99MTc

A

6hrs with abundance of gamma photons

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17
Q

Low Radiation dose of 99MTc allows for what?

A

High amounts of activity for faster and clearer images

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18
Q

Renal Excretion when given 99MTc

A

Fast biological excretion plus short half-life = High Clearance

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19
Q

How is 99MTc used?

A

bounded with various agents for imaging

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20
Q

What is the diagnostic use of 99MTc?

A
  • small radiation dose
  • gamma radiation usually involved
  • Provides dynamic info = rate of accumulation + removal from specific organ
  • Can help detect early changes in physiologic function that could come before morphologic or biochemical endpoints
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21
Q

What types of imaging can 99MTc accomplish?

A
  • Bone scanning
  • Thyroid + function
  • Renal + Function
  • Myocardial perfusion
  • Tumour imaging
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22
Q

What does Bone Scanning accomplish?

A

three phase bone scan

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23
Q

Bone Scanning is immediately used to assess what?

A

Blood Flow + blood pool to the area of concern

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24
Q

Bone Scanning is done when?

A

2-3 hrs post injection to allow for skeletal muscle to uptake
- helps accomplish full skeletal scan and areas of interest

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25
Q

Describe the Scan Appearances

A

Hot spots = high osseous breakdown and repair, very sens therefore may need additional imaging.

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26
Q

What are some indications for bone scan?

A
  • bony metastasis
  • Fractures
  • stress fractures
  • shin splints
  • Paget’s Disease
  • Osteomyelitis
27
Q

What is the IV bolus amount for Bone Scanning?

A

900-1000 MBq

28
Q

What are some indications for thyroid uptake scanning?

A
  • thyroid nodule assessment
  • Thyroid uptake hyper/hypothyroidism
29
Q

What is the IV bolus amount for Thyroid Uptake scan

A

200MBq 99mTc

30
Q

When is the scan done for Thyroid uptake?

A

20-30mins post injection

31
Q

How do the scans appear for thyroid uptake?

A

“hot” nodule = hyperfunctioning
“Cold” nodule = hypofunctioning

32
Q

What are the indications for Renal Imaging?

A

Differential renal function
Assessment of obstruction
Assessment for RAS and renovascular HTN

33
Q

What is the IV bolus amount for Renal imaging?

A

200MBq 99mTcMAG3 with prompt saline

34
Q

What two drugs does Renal Imaging Challenge?

A

Frusemide 20-40mg or captopril 25mg

35
Q

Discuss the Visual Assessment of Scan appearance for Renal Imaging.

A

Decreased tracer uptake or

proper uptake but decreased filtration.

36
Q

Comparison of Pre/Post captopril studies help identify improvements of what?

A

Renal function with administration of the ACEI

37
Q

What is the indication for ventilation and Perfusion lung scan?

A

Pulmonary embolism

38
Q

What is the Amount given to examine ventilation?

A

1000MBq 99mTc converted into a vapour and inhaled

39
Q

What is the amount given to examine perfusion?

A

200MBq

40
Q

what is given via IV bolus in Ventilation and perfusion

A

99TcPulmolite

41
Q

how is the scan done for ventilation and perfusion

A

360 deg tomography

42
Q

How do the lungs appear on the scan?

A

Comparison of ventilation and perfusion images to assess for wedge shaped defects in the perfusion scan only

43
Q

What are the indications for Myocardial perfusion imaging?

A
  • Assessment of chest pain
  • Post stent
  • Diagnosis of MI or ischaemia = rest and stress studies
44
Q

What other imaging is used alongside myocardial perfusion?

A

Stress images = exercise or pharm induced via adenosine, Dipyridamole or Dobutamine infusion

45
Q

When is reverse perfusion given during stress imaging?

A

1min before peak exercise load and predicted peak HR

46
Q

How does the myocardium appear in scan?

A

at rest and stress for areas of decreased tracer uptake

47
Q

If defect is fixed (on rest and stress)

A

Infarct

48
Q

If defect is reversible (on stress but not rest)

A

Ischaemia

49
Q

What is Positron Emission Tomography

A

Radiolabelled tracers which are injected and then construct images by computer to demonstrate location and conc of tracer

50
Q

What are the types of tracers used?

A

Natural biochemicals labelled with radionuclides of Carbon (C11), Nitrogen (N13), Oxygen (O15) and Fluorine (F18)

51
Q

How is the moment-to-moment change in conc of tracer in blood or tissue determine?

A

Absolute units

52
Q

What are some uses of Positron Emission tomography?

A
  • mapping regional blood flow
  • substrate metabolism
  • cellular proliferation
  • receptor density and binding
53
Q

How is PET radiopharm used for Brain with Fluorodeoxyglucose?

A
  • Maps normal metabolic activity
  • Identifies specific images assoc with mild cognitive impairment
  • Different dementias and alzheimers
54
Q

How is PET used to examine a Tumour?

A

Glycolysis, membrane glucose transfer capability increases in tumour tissue

55
Q

How is PET used to examine Cardiac?

A

Identifies ischaemic regions where glucose metabolism increases as consequence of decreased fatty acid metabolism

56
Q

What are the three Non-radioactive drugs?

A
  • Captopril = renovacular hypertension
  • Furosemide = Renal obstruction
  • Lugol’s solution = Suppress thyroid uptake of I-123 in a I123-MIBG scan
57
Q

What drugs are known to interfere with renal imaging?

A
  • ACE inhibitor
  • Iodinated contrast agents aminoglycosides
  • cyclosporin and cisplatin
  • Frusemide
  • Probenecid
58
Q

What drugs are known to interfere with brain imaging?

A
  • Chemotherapeutic drugs
  • Corticosteroids
  • Pyschotropic drugs
59
Q

What drugs are known to interfere with myocardial perfusion imaging?

A
  • Beta-blockers
  • nitrates
  • Calcium channel blockers
  • Vasopressin
  • Propranolol
  • lidocaine
60
Q

What are the 4 therapeutic uses of Radiopharmaceutical?

A

Thyroid disease (goitre and graves disease)
Eradication of metastatic disease (thyroid cancer)
Pain relief associated with metastatic bone lesions
Cancer chemo and radioimmunotherapy

61
Q

What are the 9 basic activities in nuclear Pharmacy?

A
  1. Procurement and storage
  2. Compounding
  3. Quality assurance
  4. Dispensing
  5. Distribution
  6. Health and Safety
  7. Provision of Drug Information and consultation
  8. Monitoring Patient outcomes
  9. Research and development
62
Q

how is nuclear pharmacy compounded?

A

behind leaded glass shielding and use lead syringe shields and lead containers

63
Q

Why should radiactive decay be considered?

A

To accomodate time from manufacture to administration

64
Q

How is Nuclear pharmacy distributed?

A

lead lined syringe containers
Some conversion to tungsten - lighter so less weight during shipment and less hazardous

SDF 2 (3 decks)

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