Chapter 1 Introduction
Pharmacology is the study of drug actions and drug interactions with living organisms.
Drugs are chemical substances that are not required for normal maintenance of body
function and produce a biological effect in an organism. The word pharmacology comes
from the Greek words pharmakon, meaning drug or poison, and logos, meaning study;
therefore, pharmacology is a study of drugs. All drugs are, or can be if misused, poisons
(Aigins, 1995). If used correctly, they are meant to relieve human diseases and suffering.
The position of the American Society of Radiologic Technologists is that “venipuncture
falls within the profession’s Scope of Practice and Practice Standards and that it shall be
included in the didactic and clinical curriculum with demonstrated competencies of all
appropriate disciplines regardless of the state or institution where such curriculum is
taught.” For this reason, pharmacology and the clinical component of venipuncture are
included in this chapter. There are three categories assigned to substances applied or
administered for therapeutic purposes. They are drugs or medications, biologics,
and alternative therapies.
A drug is a chemical agent capable of producing biologic responses in the body. These
responses may be desirable (therapeutic) or undesirable (adverse). After a drug is
administered, it is called a medication. A biologic is an agent naturally produced in
animal cells, microorganisms, or by the body itself such as hormones, natural blood
products, or vaccines. Alternative therapies include natural plant extracts, herbs,
vitamins, minerals, dietary supplemental, and therapeutic techniques that may be
considered unconventional such as acupuncture (Adams,
Josephson, and Holland, 2005).
The professional radiographer who administers drugs is expected to know the safe
dosage, the safe route of administration, limitations of the drug he administers, the side
effects, the potential adverse and toxic
reactions, the indications and contraindications for its use. He must also know the
potential hazards of any drug that is incorrectly or unsafely administered. If drug
administration errors are made due to lack of knowledge, the person who administers
the drug is legally liable. Radiologic technology students who are permitted to
administer drugs must adhere to the specific ethical and legal guidelines established for
drug administration. The student must be supervised by a licensed professional;
professional liability coverage must be adequate and the student must also demonstrate
competency before performing drug administration without supervision.
Chapter 1 Drug Names
Drugs come from many natural and synthetic sources. Some are produced from animal
sources such as hormonal drugs. Many come from plant sources such as digitalis and
atropine. Others are produced from microorganisms as are many antibiotics. Minerals
are the sources of calcium, iron and other dietary supplements and herbal remedies.
Drugs from synthetic materials are made in laboratories. Some drugs are genetically
engineered and used to treat specific diseases.
Learning drug names is complicated because must drugs have several names. The
same drug may be sold under many different proprietary or trade names. The trade or
proprietary name is assigned to a drug by a particular manufacturer of the drug. In the
United States, the initial developer of a drug has an exclusive right to name and market
a drug for 17 years. Because it often takes several years for that drug to be approved for
general use, some of those 17 years may be lost before it is marketed. No other
company is allowed to produce this drug until the 17 years has expired.
Chemical Name of a drug presents its exact chemical formula of a drug and always
remains the same. The chemical name is often cumbersome, and one is seldom required
to remember it as it is rarely used in daily clinical practice.
Generic Name of a drug is the name given to the drug before its official approval for
use. It is assigned by the United States Adopted Name Council. Usually the generic
name is less complicated and easier to remember than the chemical name. This is the
name used by the FDA, USP and WHO to describe the drug. There is one generic name
for each drug and because it is often used, it must be learned by all persons who
administer drugs.
For instance, a drug frequently administered before imaging procedures is parenteral
diazepam. Diazepam is the generic name for Valium and its chemical formula is 7-
chloro-1, 3-dihydro-1-methyl-5-phenyl-2H-1, 4-benzodiazepin-2-one.
The radiographer must be able to identify certain drugs by their trade name and their
generic name. It is not essential to learn the chemical formula of each drug.
Drugs often have several names. When a drug is first discovered, it is given a chemical
name which describes the atomic or molecular structure of a drug. When the drug is
approved by the FDA, it is given a Brand Name or Trade Name as well as its Generic
Name. When a drug is under patent protection, the company markets it under its brand
name. When the drug is already off-patent, the company may market its product under
either the generic name or brand name. Other companies that file for approval to
market the off-patent drug must use the same generic name but can create their own
brand name. As a result, the same generic drug may be sold under either the generic
name (for example, ibuprofen) or one of many brand names (such as Advil).
Generic and brand names must be unique to prevent one drug from being mistaken for
another when drugs are prescribed and prescriptions are dispensed. To prevent this
possible confusion, the FDA must agree to every proposed brand name. Government
officials, doctors, researchers, and others who write about the new compound use the
drug’s generic name because it refers to the drug itself, not to a particular company’s
brand of the drug or a specific product. However, doctors often use the brand name on
prescriptions, because it is easier to remember and doctors usually learn about new
drugs by the brand name.
Chapter 2 Drug Classification
Drugs may be classified in several ways.
They can be grouped according to their:
1. Physiologic effects on receptors,
2. Physiologic effects on specific body systems or
3. Overall physiologic effects.
There are three dominant methods of classifying these groups:
1. By their mechanism of action, meaning the specific biochemical reaction that
occurs when you take a drug.
2. By their physiologic effect, meaning the specific way in which the body responds to
a drug.
3. By their chemical structure.
The aim of drug classification is to ensure that you use a drug safely to achieve the
utmost benefit. Ultimately, every time you take a drug, your body chemistry is altered.
While this effect meant to be therapeutic, it can also cause side effects that may be
harmful. Moreover, if you take multiple drugs, your body chemistry may be changed in
such a way that a drug is far less effective or the side effects are far more severe.
By noting the classification of drugs, you and your doctor can have a better
understanding of what to expect when you take it, what the risks are, and which drugs
you can switch to when needed.
ATC Classification System
In the end, there are numerous ways to classify a drug and thousands of
different drug classes and subclasses. To bring order to chaos, in 1976 the WHO created
a multidimensional system called the Anatomical Therapeutic Chemical (ATC)
Classification System, which categorizes a drug based on five levels:
1. Level I – Describes the organ system the drug treats.
2. Level II – Describes the drug’s therapeutic effect.
3. Level III – Describes the mechanism or mode of action.
4. Level IV – Describes the general chemical properties of the drug.
5. Level V – Describes the chemical components that make up the drug (essentially
the chemical name of the drug such as finasteride or ibuprofen)
For each level, either letters or numbers are assigned. While not useful for the consumer,
the ATC system is able to classify the active ingredient of a drug under a strict hierarchy
so that it is appropriately used and not mistaken for another drug.
USP Drug Classification
In the United States, a non-profit, non-governmental organization called the
United States Pharmacopeia (USP) was established in 1820 to ensure that prescription
and over-the-counter drugs approved for use in the United States meet quality
standards in order to be placed on the National Formulary issue by the U.S. Food and
Drug Administration.
For its part, the USP classifies drugs in a far broader way than the ACT system,
categorizing a drug
Firstly, on its therapeutic use;
Secondly on its mechanism/mode of action; and
Thirdly, on its formulary classification.
Even with this streamlined system, there are still dozens of different drug classes and
thousands of different subclasses and subcategories.
Chapter 2 Drug Actions
Drug Actions
A drug does not have the capacity to change cellular structure, but acts as either
increase or decrease the rate and range of a normal or abnormal physiologic process
going on within the cells of the body.
Drugs are absorbed, distributed, metabolized and then excreted from the body.
As this process takes place, the drug reaches a point at which it has its intended effect.
This is called the onset of action. As it continues to be absorbed, the drug reaches its
peak concentration level. This is the time during which the drug attains its maximum
therapeutic response. This means that the drug I able to produce its most desired
curative or remedial effect. The time during which the drug is in the body in an amount
large enough to be therapeutic is called its duration of action. As the drug is excreted
from the body, the concentration level subsides to a point at which there is little or no
intended effect.
Drugs that are taken into the body act in different ways that depends on their
physical makeup.
All drugs must be in liquid form to be absorbed.
For this reason, drugs that are administered in solid or tablet form must go through a
phase called pharmaceutic phase before they can be absorbed. This means that the
solid form of the drug must be broken down into tiny particles to be dissolved into the
body fluids of the gastrointestinal (GI) tract.
Enteric-coated tablets do not go through the pharmaceutic phase or absorption until
they reach the small intestine where there are dissolved in an alkaline media.
Drugs that are administered orally in liquid form or drugs that are administered
parenterally do not go through this phase.
As newer and more advanced drugs are being introduced into the market each year-
including next generation targeted therapies, gene therapies and personalized
medicines – the classification of drugs will likely become even more diverse and distinct,
reflecting our over expanding knowledge about human biochemistry as a whole.
Chapter 3 Pharmacokinetics
The process that control absorption, distribution, metabolism and excretion of drugs
by the boy are called pharmacokinetics. All persons process drugs differently depending
on their age, nutritional status, ethnicity, existing physical condition, immune status,
state of mind, gender, weight, environmental factors and time of the day.
A drug must advance from its dosage form into a form that makes it biologically
available for passage into the systemic circulation. In other words, a drug must be
absorbed and take through the bloodstream to its intended site in order to act. The
amount of drug that actually reaches the systemic circulation becomes bioavailable or
reaches a state of bioavailability. Drug absorption varies from person to person and
depends on the absorptive surface available. An intended drug surface that is damaged
or absent alters the length of time it takes a drug to reach its intended site.
Drugs move to their site of absorption and then must penetrate the cell
membrane at that site. This is accomplished by varying methods. One method is passive
diffusion which requires no cellular energy. The drug simply moves across a cell
membrane from another area of lower concentration to one of higher concentration.
When the concentration equalizes on both sides of the cell membrane, the transport is
complete. Lipid solubility is the most important determinant in deciding whether a
drug will cross cell membranes, although water solubility is also of importance. Most
drugs cross cell membranes by passive diffusion.
Active Transport is another method of drug absorption. This method requires
energy from the cell and a carrier molecule such as an enzyme or protein that forms
complexes with drug molecules on the membrane surface to carry them through the
membrane and then leave them by disassociation. Active transport is necessary to move
some drugs and electrolytes such as sodium and potassium from outside to inside a
cell. Pinocytosis is a type of active transport in which a cell engulfs a drug particle,
forms a protective coat around it, and transports it across the cell membrane. Fat
soluble vitamins are transported in this manner.
Drugs taken orally are usually absorbed in the small intestine, which has a large
surface for absorption. If a portion of the small intestine has been removed or is scarred,
the ability to absorb a drug is reduced.
The quantity of blood flow to absorption surfaces affects the rate at which a drug is
absorbed. For instance, a drug is absorbed much more rapidly when it is administered
intramuscularly in the deltoid muscle than in the gluteal muscle because the blood flow
is greater in the deltoid. A person who is in severe pain or in a state of acute stress may
have decreased ability to absorb drug.
First-Pass Effect
When a drug is taken by mouth and swallowed into the stomach, it goes
from the small intestine to the mesenteric vascular system and then to the portal vein
and from there into the liver before it is transported into the systemic circulation.
Because of this travel through the gastric and hepatic circulation, a portion of the drug
is metabolized en route and becomes inactive. This partial metabolism of a drug before
it reaches the systemic circulation is called a first-pass effect. In the cases of many drugs
taken orally, this effect requires that a larger dose of drug be administered so that a
portion of the drug remains to perform its intended effect. Drugs that can e
administered by sublingual, vaginal or parenteral route avoid the first-pass effect by
going directly into the systemic circulation; however, these routes of administration
may be contraindicated for other reasons.
Some drugs after absorption are moved from the bloodstream into the liver and
then through the biliary tract, where they are excreted in bile or return to the small
intestine and back into the bloodstream. This action is called enterohepatic recycling,
allows the drug to persist in the body for long periods.
Distribution
After a drug is absorbed into the body, it is distributed to its intended target site.
The rate and extent of distribution depends on adequate blood circulation, protein
binding and the drug’s affinity for lipoid or aqueous tissue. Drugs move quickly to body
organs that have a rich supply of blood, such as heart, liver and kidneys. They reach
muscles and fatty tissues more slowly.
As a drug travels through the circulatory system, it may come into contact with
plasma proteins and bind to them or remain free. If bound to plasma protein, the drug
becomes inactive. Only free drugs are able to act on cells. As the free drug acts, there is
a decrease in plasma drug level, which allows portion of the bound drug to be released
and become active. The slow release of the drug allows blood levels of a drug to remain
somewhat constant. The health status of the person receiving the drug and the drug
itself affects drug distribution.
If two or more drugs compete for a plasma-binding site, the drug with the
strongest affinity for the site acquires it. This allows a greater amount of the other drug
free to act and may result in a toxic level of that drug or result in a drug-drug
interaction.
Lipid soluble drugs are stored in lipoid tissues. Highly lipid-soluble drugs remain
stored in fatty tissues and they are released very slowly. Drugs that are intended to
penetrate the blood-brain barrier must be highly lipid soluble and bind minimally with
plasma proteins to achieve their intended effect.
Because of the non-selective nature of placenta, most drugs are able to pass that
barrier and affect the developing fetus. The toxicity of drugs to the fetus during the first
trimester of pregnancy makes it mandatory that the pregnant mother receives no
medication without the explicit orders of her physician. Only drugs that are necessary to
maintain the optimum health of the mother should be given. This is important for the
radiographer to remember as he/she cares for female patient of childbearing age.
Metabolism
The process by which the body alters the chemical structure of a drug or other
foreign substance is called metabolism or biotransformation. These terms are
interchangeable. Generally, this process reduces lipid solubility to render the drug ready
for excretion.
Most drugs are metabolized in the liver by means of a complex chemical action
involving enzymes. These enzymes act on a wide variety of compounds. In certain drugs,
tissues from plasma, kidneys, lungs and the intestinal mucosa may be involved.
Age, health status, time of day, emotional status, the presence of other drugs in
the body, genetic variations and disease states may alter the rate of drug metabolism.
An altered metabolic state may allow a drug to accumulate in the body and produce an
adverse reaction. Conversely, rapid metabolism of a drug may interfere with the
intended effect. Drugs administered orally are significantly metabolized by the firs-pass
effect through the liver, which also alters their metabolism.
Excretion
Excretion of drugs from the body takes place chiefly in the kidneys. Some drugs
are excreted virtually unchanged through the kidneys whereas others are extensively
metabolized with only a small amount of the original drug remaining.
Other sites of drug excretion are through the biliary tract and into the feces or
through the enterohepatic cycle and later into the kidneys. Gases and volatile liquids
used for anaesthesia are excreted by the lungs. Sweat and saliva are of minimal
importance in drug excretion.
Some drugs or drug metabolites may cross the epithelium of the mammary
glands and be excreted in breast milk. This is important if the mother is breastfeeding an
infant, ad a drug, particularly a narcotic drug, is transferred in high concentrations to the
infant.
Chapter 3 Pharmacodynamics
PHARMACODYNAMICS
It is the study of the method or mechanism of drug action on living tissues or
the response of tissue to chemical agents at various sites in the body. Drugs may alter
physiologic effects in the body in the following ways:
1. By altering blood pressure
2. By altering heart rate
3. By altering urinary output
4. By altering function of the central or peripheral nervous system
5. By altering changes in all other body systems
Drugs do not produce new functions on tissues or organs of the body. Usually, a
primary site of drug action is targeted by a drug that is administered systemically;
nevertheless, all body tissues are affected in some way by every drug administered. The
beginning and ending point of drug action is generally considered the
pharmacodynamics effect. This describes the outcome effects after the drug reaches the
site of action.
The intent of drug therapy is to produce a therapeutic effect that may be to control
pain, cure a particular disease, alleviate symptoms of a disease, or diagnose a disease.
The radiographer will be involved most of the time with drugs used to diagnose disease.
The particular area for which a drug is intended and that receives a maximum effect of a
drug is called drug receptor. The function of a cell is altered but not completely
changed by a drug. A drug receptor is macromolecular component of body tissue.
Drug receptors have an affinity for a particular drug. This means that there is an
attraction between the drug and the receptor. Affinity is the factor that determines the
concentration of drug necessary to accomplish its intended effect. If there is a strong
affinity at the receptor site, the concentration of drug necessary to accomplish its effect
is low. This is referred to as the efficacy of the drug.
There are both drug agonist and antagonist. These actually provide opposite
reactions. Agonists are drugs that are able to bind with receptors to produce a
therapeutic response. Partial binding at the receptor site is also possible to produce a
partial therapeutic response. These are called partial agonist. A drug antagonist joins
with a receptor and prevents the agonist from performing its intended effect.
The molecular structure of each drug determines the affinity for a receptor. A very
small change in a drug molecule can leave the drug’s affinity to a receptor unchanged
but drastically change the pharmacologic action of drug.
Many drugs exert more than one effect on the body. For instance, a drug given at
the recommended dosage will have the intended effect; however, if given in a larger
dose, it may have an undesirable effect. The relation between the dosages at which the
intended effect of a drug is obtained and the amount that produces an unwanted effect
is called the therapeutic index. The greater the therapeutic index, the safer the drug is
since more can be tolerated without adverse effect.
Chapter 3 Drug Interactions
DRUG INTERACTIONS
While the radiographer ay never have to mix two drugs into the same syringe,
he/she must remember to consult a drug compatibility chart before doing so, should
the need ever arise. This situation may occur with an intravenous injection of contrast
medium through a butterfly needle rather than hanging IV solution. If this occurs, the
radiographer must flush the butterfly line with saline before injecting any other drug,
even another contrast medium. Many drugs combined with another drug, can become
inactivated or form a toxic compound. At times, when two drugs are combined, they
increase the effect of each drug given alone. An example of this is a dose of heparin
when given with alcohol increases bleeding. This can equate to one plus one equalling
two and is called an additive reaction. A synergistic drug reaction may occur when
two drugs interact to equal an effect greater than the sum of their separate dosage.
Some drugs are antagonistic to other drugs or interfere with the action of another
drug. When this occurs, the intended drug effect is neither neutralized nor decreased.
Drugs may also be affected by food if given orally. Directions for drug administration list
whether the drug should be taken on an empty stomach or taken with food. These
directions must be taken seriously as some drugs may be absorbed into the
bloodstream more quickly with food and others may need to be taken on an empty
stomach to enhance absorption.
ADVERSE DRUG REACTIONS
Any person who participates in drug administration must be aware of the potential harm
that may result from drugs. They may produce many unintended effects. When a drug
produces an effect that is mild, common, unintended and non-toxic this is said to be as
a side effect. When a drug produces an effect that is more severe or life-threatening, it
will fall under adverse effect. Some adverse reactions occur almost immediately after
the drug is administered and some take weeks or months of administration before an
untoward reaction is produced. A toxic reaction is an unwanted effect that is an
extension of the therapeutic effect. A drug that is given in the prescribed amount is
therapeutic but may become toxic when given in an increased amount; this is
considered as overdose. A toxic reaction does not include an allergic reaction or
anaphylactic shock, which is classified as an adverse reaction.
Immediate adverse reactions to drugs can include gastric distress and allergic or
hypertensive reactions that may range from mild urticarial to severe anaphylactic shock.
Some drugs are disease-producing themselves and may produce blood dyscrasias,
hepatic disease, gastric ulcerations or thrombosis.
Since drugs are tested extensively before they are permitted to be marketed, most
adverse reactions have been documented, and it is known that these reactions may
occur. The therapeutic or diagnostic purpose of a drug is weighted against the risk, it is
prescribed by the physician with caution.
The patient must be educated regarding the potential adverse effects of a drug
before it is administered. He must be instructed to notify his physician if adverse
reactions occur. Particular care must be given to pregnant women and nursing mothers.
All healthcare workers who administer drugs have the responsibility to understand and
educate their patients about any drug that they administer.
An unexpected or exacerbated effect from a drug is called a drug idiosyncrasy.
For example, a drug given to produce sleep instead produces a hyperactive reaction.
The cause of this reaction is not clear, but it may be due to a genetic deficiency that
creates an inability to tolerate certain chemicals.
Drug tolerance occurs when a drug received continually for a length of time
creates a change in the response to that drug. Usually, the drug is needed in
increasingly larger doses to create the desired effect. Drug tolerance is a sign of drug
dependence and the drugs that are related to this problem are narcotics and
tranquilizers. Tachyphylaxis is a rapid development of tolerance to a drug.
Chapter 4 Standard Precautions in Drug Administration
Standard Precautions in Drug Administration
All drugs and medications are potentially harmful. The radiographer must always be
alert and ware of his or her actions when administering drugs or assisting with drug
administration. One must never administer a drug that has not been specifically ordered
by a physician. All healthcare workers who administer drugs must understand the
intended action, contraindications, side effects and potential adverse effect of any drugs
they administer. The radiographer must adhere to the 6 rights of drug safety:
1. The right patient – Ask the name of the patient and check his or her ID band
before giving any medication. Even if you know the patient’s name, make sure to verify
it carefully.
2. The right drug – Check and verify the medication. Beware of look-alike and sound-
alike medication names. Misreading medications’ name is a common mistake. These
look-alike medications may also sound-alike and can lead to errors associated with
verbal prescriptions.
3. The right amount of dose – Most of the time, this can be achieved just by double
checking the label to see what dose needs to be given. However, a liquid medication
can be a bit trickier because the person giving it must measure the dose. Measuring the
dose using an oral syringe and not a household teaspoon is recommended. If the
medication does not come with a dosing cup or a syringe, be sure to ask the pharmacist
for one.
4. The right route – While it may seem unimaginable, we are often called about
medications being administered via an unintended route. For example, eardrops
administered as eye drops, or swallowing medication intended to be used with an
inhaler. Be sure to double-check the label to ensure that the right medication is being
administered via the right route. While the labelling on drops can sometimes be
confusing, remember that “otic” refers to the ears while “ophthalmic” refers to the eyes.
5. The right time – With so many medications to keep track of, it can be difficult to
remember which medicine to give and when to give it. Here are some things to
remember:
· Be aware of dosing frequency – Although most medications are taken once a
day, some are prescribed to be taken two or three or even four times a day.
· Use a schedule or medication log – The more doses a drug requires throughout
the day, the more likely the person may forget to administer a dose. To avoid this from
happening, create a schedule as a visual and/or electronic reminder to administer the
next dose.
· Set an alarm – Set a cell phone alarm or other reminder to help you remember
when doses are due.
· Communicate clearly – Many dosing mistakes, especially double dosing,
happens from communication mishaps. Keep a physical schedule handy that both
guardians and other allied health care providers can access and be sure to check off
when a medication was administered.
6. The right Documentation – Ensure that you are properly documenting the
medication, including the time, dosage, and route so that you have proof of what you
gave to the patient in case there’s a bad reaction.
Other precautions that must be taken before administration of any drug are as follows:
1. Read all labels carefully before drawing up or pouring a drug. Check the name,
strength and dosage of the drug.
2. If a drug contains a sediment or appears to be cloudy, do not use until the
pharmacist approves the drug.
3. Check the expiration date of the drug on the label. If that date has passed, do not
use.
4. Do not use drugs from unmarked or poorly marked containers. Discard them.
5. Measure exact amounts of every drug used. If medication is left over, do not
replace it in the container; discard it according the institutional policy.
6. Drugs must be stored in accordance with the manufacturer’s specifications. No
drug should be stored in an area where temperature and humidity vary greatly
and or extreme. Low room temperature is advised.
7. If a medication is a liquid to be poured, pour away from the label.
8. Do not combine two drugs in a syringe without verifying their compatibility with
the pharmacist. If in doubt, do not combine.
9. Before selecting a medication, check the label of the container three times;
before taking it from storage, before pouring it or drawing it up and after it has
been prepared for administration.
10. When approaching a patient who is to receive a drug, ask the patient to state his
or her name. Do not accept the fact that a patient answers to what is thought to
be the correct name. An anxious patient may respond incorrectly. Read the name
label on the patient’s wrist.
11. After identifying the patient, explain to him or her about the drug and how it will
be given.
12. A drug history of allergies must be taken before any drug is administered.
13. The radiographer must not administer a drug that she or he has not prepared.
14. Report and document any drug that the patient refuses to take.
15. Document any drug administered immediately according to department
procedure.
16. Do not leave a patient unattended who may be having a drug reaction.
17. A patient who has received a sedative, hypotonic, antianxiety or narcotic
analgesic drug must not be allowed to drive himself or herself home.
18. A child who has received a medication and is sleeping may not leave the
department until fully awake.
19. Patients should be observed for 1 hour before leaving the department alone after
receiving any drug.
Chapter 4 Special Considerations in Drug Administration
Special Considerations When Administering Drugs
Age group Physiologic Changes Precautions
Pregnant Many drugs cross the placental barrier. Drugs during pregnancy must be avoided
women Drug effects depend on fetal age and can or administered only to women who
result in harm to the fetus. absolutely require treatment. If in doubt,
inform patient’s physician of possible
pregnancy before administering any drug.
Infants Lack well-developed muscle mass; lack Only persons educated in drug
the protective mechanisms of older administration to infants must administer
children and adults. Skin is thin and medications to them.
permeable; stomachs lacks mucous
barrier; temperature control is poor; they
become dehydrated easily and have
immature liver and kidneys that cannot
manage foreign chemicals.
Breastfeed May have all drugs in maternal Mothers who are breastfeeding may be
Infants circulation transferred to colostrum and advised by the physician to cease
breast milk. breastfeeding for a prescribed time if they
are to receive radioisotopes or radiation.
All other drug therapies must be evaluated
as they may harm the infants. A detailed
history must be taken and no drugs should
be administered without establishing that
they will not harm the infant.
Pediatric At 1 year of age, liver metabolizes more Children are not small adults. Physiologic
Patients rapidly than in adults, renal function may differences vary and olny those
be more rapid than adults. Standard experienced in medicating children must
dosage for children depends on child’s administer rugs to them. Topical drugs and
weight or body surface. Topical drugs are solutions, including antiseptics can cause
more easily absorbable through the skin. poisoning in children. Cleanse only with
soap and water.
Elderly Blood-brain barrier is more easily Drugs affecting the CNS and
Patients penetrated with increasing rate of cardiovascular system must be given with
dizziness and confusion. Reduced extreme caution. Patients must be
baroreceptor response increases monitored closely and assisted with
hypotensive effects of some drugs. Liver ambulation to prevent falls. Do not allow
size, blood flow and enzyme production elderly patients who have been given drugs
decrease, increasing the half-life of some to leave the area unattended.
drugs and leading to possible toxic
reactions. Increased adipose tissue in
abdominal area may lead to toxicity from
fat-soluble drugs. Decreased renal blood
flow and filtration decrease elimination of
drugs from the body. Slower gastric
emptying time and increase in pH of
gastric juices increase risk of gastric
irritation.
SYSTEMS OF DRUG MEASUREMENT
The metric system of measurement has been adopted in most countries of the
world as the official standard; however, its use is recommended but not required in the
United States.
It is used most medical settings in this country, but the apothecary system of
measurement are also used. This means that anyone who administers drugs must
understand and be able to use the two systems interchangeable. Household
measurements are not commonly used in medical facilities and only those most
commonly used will be mentioned. The radiographer who plans to administer drugs
must learn to convert from metric o apothecary measurement depending upon how the
physician’s order is written.
The metric unit of measure is the Liter (L), which contains 1,000 milliliters (mL) or
the approximate cubic metric equivalent of 1,000 cubic centimeters (cc). The unit of
weight is the gram (g). Kilograms (kg), milligrams (mg) and micrograms (ug) are used in
health care. The kilogram is 10,000 g or in nonmetric terms, 2.2 lb.
