PharmacologyandDrugAdministrationforImaging TechnologistsEBook2ndEdition,(EbookPDF)
https://ebookmass.com/product/pharmacology-and-drugadministration-for-imaging-technologists-e-book-2nd-edition-
ebook-pdf/
The Palgrave Companion to Chicago Economics Robert A
https://ebookmass.com/product/the-palgrave-companion-to-chicagoeconomics-robert-a-cord/
ebookmass.com
This page intentionally left blank
11830 Westline Industrial Drive
St. Louis, Missouri 63146
PHARMACOLOGY AND DRUG ADMINISTRATION FOR
ISBN-13: 978-0-323-03075-5 IMAGING TECHNOLOGISTS, SECOND EDITIONISBN-10: 0-323-03075-0
Copyright © 2006, 1998 by Mosby, Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, PA, USA: phone: (+1) 215 239 3804, fax: (+1) 215 239 3805, e-mail: healthpermissions@elsevier.com. You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting “Customer Support” and then “Obtaining Permissions.”
Notice
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Authors assumes any liability for any injury and/or damage to persons or property arising out or related to any use of the material contained in this book.
The Publisher
ISBN-13: 978-0-323-03075-5
ISBN-10: 0-323-03075-0
Acquisitions Editor: Jeanne Wilke
Developmental Editor: Rebecca Swisher
Publishing Services Manager: Julie Eddy
Project Manager: Joy Moore
Design Project Manager: Bill Drone
Reviewers
JULIE A. BENSON, MHA, MN, ARNP
Tacoma Community College Tacoma, Washington
DEANNA BUTCHER, MA, RT(R)
Program Director St. Luke’s College Sioux City, Iowa
RICHARD R. ESPINOSA, RPh, PharmD
Department Chair for Allied Health Sciences and Associate Professor Austin Community College Austin, Texas
DIANE H. GRONEFELD, MEd, RT(R)(M)
Associate Professor Northern Kentucky University Highland Heights, Kentucky
LINDA M. HOMOLKA, BA, RT(R) Medical Imaging Instructor Owens State Community College Toledo, Ohio
JEANNEAN HALL ROLLINS, MRC, RT(R)(CV)
Associate Professor, Radiologic Sciences Arkansas State University Jonesboro, Arkansas
LEONARD L. NAEGER, BS, MS, PhD, RPh Professor of Pharmacology St. Louis College of Pharmacy St. Louis, Missouri
PAULA PATE-SCHLODER, MS, RT(R)(CV)(CT)(VI)
Associate Professor College Misericordia Dallas, Pennsylvania
MARY SEBACHER, MEd, RT(R)
Clinical Assistant Professor University of Missouri––Columbia Columbia, Missouri
ERICA KOCH WIGHT, MEd, RT(R)(M)(QM) Program Director and Assistant Professor University of Alaska––Anchorage Anchorage, Alaska
RAY WINTERS, MS, RT(R)(CT)
Associate Professor and Chair of Radiologic Sciences Arkansas State University Jonesboro, Arkansas
This page intentionally left blank
Preface
Our intent in writing this textbook is to help students in the medical imaging professions better understand the importance of pharmacologic principles and practices in patient care. Some technologists do not become fully aware of their role in “real” patient care until they actually begin practicing their profession.
The strengths of this textbook for both student and instructor are:
● Clear and understandable content
● Measureable learning objectives at the beginning of every chapter
● A “Key Terms” list at the beginning of every chapter
● Interesting and entertaining “Did you know?” boxes throughout the text
● “Alert!” symbols to draw attention to adverse drug reactions or toxic effects
● Learning exercises and sample quiz/test questions at the end of each chapter
● Online instructor’s materials including teaching strategies, supplemental activities, student handout materials, and test questions. (NEW!)
A pharmacology textbook is never “finished.” There are always new drugs, contrast media, radionuclides, and techniques on the market and new information available about existing products. The available information seems endless, and it is a tremendous challenge to acquire enough knowledge to be a safe practitioner. We have made every effort to make the content very current by including discussions of contemporary and traditional medications and contrast media, common problems, up-to-date regulations, legal issues for technologists administering drugs, and emergency pharmacology. Particular attention has been paid to intravenous introduction of contrast media, drug nomenclature, and the physiologic processes responsible for drug actions.
OUR MISSION
The mission of Pharmacology and Drug Administration for Imaging Technologists is to
focus on essential information that technologists need to know for safe administration of drugs; to clearly present this complex subject so readers can easily understand this material; and to provide a consistent, practical format and design with illustrations and tables that will aid readers in comprehension.
Nothing teaches the imaging technologist more about pharmacology than actually giving medications to the patient. Students should approach each encounter with a patient as an opportunity to learn. As a student or practicing technologist, you should accept it as a personal challenge to learn about each medication (contrast agent, radionuclide, and so on) ordered for a patient under your care and to understand why the medication is given in that particular situation. Because pharmacology is a rapidly changing and dynamic field, we recommend that you be exposed to supplemental drug information, such as package inserts or current drug handbooks. We encourage you to develop the habit of seeking upto-date and timely information to supplement this book to provide specific details that cannot be covered in a textbook.
PATIENT CARE
In working with patients, you will quickly learn that medication administration is one of the most challenging components of your role as a technologist. A technologist who develops the knowledge and skills needed to competently administer medications is highly visible and will gain the respect of both patients and colleagues in the health care system. Both the responsibilities and the personal rewards are great.
We welcome your suggestions or comments on this book so that we may continue to provide a clear and useful exposition of introductory pharmacology in future editions.
Steven C. Jensen Michael P. Peppers
This page intentionally left blank
Acknowledgments
I wish to acknowledge the mental stimulation Ihave received from the many students who haveasked challenging questions throughout my 30 years as a teacher at Southern Illinois University, Morehead State University, Western Wisconsin Technical Institute in Lacrosse, Wisconsin, and Mercy Hospital in Cedar Rapids, Iowa. The support of my professional colleagues, especially Robert Broomfield, Eric Matthews, Michael Grey, Rosanne Szekely, Karen Having, Scott Collins, and Don Borst at Southern Illinois University has been invaluable. I am grateful for the help of the editorial, production, and design staff at Elsevier/Mosby and specifically thank Jeanne Wilke and Rebecca Swisher for their professionalism, attention to detail, and extreme patience. As always, I owe a special debt of gratitude to my children, Jordan and Emily, for their constant love and good humor andfor allowing me time away from them to complete this book. Finally, my portion of this book could not have been completed without the dedication, expertise, and abilities of my wife, Catherine. She has the knack of making the complex simple and the simple enjoyable. Her proofreading and editing skills are evident throughout the text and online instructor materials.
S.J
I wish to acknowledge all the patients I have had the honor of treating, consulting for, and laughing andcrying with over my years of clinical practice; you have taught me things that no textbook could possibly offer! I am also grateful to David Rush, PharmD, and Rusty Ryan, PharmD, for helping mebreak through difficult barriers early in my educational years; you had faith in my abilities
and opened doors for me that were otherwise closed. I acknowledge my emergency medicine/ critical care preceptors, Joseph Barone, PharmD, and Wesley Byerly, EMT-P, PharmD, for instilling in me the importance of never quitting in my quest for information and the importance of maintaining compassion and human feelings for the patient, no matter what the circumstance. I wish to thank all the nurses, doctors, and pharmacists at Mineral Area Regional Medical Center in Farmington, Missouri, for their support and trust when allowing me to become involved with their patients at the clinical level. I wish to notably thank Marie LaRose, RN, and Perry Bramhall, DO, for being instrumental catalysts to my clinical career in the rural environment; in many ways I wish I were still there working with you. A special acknowledgment is due for Henry Cashion, RT(R), Director of Mineral Area Regional Medical Center School of Radiologic Technology. Henry has an enthusiasm and passion for making certain that his students are armed with the necessary skills to take care of patients. He is years ahead of many when it comes to practical, clinical education for the radiologic technologies. In the 5 years that I had the honor of teaching for his program, it became very apparent to me that Henry is an individual with high standards of ethical conduct. Henry, your students are some of the brightest that I have ever had the pleasure of teaching, and it was an honor working with you. (It is with great honor that I have now been able to see those very students out in clinical practice over the most recent 10 years.) My portion of this textbook would not have been written without your foresight.
M.P.
7Pharmacodynamics of Radiopaque
Contrast Media, 81
Key Terms, 81
Objectives, 81
Iodinated Radiopaque Contrast Media, 81
Diagnostic Pharmacodynamics, 81
Adverse Pharmacodynamics, 82
General Adverse Reactions, 89
Paramagnetic Agent Adverse Reactions, 90
Ultrasound Microbubble Agent Adverse Reactions, 91
Screening, 91
Drug-Drug Interactions, 91
Barium Sulfate, 93 Conclusion, 94
Learning Exercises, 95
8Routes of Drug Administration, 100
Key Terms, 100 Objectives, 100
Introduction, 100
Oral Route, 102
Sublingual and Buccal Routes, 102
Topical Route, 102
Rectal Route, 103
Parenteral Route, 103
Charting, 114
Chest Tubes and Lines, 116
General Administration Guidelines, 117
Learning Exercises, 121
9Infection Prevention and Control, 126
Key Terms, 126 Objectives, 126
Introduction, 126
Microbiology of Infections, 126
Fundamentals of Infection, 128
Hepatitis, HIV, and Tuberculosis, 132
Infection Prevention and Control, 134
Medical Asepsis, 136
Employer Responsibilities, 142 Conclusion, 143
Learning Exercises, 144
10Anxiety, Phobia, and Conscious Sedation, 147
Key Terms, 147 Objectives, 147 Introduction, 147 Conscious Sedation, 148
Agents Used for Conscious Sedation, 149
Barbiturates, 149
Benzodiazepines, 150
Opiate Analgesics, 152 Conclusion, 152
Learning Exercises, 153
11Pharmacology of Emergency Medications, 155
Key Terms, 155 Objectives, 155 Introduction, 155
Cardiorespiratory Arrest, 155 Emergency Medications for Cardiorespiratory Arrest, 156 Other Cardiac Emergency Medications, 171 Conclusion, 171
Learning Exercises, 172
Answer Section, 175
Bibliography, 181
The Role of the Imaging Professional
OBJECTIVES
At the conclusion of this chapter, you should be able to:
1.Discuss the standards of care in the medical imaging professions.
2.List sources of information on standards of care.
3.Determine the legal ramifications of drug administration and venipuncture for imaging professionals in your state.
4.Locate the policies for drug administration and venipuncture at the hospital or clinic where you are most often assigned.
5.Define HIPAA and discuss the importance of following HIPAA guidelines. KEY
1
The physician opens the lead-lined door and steps into the brightly lit hallway. The act and its required effort were harder this time . . . it always is when one must face the family.
In the waiting room, the physician sees that the hospital chaplain has arrived and offers an all-too-familiar glance before turning to the parents. Their faces are ashen, yet it’s their eyes the physician dislikes the most. For without a word being said, the dire nonverbal messages had been conveyed. “No, your daughter is not dead,” the physician says. “During the examination, however, she experienced complications. She is now in a coma.”
What? How? Why? These are questions that demand answers; questions that must be answered with compassion. Both the questions and answers will never end.
“She had a seizure and went into cardiac arrest,” the physician explains. “We got her back, and now hope that she’ll respond further. You may see her for a few minutes. She is on a machine that assists her breathing. We’re doing everything we can.”
The kidney exam was necessary; her RLQ pain and workup tests confirmed it. The IV line was established. The questionnaire was completed. The patient’s history of hay fever and asthma, as well as the evening hour, called for nonionic contrast. The risks were known. Radiology personnel were ready for everything . . . except for the physician’s response time.
? DID YOU KNOW?
Pauscher v.Iowa Methodist Medical Center (408 N.W. 2d 355, 358 [Iowa 1987]) was a case brought against a hospital for wrongful death. The hospital insisted that it was unnecessary to inform a patient that intravenous pyelogram (IVP) tests result in death for only 1 in 100,000 people. When the patient died from the test, her family sued and won.
malpractice is a breach of duty to adhere to a standard of care. In both cases, a standard of care is applied to measure the competence of the professional. The traditionally recognized standard of care required that the medical professional practice his or her profession with the average degree of skill, care, and diligence exercised by members of the same profession practicing in the same or similar locality in light of the present state of medical and surgical practice. In essence, the practice of medical professionals was held to a regional standard.
Medicine has rapidly become more diverse and specialized. As communication methods (i.e., electronic) have evolved, the law has been adapted in most courts to disregard the previously described geographic considerations and to set the standard as that of a reasonable specialist practicing in the same field. Therefore, no matter where he or she practices, an individual practicing in the imaging sciences must maintain the same level of competence as a reasonable imaging practitioner in the same specialty. ASRT Practice Standards may be found at www.asrt.org.
The hospital situation described in the box provides another recent, real-world example; names and hospital locations have been removed to protect those involved.
HOSPITAL ADMITS FATAL MISTAKE THAT POISONED PATIENT
A woman who underwent surgery for a brain aneurysm was mistakenly injected with a highly toxic antiseptic solution and died, hospital officials have admitted. (Patient’s name), 69, had the operation (date) at (hospital) and died Tuesday after amputation and other extreme attempts to keep her alive.
“We’re just so sorry and so devastated this happened,” (administrator) said Tuesday. “It’s a very unfortunate error that we all feel horrible about.”
Hospital officials have apologized, issued adetailed staff memorandum detailing what happened, retrained staff, and changed procedures in an effort to prevent similar mistakes.
“We have offered our heartfelt apologies to the family of the patient and are doing everything we can to help them in this time of grief, but perhaps the only way we can make our apology real is to do everything we can to prevent medical errors in our system.”
At the end of (patient’s name) operation, a technician (technologist) was supposed to
injecta harmless marker dye used for x-rays intoa leg artery. Instead, the syringe was filled with chlorhexidine, a toxic antiseptic used to clean the skin.
“The cleansing solution basically acted as a poison, which caused widespread damage to the organs of her body,” (administrator) said.
The damage “couldn’t be remedied or reversed,even through aggressive treatment,” headded.
Over the next 2 weeks the patient’s health deteriorated as she underwent a leg amputation and suffered a stroke and multiple organ failure, leading to death.
Immediately after the operation, “things were looking good, but in reality when that plunger was pushed, my mother’s fate was sealed,” (patient’s son) told a local television reporter.
A hospital staff memo, issued on behalf of (administrator) before (patient) died, said she had been the victim of “an avoidable mistake that caused massive chemical injury.”
(Administrator), the hospital’s quality chief, said that “while no single person is responsible, all of us are responsible.”
Everyone involved in the mistake was takenoff duty and retrained, along with theentire medical staff, hospital officials said. The technician (technologist) and others involved, who were not identified, are now back at work.
A hospital investigation concluded the issuewas not carelessness but a system thatallowed two clear solutions to be confused.
(Hospital) had recently switched from a brown iodine antiseptic to a colorless
Liability
versionthat was better at killing germs. The marker dye is also clear. The syringe was filled froman unlabeled cup containing the antiseptic.
(Administrator) said procedures have been changed to ensure that the two solutions are never put on the same table during a procedure. The liquid antiseptic “now comes as a swab on a stick,” making an accidental injection impossible, he said.
When the new principle is applied to imaging professionals, the liability issues increase as radiographers, nuclear medicine technologists, radiation therapists, and sonographers, depending on the limitations of state statutes and regulations, cross specialization lines and practice in fields in which they have limited education and experience. Some states permit radiographers to perform nuclear medicine and sonographic studies as well as therapeutic procedures, allow nuclear medicine technologists to perform sonographic studies, and permit sonographers to swing back and forth across lines of specialization. Many members of these groups hold credentials in more than one field and are thereby qualified to cross lines and meet the standards of the specialties in which they practice. However, a large percentage are trained on the job with limited direction and supervision.
Individuals with limited education and experience who practice as those with the appropriate education and experience are expected to perform in the same manner as qualified personnel. A radiographer performing nuclear medicine studies is held to the standard of a nuclear medicine technologist and not to that of a radiographer practicing nuclear medicine. Health care facilities that require employees to perform procedures beyond the employee’s educational expertise are ultimately liable for the employee, but the employee also remains personally liable for all professional activity.
Educational Standard
The educational requirements that determine the standard of care are generally those recognized by the profession as appropriate for the field. In radiography, nuclear medicine, radiation therapy, and sonography, educational standards have been developed that define what an accredited program must do to educate students. Curriculum guides for the imaging sciences also define specific areas of study (e.g., pharmacology and drug administration techniques) and propose appropriate content for each area. The educational essentials and the curriculum
? DID YOU KNOW?
Think the new equipment for magnetic resonance imaging (MRI) is just what your patient needs? Maybe not, if he is like the plaintiff with panic disorder in Curtis v.RI Imaging Services II (148 Or App 607, 941 P2d 602 [Oregon 1997]). Curtis sued for psychological injuries sustained when an imaging provider failed to explain the claustrophobic effects of MRI scanners and never obtained a history of his asthma condition before his examination.
Pour monter notre ménage, hélas comment ferons-nous?
Toi devant, moi derrière, nous pousserons le tonneau.
[10]
But the evidence of the scalpel forces me to give up this family idyll. There is no outward sign of sex in the Scarabæus, but on dissecting a couple employed on one and the same ball they often turned out to be of the same sex. In fact, there is neither community of family nor community of labour. What, then, is the reason of the apparent partnership? Merely an attempt at filching. The eager fellow-worker, under pretence of giving a helping hand, cherishes the project of carrying off the ball at the earliest opportunity. To make one for itself at the heap demands labour and patience; to abstract a ready-made one, or at least to foist one’s self in as a sharer of the feast, is much more convenient. If the owner’s watchfulness should slacken, one will flee with the treasure; if too closely looked after, one can at least sit down at table on the pretext of services rendered. With such tactics all turns to profit, so that pillage is carried on as one of the most lucrative of trades. Some, as I have just said, play an underhand game, hastening to the aid of some comrade who has not the least need of them, and under the cloak of charitable assistance conceal a highly indelicate greed. Others, bolder or more confident in their strength, go straight to the goal and rob by main force. Every moment some such scene as this will take place. A beetle departs alone, rolling his ball, his own property, acquired by conscientious labour; another comes flying, whence I know not, drops heavily, folds his smoky wings under their elytra, and with the back of his toothed feet oversets the proprietor, which, being hindside before, cannot defend itself. While the latter [11]struggles to its feet the aggressor stations itself on the top of the ball, as a point of vantage whence to repel attack, folds its feet under its breast, ready for action, and awaits events. The bereaved owner moves round the ball, seeking a favourable point whence to attempt an assault; the thief revolves on the top of the citadel, constantly facing him. If the former raises itself for an escalade, the latter gives it a cuff which stretches it flat on its back. Secure on the top of the fortress, the besieged would bring to nought for all time the efforts of its adversary to recover its lost property if the besieger did not alter his tactics. Sapping threatens to bring down both citadel and garrison. The ball being undermined, staggers and rolls, carrying with it the robber, struggling his hardest to keep at the top, which he generally succeeds in doing, thanks to the hurried gymnastics that enable him to regain the altitude lost by the rotation of his standing place. If a false movement should bring him to the ground, the chances
[To face p 12
GEOTRUPES STERCORARIUS FIGHTING FOR THE PELLET
But first let us dissipate an error current in books. In the magnificent work of M. Emile Blanchard, Metamorphoses, Habits, and Instincts of Animals, I find the following passage: “Sometimes our insect is stopped by an insurmountable obstacle: the ball has fallen into a hole. At such a time the Ateuchus1 displays a really astonishing grasp of the situation, and a yet more astonishing power of communication between individuals of the same species. Recognising the impossibility of getting the ball over the obstacle, the Ateuchus seemingly abandons it, and flies away. If you are sufficiently endowed [13]with that great and noble virtue called Patience, remain near this forsaken ball. After a while the Ateuchus will return, and not alone; it will be followed by two, three, or four companions who, alighting at the appointed spot, will join in trying to lift up the load. The Ateuchus has been to seek reinforcements, and this explains why several beetles uniting to transport a single ball is such a common sight in dry fields.” I also read in Illiger’s Entomological Magazine: “A Gymnopleurus pilularius,2 while constructing the ball of dung destined to contain its eggs, let it roll into a hole, whence the insect tried long and vainly to extract it. Finding this only waste of time, he hastened to a neighbouring heap of manure to seek three of his kind, which, uniting their efforts to his, succeeded in getting out the ball, and then went back to their own work.”
I humbly beg pardon of my illustrious master, M. Blanchard, but assuredly things do not happen thus. First, the two accounts are so much alike that they must have had a common origin. After observations not followed up closely enough to merit blind confidence, Illiger put forward the story of his Gymnopleurus, and the same fact has been attributed to the Scarabæus because it really is a common thing to find two of these insects busy rolling a ball, or getting it out of some difficult position. But the partnership does not at all prove that one went to ask help from the other in some difficulty. I have had a large measure of the patience [14]recommended by M. Blanchard; I may claim to have spent long days in the intimacy of Scarabæus sacer; I have tried every means to comprehend its manners and customs, and to study them from life, and never did I see anything which suggested that one had called its companions to its aid. As I shall presently relate, I have put the dung-beetle to proofs far more serious than that of a ball fallen into a hole, and into far graver difficulties than having to climb a slope—a thing which is mere sport for the obstinate Sisyphus, who seems to enjoy the rough gymnastics required by steep places, as if the ball grew thereby
firmer, and therefore more valuable. I have invented situations where the insect had extreme need of help, and never could I detect any proof of good offices between comrades. I have seen pillaged and pillagers, and nothing else. If a number of beetles surrounded the same ball, it meant battle. My humble opinion is that several Scarabæi gathered round a pellet with intent to thieve was what gave rise to these stories of comrades called in to give a helping hand. Incomplete observations have turned an audacious robber into a serviceable companion who put his own work aside to do a friendly turn. It is no slight thing to admit that an insect has a truly surprising grasp of the situation and a facility of communication between individuals more surprising still; therefore I insist on this point, Are we to suppose that a Scarabæus in distress conceives the idea of begging for help?—flies off, explores the country round to find comrades at work on a dropping, and having found them, by some pantomime, especially by movements of the antennæ, addresses them more [15]or less thus: “Hullo, you there! My load is upset in a hole yonder; come and help me to get it out. I will do as much for you another time.” And are we to suppose too that his colleagues understand him? And, more wonderful still, that they leave their work, their ball newly begun, their beloved ball, exposed to the greed of others, and certain to be filched during their absence, in order to help the supplicant! I am profoundly incredulous of so much self-sacrifice, and my incredulity is borne out by all which I have seen during many long years, not in collection boxes, but on the spots where the Scarabæi work. Outside of the cares of maternity—cares in which it almost always shows itself admirable, the Insect—unless, indeed, it lives in society like bees and ants and some others—thinks and cares for nothing but itself.
Let us drop this discussion, excused by the importance of the subject. I have already said that a Scarabæus, owner of a ball which it is pushing backwards, is often joined by another which hastens to its aid with interested views, ready to rob if it gets the chance. Let us call the pair associates, though that is hardly the name for them, since one forces itself on the other, who perhaps only accepts help for fear of worse. The meeting is, however, perfectly peaceable. The arrival of the assistant does not distract the proprietor for an instant from his labours; the newcomer seems animated by the best intentions, and instantly sets to work. The way they harness themselves is different for each. The owner of the ball occupies the chief position, the place of honour; he pushes behind the load, his [16]hind feet upraised, his head downward. The helper is in front, in a reverse position, head raised, toothed arms on the ball, long hind legs on the ground.