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Pharmacology
Pharmacology
Safety – the ultimate goal
Patient advocate
Responsible = responsive
Correct medication history and administration
Be aware of specific facility guidelines
Pharmacology
May be responsible for obtaining, maintaining, or giving meds
Meds necessary to perform studies
Contrast – IV or PO
Anesthetics
Anti-anxieties
Sedation (moderate/conscious/anesthesia)
Need a basic knowledge of these meds
Actions, outcomes (expected and unexpected)
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Pharmacology
Emergencies in the radiology department
Examples:
allergic reactions
angina
asthma attacks
diabetic emergencies
cardiac arrest
RTs may be responsible for giving and charting meds
Know what drugs are needed, where they are kept, and how to administer
Know your state laws and facilities policies
Pharmacology
Intravenous Medications
RTs are responsible for assuring the safety of the patient
Should check site for signs of patency
Not necessarily responsible for the medication infusion
If a patient needs a med while in your care – check with MD
Some basic knowledge is key
Pharmacology
Written Order – must come from a LIP
NP, APN, PA, or MD
Verbal Order – not legal in many states except in emergencies
During emergencies – rules bend slightly
May take a verbal order – verify by stating back, show med vial if able
Once emergency is ended – get written order and document
med, dose, route, rate, and time
Have physician sign before leaving the department
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Pharmacology
Drugs = Medications
Prescribed vs. OTC vs. recreational
Generic vs trade
proprietary vs commercial
typically less expensive
must have order to substitute
Unsure? Know how to look it up
Internet, PDR, drug insert
Pharmacology
Pharmacokinetics
Mechanism, action, and excretion
Based on chemical composition
Affects the way individuals respond to medications
Vary greatly depending on age, weight, physical condition, immune status
other drugs, history of substance abuse
Absorption, Distribution, Metabolism, Excretion
Pharmacology
Absorption
Moves the drug from the site of administration to central circulation
Routes:
Oral (PO), sublingual (SL), buccal, nasal, rectal
use mucosal lining of the GI and respiratory tract
Transdermal, topical
absorbed through the skin
Intramuscular (IM), subcutaneous (SQ), intra-dermal (ID)
use blood vessels in the muscle and skin
Intravenous (IV), intra-arterial (IA), intrathecal
direct absorption into the circulating blood
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Pharmacology
Distribution
How medication travels from bloodstream to target site
Depends on conditions of circulation (cardiac output = HR x BP)
Action more rapid when target is blood filled organs
Pharmacology
Metabolism
Breaks down medication for excretion
Typically occurs in the liver
Excretion
Eliminates waste products from metabolism
Kidneys, intestines, lungs, breast milk, and other exocrine glands
Good hydration prevents toxic build up of waste products
Pharmacology
Drug Reactions
Therapeutic effect – desired purpose of medication
Side effect – predictable action/effect other than desired
Toxic effect – poisonous, potentially lethal
more common in elderly, renal and liver impairment (antidote)
Idiosyncratic effect – unusual reaction
Allergic reaction – hive, itching, respiratory issues (slight or severe)
Synergistic effect – combined drugs that produce undesired effects
HTN and diuretic meds that cause syncope and hypotension
Iatrogenic – medication error
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Pharmacology
Right’s of Medication Administration
Right Patient
Right Medication
Right Dose
Right Time
Right Route
Right Documentation
Right Reason
Right Drug/Drug interaction
Right education
REMEMBER: The patient always has the right to refuse!
Always!!!
Confirm the order, Check the expiration date, Check for allergies
Pharmacology
Drug Reactions
Any drug has the potential for an allergic reaction
Monitor patients – especially when giving CNS depressants
Know where emergency equipment is located and how to use
Know your facilities protocols and policies
Know how to look up medications (Intranet, PDR, drug insert)
HOCA – have greater risk of reaction d/t ionic concentration
Pharmacology
Routes of Administration
Enteral – oral (most common), rectal, ngt/peg
can be capsules, pills, tablets, liquids, granules, chewables
should be given whole – not crushed or cut (ER/XL)
absorbed into bloodstream from stomach or small intestine
Inhalation – liquid meds or pills that are vaporized using O2 or air
reusable inhalers = rescue inhalers
nebulizers – hand held or masks
radioactive gasses for nuclear med studies
Sublingual/buccal route – under the tongue or inside the cheek
considered topical – not oral/enteral
immediate absorption via the mucous membranes
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Pharmacology
Topical - applied to the surface of the skin
May have local or systemic affect
Also called transdermal
Absorbed through the skin into the bloodstream
NTG, Nicoderm, Scopalamine
Parenteral - Injected directly into the body
Used for faster onset or when NPO or n/v
Bypass the GI tract
Rapid absorption and onset
Routes: ID – intra-dermal, SQ – subcutaneous, IM – intramuscular, IV – intravenous
Intrathecal, Epidural, Intra-arterial
Pharmacology
Syringes
Barrel – the long cylinder that holds the medication
typically marked in CCs or MLs
Plunger – pushed inward to expel the medication
Needle – different lengths (inches)
bores (gauges) diameter of the opening
Most are disposable – may be metal on some OR/sterile trays
metal are reusable and can be autoclaved
Pharmacology
Starting an IV
veins most often used
anterior forearm, posterior hand, wrist, anticubital (AC)
when selecting a site look for those largest and most superficial
AC is typically the access of choice
larger bore means faster flow
may be impeded by movement
may become sclerotic with frequent use
ask the patient where they prefer
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Pharmacology
Pharmacology
Special Considerations
never start IV on same side as peripheral dialysis access or mastectomy
children, obese, and frail patients are more difficult
after 2 failed attempts – let someone else try (utilize IV/PICC team if available)
may use power port or power PICC for contrast
cleanse the port each time you access per facility policy
generally withdrawal to get blood return before you inject
hand hygiene before and after procedure
always wear gloves
Pharmacology
Precautions
needle sticks continue to be a common job related injury
use standard/universal precautions on all patients
wear gloves when may be in contact with blood
do not recap needles
dispose of all sharps and contaminated waste appropriately
use needless system whenever possible
follow all facility policies
read all medication labels at least 3 times
label any syringes that are not used immediately
check the patients identity
check for allergies
monitor for side effects
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Pharmacology
IV fluids
may be free flowing or on a pump
may contain medication that requires a specific rate
cardiac and renal patients do not tolerate large amount of fluids
free flow – use roller clamp to control the rate
the higher the bag – the faster the flow
pumps should be set to dose mode or ml/hr
monitor site for infiltration
monitor patient for signs of adverse reaction or allergy
Pharmacology
Extravasation/Infiltration
when IV fluids or meds leak into tissue
can be painful and dangerous
may cause swelling, heat, sloughing of tissue
stop the infusion and notify MD
remove the needle and apply ice (20-60 mins 3 x daily)
document IR (incident report)
chart carefully
Pharmacology
Discontinue IV
gather dressing, tape, bandaid/bandage
hand hygiene
explain procedure to patient
clamp the drip
loosen the tape/dressing
remove the catheter while applying pressure
check the catheter to make sure it is intact
apply dressing
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References
Adler, A. & Carlton, R. (2012). Introduction to
radiologic sciences and patient care (5th Ed.). St.
Louis: Mo.: Elsevier Saunders.
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