Radiographic Contrast Media RAD TECH 255 SPECIAL PROCEDURES WEBPAGE VERSION MERRILLS VOL2 RTA BOOK REV: SPRING 2010

Subject Contrast Range of differences in the intensity of the x-ray beam, after it has been attenuated by the subject (patient). For LOW CONTRAST stucures: What can be done to attain medical information- see the difference between muscle, organs or vessels Define and outline – organ structure and function CONTRAST MEDIA used to: enhance subject contrast or render high subject contrast in a tissue that normally has low subject contrast

Contrast media Defines subtle differences in subject contrast Increases atomic number of area injected Results in a SHORTER scale of subject contrast

Radiographic Contrast : Influenced by… Radiation Quality (KVP) Film Contrast Radiographic object (Patient) Atomic Number Fat = 6.46 Water = 7.51 Muscle = 7.64 Bone = 12.31

KVP TYPE OF CONTRAST USED DETERMINES KVP RANGE BARIUM _______kVp IODINES ________kVp (Ionic / Nonionic Water or Oil)

INJECTABLE CONTRAST MEDIA for RT 255 procedures INVASIVE PROCEDURES The “o-grams”

BEFORE CONTRAST INJECTION ALWAYS TAKE A “SCOUT” BEFORE CONTRAST INJECTION Why? List 4 reasons

SPECIAL “o-grams” Venogram Arthrogram Sialogram Myelogram Arteriogram Angiogram Galactogram Hystersalpingogram…….. etc

CONTRAST INJECTION KNEE ARTHROGRAM

DOUBLE CONTRAST WITH IODINE - HIP Arthrogram

To check fertility can be oil or water based contrast

Myelogram

Myelogram Contrast Pantopaque was introduced in 1944 as a oil contrast medium The first low-osmolar contrast medium to be produced was metrizamide (Amipaque) Oil never completely re –absorbed (Pre-employment L.sp)

SIALOGRAM

Galactography - Breast Duct

Cerebral Angiogram

LYMPHANGIOGRAM Now largely replaced by ________ ?

Dacryocystography Now largely replaced by CT

SPECIAL PROCEDURES ARE INVASIVE ALWAYS GET PATIENT’S HISTORY AND CONSENT BEFORE BEGINNING OR GIVING ANY CONTRAST MEDIA

CONSENTS SIGNED AND WITNESSED AFTER PROCEDURE HAS BEEN EXPLAINED CHECK DEPARTMENT PROTOCOL WHO’S RESPONSIBLE ??????

CONSENTS ASSAULT verbal threat of harm BATTERY FALSE IMPRISONMENT Unlawful touching - unauthorized treatment “X-RAY” TAKEN ON WRONG PATIENT FALSE IMPRISONMENT Restraints require permission from patient or authorized person

The ARRT has a published code of ethics. The ARRT Code of Ethics provides the radiologic technologist with an operational blueprint of norms of professional conduct.

Review of Ethics (Pt Care Book –Professional Ethics) The science of rightness and wrongness of human conduct and character is termed ethics. __________is the ethical principle that means that “above all, do no harm.” _________ principle that means that being truthful is right. __________ is the ethical principle that means that actions benefit others.

Review of Contrast Agents Types of Contrast Routes of Adminstration Chemical Components

Contrast Media changes the density of the organs Therefore changing the Subject contrast will change the Radiographic contrast and film contrast May need to INCREASE TECHNIQUE FROM SCOUT IMAGE* f/s

Contrast Media (review) Negative contrast (AIR OR CO2) Radiolucent Low atomic # material Black on film Positive contrast (all others) Radiopaque High atomic # material White on film

Types of Contrast Media Radiolucent- negative contrast agent x-rays easily penetrate areas- appear ____ on films Negative Contrast Media Air and gas complications emboli-air pockets in vessels lack of oxygen Radiopaque- positive contrast agent- absorbs x-rays areas- appear ____ on films Positive Contrast Agents BARIUM IODINES Both + & - can be used in same study

2 BASIC TYPES OF CONTRAST material BARUIM Z# 56 NON WATER SOLUABLE GI TRACT ONLY INGESTED OR RECTALLY KVP 90 – 120* IODINE Z# 53 WATER SOLUABLE POWDER LIQUID INTRAVENOUS OR Intrathecal GI TRACT Also OIL based KVP BELOW 90*

Methods of Administration of Contrast Material INGESTED (ORAL) RETROGRADE AGAINST NORMAL FLOW INTRATHECAL Spinal canal PARENTERAL (IV, Intrathecal) Injecting into bloodstream (anything other than oral)

Contrast media for SPECIAL PROCEDURES Diagnostic agents that are injected into Circulatory System, Joint Spaces, Ducts Body orifices/organs: uterus, breast, salivary & lymph glands

BLOOD WORK LAB TESTS to check function of kidneys prior to injection of contrast WATCH THE UPPER LIMITS BUN = BLOOD UREA NITROGEN Merrills pg 214 range is 8 to 25 pg 242 range is 10 - 20 always check with RAD when level above 20 CREATININE levels range: pg 214 (0.6 - 1.5) pg 242 (0.05 - 1.2) always check with RAD when level above 1.2 Indicates function of kidneys Diseases / dehydration / kidney failure

EGFR (new test) Estimated Glomerular Filtration Rate More advanced test for CREATININE levels Why is this important?

various water-soluble contrast media for urography and angiography Both ionic and non-ionic monomers* are all extracellular contrast media are excreted unmetabolized by glomerular filtration Approximately 85-90% of the injected dose is found in urine within the first 6 hours 95-100% within the first 24 hours

monomers* The ionic monomeric agents are salts that dissociate into two molecules one anion containing the radiopaque property due to three iodine atoms and one cation without radiopaque properties More on this later in the lecture…..

BARUIM SULFATE Not used in Special Procedures BARIUM – a review BARUIM SULFATE Not used in Special Procedures

Barium Sulfate High atomic number Z #? ______ Not soluble in water Used to coat the lining of organs Supplied in different thicknesses Used Esophogram, UGI, Small Bowel,Lower GI or BE

EXTRAVASATION OF CONTRAST INTO PERITONEUM Ba ADVERSE REACTIONS BARIUM INERT SUSPENSION MAY CAUSE ALLERGY OCG TABLETS (IODINE) ALLERGY AFTER EXAM – MAY SOLIDIFY DIFFICULT TO EVACUATE INCREASE FLUIDS, MILD LAXATIVE EXTRAVASATION OF CONTRAST INTO PERITONEUM

Extravasation of BA in abd

Ingested CONTRAST Gastrografin or Hypaque High atomic # Close to iodine Water soluble Similar usage as Barium

GASTROGRAFIN Adverse Reactions Water soluble, safe in the abdominal cavity Safe to use if perforation is suspected Very harmful to the lung tissue Do not use if aspiration is possible

Gastro – Pathology present Bowel Obstruction Note contrast Seen in kidneys as well

IODINE IONIC OR NON IONIC WATER OR OIL BASE

IODINATED CONTRAST iodine z # 53 WATER BASED INJECTED VESSELLS/DUCTS INGESTED Organ function/flow OPEN WOUNDS OIL BASED INJECTED NEVER VESSELLS ONLY DUCTS NOT INGESTED OPEN WOUNDS

INJECTION OF IODINE into Vessels ALWAYS A WATER BASED IODINATED COMPOUND BOLUS INJECTION INFUSION DRIP IONIC VS NON IONIC CONTRAST 50 -70 % CONCENTRATE

IODINE WATER BASED CONTRAST IONIC LESS $$$ MORE REACTIONS NON IONIC MORE $$$ LESS REACTIONS

CONTRAST MEDIA IODINE is either: IONIC or NON-IONIC Osmolarity # Of Particles (Cations + And Anions -) In Solution Per Kilogram Of Water High Osmolarity =more Cations And Anions Can Upset Homeostasis Nonionic Have No Charged Particles

Contrast Agents IONIC High Osmolality (Higher risk of complications) Diatrizoate sodium (Hypaque) Iothalamate meglumine (Conray) NON-IONIC Low Osmolality (Lower risk of complications) Gadodiamide (Omniscan) Iodixanol (Visipaque) Iopamidol (Isovue) Iopromide (Ultravist) Ioversol (Optiray)

More money Less reactions Less money More reactions

OIL – BASED IODINE CONTAST Instilled in ORGAN – Not vessells Oil-based iodine contrast media are made from fatty acids of poppy seed oil containing 48% and 37% iodine

FAT EMBOLUS IF IT GETS INTO BLOOD VESSEL Oil Based Iodine Fatty Acids Insoluble in water White on the radiograph = Radiopaque Uses Broncography (lungs) Tear ducts Salivary glands Lymphatic system Hysterrosalpingogram Galactography (breast ducts) FAT EMBOLUS IF IT GETS INTO BLOOD VESSEL

CONTRAST MEDIA CHEMICAL PROPERTIES TRIIODINATED COMPOUNDS BASED ON THE BENZOID ACID RING IODINE IS USED DUE TO THE HIGH ATOMIC NUMBER

The benzene ring is associated with the anion.

CONTRAST MEDIA IONIC CONTRAST NON IONIC CONTRAST

Iodine Contrast Material Non-Ionic Contrast Less patient allergic reactions Ionic Contrast Anion - Cation + More patient allergic reactions Ionic contrast media dissociates into two molecular particles in blood plasma = Causing pt reactions The benzene ring is associated with the anion. Nonionic contrast media is associated with low osmolality.

Iodine Contrast Material ANIONS - CHARGE IONS Responsible For Stabilizing And Detoxifying The Contrast Media CATIONS + CHARGED IONS Responsible For Increasing The Solubility Of The Medium The benzene ring is associated with the ________ ?

Newer Contrast Agents Balance Safety and Visualization In addition to osmolality, toxicity is a concern Although the mechanism of contrast medium toxicity is not completely understood it is believed that "chemotoxicity" is related to the protein-binding capacity of the medium, which is caused by non-specific weak interactions between the contrast medium and surrounding enzymes.

What contributes to discomfort, side effects, reactions: VISCOSITY – (thick, sticky) thicker – harder to inject, more heat and vessel irritation (higher = greater viscosity) Warming contrast will help TOXICITY - (higher = greater viscosity) MISCIBILITY - easily mixes with blood OSMOLALITY - is a measure of the total number of particles in solution.

Iodinated CONTRAST AGENTS Adverse Reactions Osmolarities higher than body fluids Viscous Greater chance for contrast reactions Anaphylatic shock is the most severe Injection of ionic contrast media may lead to hypovolemia.

Hypovolemia basically means low blood volume Symptoms of hypovolemia may include cold hands and feet, light headedness, infrequent urination, increased heart rate, and weakness. Low blood volume can result in multiple organ failure, kidney damage, brain damage, and death hypovolemia differs from dehydration (which is excessive loss of body water hypovolemia can lead to dehydration

Hypovolemia is the most common cause of Orthostatic hypotension What? __________

High osmolality of the contrast media is related to adverse reactions.

CONTRAST MATERIAL ADVERSE REACTIONS ALWAYS GET PATIENT’S HISTORY BEFORE ANY CONTRAST MEDIA IS GIVEN SEE Ch. 19 Table 19-7 pg 296 Carlton Pt Care (3RD ed)

Reaction classification Immediate reactions were defined as those occurring within the department (within one hour) Delayed as those occurring between the time the patients left the department and up to seven days later

Delayed Side Effects to Contrast Skin effects included itching, rash, and hives. Nausea, vomiting, and diarrhea were the gastrointestinal side effects General side effects included headache, dizziness, and fever. Infants and patients older than 60 years are at increased risk of developing a side effect.

General Factors for Contrast Reactions Nonionic vs ionic Risk Factors Severity of Reactions Renal toxicity Glucophage Diabetic? Screening Creatinine Pretreatment

CONTRAST MEDIA & ADVERSE REACTIONS RISK Any foreign substance introduced in the body Chance the body will react negatively to the material Minor to Life Threatening Minor = 5% Major 0.1%

GOOD PATIENT HISTORY Kidney problems Diabetes Heart conditions Allergies Asthma Previous reaction Current medications Beta Blockers Antihypertensive medications VITAL SIGNS

CONTRAST REACTIONS > 10 million diagnostic procedures per year General > 10 million diagnostic procedures per year Conventional ionic contrast reactions - 10% 1 in 1000 severe

Contraindiatons for Contrast Renal Failure (Check BUN & Creatinine) Elevated levels could cause renal shutdown Anuria (no urine production) Asthma (possible allergies) Hx of Contrast Allergy / Reactions Diabetes - get a hx of medications taken glucophage must be stopped 48 hrs before contrast injection Multiple Myeloma

MORE Risk Factors for Contrast Reaction Older patient age Allergic Rhinitis, medication or Food Allergy Cardiovascular disease WHO are at increased risk of developing a side effect? (2 age classifications?)

CONTRAINDICATIONS Pregnancy (risk of fetal Thyroid toxicity) + Radiation concerns Allergic Reaction Pathologic Conditions Infection

Allergic to Iodine May or may not react if previous iodine given General Rule: No Iodine Contrast will be given Pre – medication is available May or may not react if previous iodine given

Aseptic Technique for injection betadine scrub Contains iodine

REACTIONS & Treatment USUALLY** WITHIN FIRST 5 MINUTES Nausea & Vomiting & Urticaria Hypotension (bradycardia) Hypotension (tachycardia) Bronchospasm Anaphylactoid Seizures Extravasation

Uticaria (hives) rash – itching Flush face – feeling of warmth Categories of Adverse Reactions MILD Carlton – Patient Care Book: Vol 3 Ch. 19 pg 297 or Vol 4 Ch. 20 pg 337 nausea, vomiting Uticaria (hives) rash – itching Flush face – feeling of warmth Headace, Chills, Anxiety Diaphoresis Treatment – does not usually get worse Watch patient and reassure (cool cloth on forehead, emesis basin

Catagories of Adverse Reactions MODERATE Carlton Pt Care Hypotension (bradycardia) Hypertension (tachycardia) Dyspnea Bronchospasms /wheezing Laryngeal Edema TREATMENT: Needs immediate treatment –GET RN/RAD Needs Meds* – (Keep IV line in) could lead to severe reactions

Catagories of Adverse Reactions SEVERE Carlton Pt Care Laryngeal edema Convulsions Profound hypotension Clinically manifested arrhythmias Unresponsiveness Cardiopulmonary Arrest PROMPT TREATMENT – CODE BLUE!

Rx for REACTIONS have ready on Emergency cart or Crash Cart UTICARIA (HIVES) – Benadryl (diphenhydramine) Vistaril (hydorxyzine) Tagament or Zantac Facial/Laryngeal Edema/Bronchospasms Epinephrine , Oxygen

Contrast Reactions/MYTHS not caused by iodine Ionic vs non ionic - binding elements not related to shellfish not true allergy (no drug-antibody) mechanism remains unknown

Anaphylactoid (idiosyncratic) unpredictable dose independent prevalence 1-2% (0.04 - 0.22% severe) fatal 1 in 75,000

RENAL TOXICITY (increased serum creatinine > 0.5 mg%) 2-7% 5 – 10 x increase with pre-existing renal insufficiency direct relationship between serum creatinine and likelihood nephrotoxicity Hydrate 100 ml/hr Normal saline 4 hrs prior to procedure, continue for 24 hours

GLUCOPHAGE Vol 4 Ch. 19 pg 297 or Pt is DIABETIC = oral diabetic agent MUST STOP __ DAYS BEFORE EXAM withhold drug for 48 hrs after contrast administration patients with renal insufficiency may develop lactic acidosis The signs of lactic acidosis are deep and rapid breathing, vomiting, and abdominal pain What is the name of the medication given for GI peristalsis?

Benadryl (diphenhydramine) Epinephrine Pre-Medications Steroids (Prednisone) Benadryl (diphenhydramine) Epinephrine

EXTRAVASATION Contrast material has seeped outside of vessel Local redness and swelling Apply WARM Compress 1st 24 hours Cool compress for swelling

EXTRAVASATION The act of injecting a drug/contrast into an area other than the vessel (soft tissue) RTA BOOK: Pharmacology Chapter Defines as: Discharge or escape of fluid from a vessel into the surrounding tissue that can cause localized vasoconstriction, resulting in sloughing of tissue and tissue necrosis if not reversed with an antidote.

Extravasation of Contrast into soft tissue of arm

Contrast leaking from bladder

Summary - Delayed side effects persist in IV iodinated contrast media History of asthma and allergy predisposes patients to increased incidence of adverse reactions Intravenous iodinated contrast agents are generally safe. Though the frequency of side effects has fallen significantly since the introduction of nonionic, monomeric contrast agents,however, side effects remain an important issue. Late adverse reactions were first recognized in the mid-1980s

Summary of Contrast Reactions Anaphylactoid reactions may present with mild symptoms such as skin rash, itching, nasal discharge, nausea, and vomiting moderate symptoms like facial or laryngeal edema, bronchospasm, dyspnea, tachycardia, and bradycardia severe symptoms such as life-threatening arrhythmias, hypotension, bronchospasm, laryngeal edema, pulmonary edema, seizure, syncope, and death

Summary of Contrast Reactions Nonanaphylactoid reactions are due to the ability of the contrast media to upset the body homeostasis, especially the blood circulation. Increasing iodine concentration increases the risk of these reactions, which is also affected by the volume and route of administration of contrast. Larger volumes or intra-arterial administration are more likely to produce a reaction. The cardiovascular, respiratory, urinary, gastrointestinal, and nervous systems are most commonly affected by physiologic changes produced by contrast media. The symptoms of nonanaphylactoid reactions are warmth, metallic taste, nausea, vomiting, bradycardia, hypotension, vasovagal reactions, neuropathy, and delayed reactions

SCHEDULING CONSIDERATIONS Diabetics – first (Insulin= low blood sugar occurs while fasting) After Nuclear Medicine Tests (iodine goes to thyroid and will alter results) Iodine BEFORE Barium BE before UGI ( IVP before BE) WATER – OIL - BARIUM

SPECIAL PROCEDURS CONTRAST MEDIA ARTHROGRAMS Injected into JOINT SPACES IODINE (positive contrast) WATER soluble (Ionic or Non-Ionic) AIR (negavitve contrast)

SPECIAL PROCEDURS CONTRAST MEDIA MYELOGRAMS Injected INTRATHECALLY (into the subarachnoid space) Nonionic water-soluble contrast (NO IONIC CONTRAST)

31 y/o male DIES after Myelogram Procedure Myelography is safely performed using nonionic water-soluble radiographic contrast media intended for this route of administration Misadministration of ionic contrast media intrathecally can result in a syndrome of spasms and convulsions, often leading to death ISOVUE –M ( 20 or 30 cc)

mix-up between look-alike vials ionic HYPAQUE (diatrozoate meglumine) nonionic OMNIPAQUE 300 (iohexol) Each type of contrast media should be stored separately, based on its use.

SPECIAL PROCEDURS CONTRAST MEDIA SIALOGRAPHY – injected into Salivary Ducts IODINE – WATER (ionic or nonionic) OR OIL BASED SINOGRAPHIN (OIL) RENOVUE (WATER)

MRI Contrast

MRI with contrast Without With What is the name of the contrast used for MRI ?

Gadolinium z# 64 Once injected, gadolinium accumulates in abnormal tissues of the brain and body. Provides a greater contrast between normal and abnormal tissues MORE dilute than used for Radiology

gadolinium On its own gadolinium is toxic to the human body, but when coated in a special chelating agent, it is safe to use. When the chelating agent breaks down prematurely, or the kidneys are unable to excrete the gadolinium from the body, gadolinium poisoning can occur

Gadolinium Side Effects With impaired kidney function, gadolinium could lead to a serious and potentially fatal disorder called Nephorgenic Systemic Fibrosis. (NSF) More common conditions associated with exposure includes impaired kidney function irritation of blood vessels facial swelling skin conditions, including rashes, itching and hives

CT Contrast Oral/Rectum IV: Iodine Usually less dilute – Barium or Iodine IV: Iodine Usually less dilute than for Radiology

CT w contrast

CT Contrast CT Scan Contrast Indications History of tumor, cancer, or surgery Looking for infection, inflammation Evaluating blood vessels Investigate a finding in a scan done without contrast CT Scan Contrast Side Effects Mild to life-threatening allergic reaction Flushing/redness and hives Shortness of breath Nausea, vomitting Blood clots Dizziness

PATIENT PREP COVERED WITH EACH EXAM

REVIEW SPECIAL PROCEDURS CONTRAST MEDIA ONLY Water sol. Arthrograms Myelograms Angio/Arterio grams Cardiac Cath Venograms Water or OIL Hysterosalpingogram Sialogram Lymphangiograms Lasts longer – may cause FAT EMBOLI

REVIEW (Bontrager Slides)

SEE : PT CARE : Pharmacology 4th Ed Ch.20 (charts p293/p.299 )

MEDICATION Atropine Benadryl Dilantin Epinephrine Heparin Lasix PT CARE : Pharmacology 4th Ed Ch.20 (charts p293/p.299 ) Sample CRASH CART Medications MEDICATION Atropine Benadryl Dilantin Epinephrine Heparin Lasix Sodium Bicarbonate Xylocaine INDICATION (used for what?_ ______________ ________________ _________________ ___________________ __________________ Spring 2010

REVIEW TYPES OF CONTRAST & USES ADVERSE AFFECTS OF CONTRAST USAGE CONTRAINDICATIONS FOR CONTRAST

RTA Book – Contrast Media Review Questions RTA Book – Contrast Media

Contrast media are used in radiographic imaging to a) increase the radiographic density of the area of interest b) enhance the subject contrast of the area of interest c) decrease the radiographic density of the area of interest d) lower the subject contrast of the area of interest

Radiographic images that demonstrate few density differences define a) low subject contrast b) high subject contrast c) low x-ray photon absorption d) high x-ray photon absorption

A negative contrast agent will a) increase density and is radiopaque b) decrease density and is radiopaque c) decrease density and is radiolucent d) increase density and is radiolucent

Perforation of the colon during a lower GI barium study may result in complications resulting from a) flocculation b) bronchospasm c) convulsion d) extravasation

Depending on the environment of the barium sulfate,such as acid in the stomach, the powder may have a tendency to clump – this is called a) flocculation b) bronchospasm c) convulsion d) extravasation

4. Perforation of the vessel while injecting a contrast media may resulting in a) flocculation b) bronchospasm c) convulsion d) extravasation

Barium sulfate: 1. is filtered by the kidneys 2. is absorbed by the stomach 3. coats the gastrointestinal lining 4. is absorbed by the jejunum

High atomic number elements absorb x-rays at a greater rate than low atomic number elements. 1. true 2. false

Barium sulfate is contraindicated if the patient is suspected of having a gastrointestinal tract perforation. 1. true 2. false

Radiolucent contrast media: 1. are positive contrast agents 2. appear dark on radiographs 3. are composed of elements with high atomic numbers 4. none of the above

Radiopaque contrast media: 1. are positive contrast agents 2. appear light on radiographs 3. are composed of elements with high atomic numbers 4. all the above

Each of the following is an example of a negative contrast media except: 1. air 2. soda water 3. barium sulfate 4. gas-producing crystals

An air embolus can form as a complication of negative contrast media administration. 1. true 2. false

An fat embolus can form as a complication of AN OIL BASED contrast media administration. 1. true 2. false

Ionic contrast media dissociates into two molecular particles in blood plasma. 1. true 2. false

Most adverse reactions associated with Ionic contrast media are significantly decreased with the non-ionic contrast media 1. true 2. false

Which of the following acute reactions to contrast media usually requires no medical treatment? a) bronchospasm b) laryngeal edema c) urticaria d) convulsions

Which of the following acute reactions to contrast media usually requires immediate medical treatment? a) Bronchospasm / laryngeal edema b) Nausea & Vomiting c) Urticaria d) Warn flush /metallic taste

What can be done for a patient who will receive water- soluble iodine contrast media to reduce allergic-like effects? a) premedicate with steroids and antihistamines b) give intravenous fluids c) instruct the patient to drink warm salt water before the procedure d) give a negative contrast agent with the iodinated medium

When you schedule multiple procedures, what examination is usually done last? a) thyroid function tests b) Upper GI c) air-contrast colon (BE-AC) d) Intravenous pyelogram (IVP)

When you schedule multiple procedures, what examination is usually done last? a) thyroid function tests b) Upper GI c) air-contrast colon (BE-AC) d) Intravenous pyelogram (IVP) It will take the BA the longest to travel through the GI tract

When you schedule multiple procedures, using contrast media – which examination must be done first? a) thyroid function tests (Nuc Med) b) Upper GI c) air-contrast colon (BE-AC) d) Intravenous pyelogram (IVP)

When you schedule multiple procedures, using contrast media – which examination must be done first? a) thyroid function tests (Nuc Med) b) Upper GI c) air-contrast colon (BE-AC) d) Intravenous pyelogram (IVP) WHY?

Antihistamines are used to prevent and treat nausea and vomiting. 1. true 2. false

Antihistamines are used to prevent and treat nausea and vomiting. 1. true 2. false So what is it used for?

Antihistamines are used to prevent and treat ____________ Allergic reactions to contrast media

Glucophage is the brand name for __________________________ What is it used for? _________________________

Glucophage is the brand name for METAFORMIN What is it used for? DIABETICS RTA BOOK PHARMACOLOGY CHAPTER

Which type of drug is used to prevent and control the occurrence of seizures? 1. anticonvulsants 2. antiemetics 3. antihistamines 4. antihypertensives

Which type of drug is used to prevent and control the occurrence of seizures? 1. anticonvulsants 2. antiemetics 3. antihistamines 4. antihypertensives

An intravenous push refers to a rapid bolus injection. 1. true 2. false

An intravenous push refers to a rapid bolus injection. 1. true 2. false What is the name when it is injected slowly?

What is the name when contrast it is injected slowly? INFUSION DRIP

The act of injecting a drug into a vein is termed extravasation. 1. true 2. false

The act of injecting a drug into a vein is termed extravasation. 1. true 2. false What does it mean? ______________

extravasation What does it mean? ______________ The act of injecting a drug/contrast into an area other than the vessel (soft tissue) is termed extravasation. RTA BOOK: see definiton

Contrast media are: 1. diagnostic agents 2. dyes 3. all radiopaque 4. all radiolucent

Contrast media are: 1. diagnostic agents 2. dyes 3. all radiopaque 4. all radiolucent

An air embolus can form as a complication of negative contrast media administration. 1. true 2. false

An air embolus can form as a complication of negative contrast media administration. 1. true 2. false

Oil-based iodine contrast media are used for each of the following except: 1. dacrycystography 2. bronchography 3. lymphography 4. myelography

Ionic contrast media dissociates into two molecular particles in blood plasma. 1. true 2. false

Iodinated contrast media dissociates into two molecular particles in blood plasma. 1. true 2. false

The benzene ring is associated with the: 1. anion 2. cation 3. positive charge 4. none of the above

LIST 4 TYPES OF HIGH RISK PATIENTS

Oil-based iodine contrast media are made from: 1. fatty acids 2. carbohydrates 3. amino acids 4. none of the above

Osmolality is a measure of: 1. the number of iodine atoms per molecule 2. particle density 3. the total number of particles in solution 4. none of the above

High osmolality of the contrast media is related to adverse reactions. 1. true 2. false

Injection of ionic contrast media may lead to hypervolemia. 1. true 2. false

Myelography most commonly uses ___ contrast media. 1. ionic 2. nonionic 3. nonionic and ionic 4. neither ionic nor nonionic

End of Contrast Media for Special Procedures RT 255 Rev Spring 2010