Pharmacology is the science of how drugs act on biological systems and how the body

responds to the drug. The study of pharmacology encompasses the sources, chemical
properties, biological effects and therapeutic uses of drugs.

Pharmacology can be defined as the study of substances that interact with living systems
through
chemical processes, especially by binding to regulatory molecules and activating or inhibiting
normal body processes. These substances may be chemicals administered to achieve a
beneficial therapeutic effect on some process within the patient or for their toxic effects on
regulatory processes in parasites infecting the patient. Such deliberate therapeutic applications
may be considered the proper role of medical pharmacology, which is often defined as the
science of substances used to prevent, diagnose, and treat disease. Toxicology is the branch of
pharmacology that deals with the undesirable effects of chemicals on living systems, from
individual cells to humans to complex ecosystems

Pharmacokinetics - refers to what the body does to a drug.

(the absorption, distribution, metabolism, and excretion of a drug).

Pharmacodynamics - describes what the drug does to the

body. (the biochemical and physical effects Of drugs and the
mechanisms of drug actions)

Therapeutics are treatments used to alleviate or prevent a

particular disease.

Chemotherapy - is a cancer treatment where medicine is

used to kill cancer cells.
—the relation of the individual's

Pharmacogenomics the relation of individual’s genetic makeup to his or her response to

specific drugs

Pharmacy - the art, practice, or profession of preparing, preserving, compounding, and

dispensing medical drugs.

Pharmacognosy - the study of the physical, chemical, biochemical and biological properties of
drugs, drug substances, or potential drugs or drug substances of natural origin as well as the
search for new drugs from natural sources.

Drug nomenclature is the systematic naming of pharmaceutical drugs.

Drugs have 3 types of names:

Chemical names, the most important of which is the IUPAC (International Union of Pure and
Applied
name Chemistry); organic chemical compounds.

Trade names, which are brand or proprietary names is selected by the drug company selling
the product. Trade names are protected by copyright. The symbol @ after the trade name
indicates that the name is registered by and restricted to the drug manufacturer.
Generic or nonproprietary names, the most important of which are the International
Nonproprietary,' Names (INNS); Under the INN system, generic names for drugs are
constructed out of affixes and stems that classify the drugs into useful categories while keeping
related names distinguishable. A
marketed drug might also have a company code or compound code.

Generic names

Generic names are used to provide a clear and unique identifier for active chemical
substances, appearing on all drug labels, advertising, and other information about the

substance. Relatedly, they help maintain clear differentiation between proprietary and
nonproprietary
aspects of reality, which people trying to sell proprietary things have an incentive to obfuscate;
they help people compare apples to apples. They are used in scientific descriptions of the
chemical, in discussions of the chemical in the scientific literature and descriptions of clinical
trials Generic names usually indicate via their stems what drug class the drug belongs to. For
example, one can tell that aciclovir is an antiviral drug because its name ends in the -vir suffix.

Chemical names
The chemical names are the scientific names, based on the molecular structure of the drug.
There are various systems of chemical nomenclature and thus various chemical names for any
one substance. The most important is the IUPAC name. Chemical names are typically very long
and too complex to be commonly used in referring to a drug in speech or in prose documents.
For example, "1-(isopropyl amino)-3-(1-naphthyloxy) propan-2- ol" is a chemical name for
propranolol Sometimes, a
company that is developing a drug might give the drug a company code, which is used to
identify the drug while it is in development. For example, CDP870 was UCB's company code for
certolizumab pegol; UCB later chose "Cimzia" as its trade name. Many of these codes, although
not all, have prefixes that correspond to the company
name.

Chemical group
a set of medications and other compounds that have a similar chemical structures. A chemical
structure determination includes a chemist's specifying the molecular geometry and, when
feasible and necessary, the electronic structure of the target molecule or other solid. Molecular
geometry refers to the spatial arrangement of atoms in a molecule and the chemical bonds that
hold the atoms together, and can be represented structural formulae and by molecular using
models; complete electronic structure descriptions include specifying the occupation of a
molecule's molecular orbitals. Structure determination can be applied to a range of targets from
molecules very (e.g., diatomic oxygen or nitrogen), to very complex ones (e.g., such as protein
or DNA). From Wikipedia, the free encyclopedia

Mechanism of Action (MOA)

refers to the specific biochemical interaction through which a drug substance produces its
pharmacological effect. Referring to the way in which the drug interacts and produces a medical
effect. A mechanism of action usually includes mention of the specific molecular targets to
which the drug binds, such as an enzyme or receptor. Receptor sites have specific affinities ror
drugs based on the chemical structure Of the drug, as well as the specific action that occurs
there. Drugs that do not bind to receptors produce their corresponding therapeutic effect by
simply interacting with chemical Or physical properties in the body. Common examples Of drugs
that work this way are antacids and laxatives.
In contrast, a mode of action (MOA) describes functional Or anatomical changes, at the cellular
level, resulting from the exposure Of a living organism to a substance.

Beta blockers exert their pharmacological effect, decreased heart rate, by binding to and
competitively
antagonizing a type of receptor called beta adrenoceptors

Aspirin
The mechanism of action of aspirin involves irreversible inhibition of the enzyme
cyclooxygenase; therefore suppressing the production of prostaglandins and thromboxanes,
thus reducing pain and
inflammation. This mechanism of action is specific to aspirin and is not constant tor all
nonsteroidal anti-inflammatorv drugs (NSAlDs)_ Rather, aspirin is the only NSAID that
irreversibly inhibits COX-I

This type of categorization is from a pharmacological perspective and categorizes them by their
biological target. Drug classes that share a common molecular mechanism of action modulate
the activity of a specific biological target The definition of a mechanism of action also includes
the type of activity at that biological target. For receptors, these activities include agonist,
antagonist inverse agonist, or modulator. Enzyme target mechanisms include activator or
inhibitor. Ion channel modulators
include opener or blocker. The following are specific examples of drug classes whose definition
is based on a specific mechanism of action:
Mode of action
This type of categorization of drugs is from a biological perspective and categorizes them by the
anatomical or functional change they induce. Drug classes that are defined by common modes
of action (i.e., the functional or anatomical change they induce) include:

•Antifungals
•Antimicrobials
•Antithrombotic
•Bronchodilator
•Chronotrope (positive or negative)
•Decongestant
•Diuretic or Antidiuretic
(positive or negative)
•Inotrope

Primary effect
-effects of drugs that are predicted, intended, and desired. -includes: palliative, supportive,
substitutive,
chemotherapeutic, and restorative effects. One major problem of pharmacology is that no
drug produces a single effect. The primary effect is the desired therapeutic effect. Secondary
effects are all other effects beside the desired effect which may be either beneficial or
harmful. Drugs are chosen to exploit differences between normal metabolic processes and any
abnormalities which may be present. Since the differences may not be very great, drugs may be
nonspecific in action and alter normal functions as well as the undesirable ones. This leads to
undesirable side effects.
The Legal Prescription

THE RIGHT MEDICATION

1. When preparing or giving medicines, focus all your attention on the task, Do not
permit yourself to be distracted while working with medicines.

2. Make certain that you have a written order for every medication for which you assume
the responsibility of administration. (Verbal and Routes of Drug Administration
telephone orders should be written out and signed by the prescriber as soon as
possible. These orders should be used only in limited circumstances and not for the
convenience of the prescriber.)

3. Make a habit of reading the label of the medicine and comparing it to the requisition
carefully at least three times: first, when removing the drug from the supply drawer or
medication cart; second, when placing the medication in a cup or syringe; and third,
just before administering it to the patient, before the container is discarded.

4. Never give a medicine from an unlabeled container or from one on which the label is
not legible.

5. If you must calculate in some way the dosage for a client from the preparation on
hand and you are uncertain of your calculation, verify your work on paper by having
some other responsible person (instructor, lead technologist, pharmacist) check it. Whenever
the result of a calculation calls for more than two units of a drug to make a dose, double-check
the calculation. It is highly unusual for more than two units of a drug to be administered in a
single dose.

6 When measuring liquids, hold the container so that the line indicating the desired
quantity is on a level with the eye. The quantity is read when the lowest part of the
concave surface of the fluid (meniscus) is on this line.

7. Dosage forms such as tablets, capsules, and pills should be handled so that the
fingers do not come into contact with the medicine Use the cap of the container to
guide or lift the medicine into the medicine glass or container that you will be taking to
the patient.

8. Avoid wasting medicines. Medicines tend to be expensive; a single capsule may cost
the patient several pesoses.

9 When pouring liquid medicines, hold the bottle so that the liquid does not run over the
side and obscure the label Wipe the rim of the bottle with a Glean piece of tissue
before replacing the stopper or cover.

10. When preparing an injection, always label the syringe immediately. Keep the vial with
the syringe, and do not rely on memory to determine what solution is in which syringe.
11. Never administer medication prepared by another person. In doing so, you accept the
responsibility for accuracy, dose, correct medication, and so forth. If the person who
prepared the medication has made an error, you are accountable for any harm done
to the patient

12. If patient expresses doubt or concern about a medication or the dosage of a

medication, reassure the patient as well as yourself by rechecking to make certain
that there is no error, before the medication is administered. You may need to recheck
the order, the label on the medicine container, or the patient's chart The patient
should be able to talk about whatever feelings caused the doubt or concern, thus
providing the opportunity for the patient to exercise some control over the
environment

13. Assist weak or helpless patients to take their medications. Do so as patiently and
unhurriedly as possible.

14. Remain with the patient until the medicine has been taken. Most patients are very
cooperative about taking medicines immediately when the drugs are provi<ed
However, some are more ill than they appear and may forget, or may lose the ability,
to take the dose provided.

15. Stay with the patient receiving IV medication for a least 5 minutes, and monitor
closely for adverse effects. (In the case of contrast agents, remain with the patient for
a minimum of 60 minutes)

16. Do not leave a tray or cart of medicines unattended.

17. Never chart a medicine as having been given until it has been administered. The
name of the drug, the dosage, the time of administration, and the route of
administration should be noted on the medication record in the chart In the recording
of parenteral medications, the site of injection is always included. The patient's
response to the medication (adverse as well as intended) should be recorded in the
progress notes.

18_ Acquire full understanding of common abbreviations and symbols related to

medication administration.

THE RIGHT PATIENT

Always verify that you have the correct patient before giving them medication. Check the chart
but also look at their bracelet and ask them to identify themselves. Some hospitals will actually
make you scan
their bracelet first so the computer verifies their identity.

RIGHT DRIUG/MEDICATION
Make sure you are giving the correct drug thal is on their chart and prescription.

THE RIGHT DOSE

Double check the amount of the drug.
Is it the correct dosage for their age/size?
THE RIGIIT LOCATION/ROUTE
This refers to whether you are administering
it orally or intravenously. Don't rely on your
memory or guess, always check the chart.

THE RIGHT TIME

How long ago was the previous dosage? Try to stay
within 30 minutes of the scheduled dose if you can.

The Right Time

• The right time is the time at which the prescribed
dose should be administered
• Daily drug doses are given at specific times during
the day to keep plasma levels within desirable
concentrations.
• Do you know what SID, BID, TID, and QD mean?
• What about q24H, q12H, q8H, and q6H?
• PRN?

THE RIGHT DOCUMENTATION

Record everything.
Patient, amount of medication and any side effects.
Assess and evaluate the patient and make sure they are
responding correctly to the medication.
If not, record it in the paperwork.

6 Rights of Medication Administration

Georgetown's Department of Disability Services

released these 10 rights of medication:
Right Patient
Right Medication
Right Dose
Right Time
Right Route
Right Education
Right to Refuse
Right Assessment
Right Evaluation
Right Documentation
Antiplatelet
Aspirin, clopidogrel, and dipyridamole are some of the most common oral
medications for inhibiting platelet effects. Eptifibatide, abciximab, and
tirofiban are the most frequently used intravenous medications for inhibiting
platelet function.

Thrombolytic medication is used to actively break up a newly formed

clot such as found in patients with acute myocardial infarction, acute
stroke secondary to blood clot, or lower leg ischemia. Alteplase,
retaplase, streptokinase, Tenecteplase, and urokinase are the most
frequently used medications in this class. If a patient has recently been
given an agent in this class, the patient is at very high risk for bleeding
Internally and externally. Use caution with all intravenous (IV) sites. QC
not start an IV line in these patients without physician orders and close
supervision.

ENDOCRINE MEDICATIONS
Diabetes and hypothyroidism are two common endocrine problems for which patients frequently
receive drug treatment.

Antidiabetic medication is required for patients who have difficulty maintaining proper balance
between blood sugar and tissue sugar. Some patients are termed insulin dependent (diabetes
mellitus type 1) because they have little or no circulating endogenous insulin. Diabetic patients
who have sufficient circulating endogenous insulin but poor receptor sensitivity to the insulin are
termed non—insulin dependent (diabetes mellitus type 2). There are several types of insulin,
including ultrashort acting, short acting, intermediate acting, long acting, and ultralong acting.
Regardless of the type of insulin, the technologist should remember that patients taking insulin
may: require regular meals so that blood sugar does not drop to dangerously low values. which
can lead to seizure activity and a comatose state. The technologist should ensure that all
diabetic patients are aware Of the time constraints from sitting in the radiology suite when meals
are planned around the insulin given (even if the insulin was given hours earlier). Non—insulin-
dependent diabetic patients may require oral medications to assist the endogenous insulin to
function appropriately. Common drugs in this category include glimeprimide, glipizide, glyburide,
rosiglitazone, pioglitazone, nateglinide, and metformin. Technologists need to always be aware
Of patients receiving metformin because this drug should be held before and for at least 48
hours after receiving a radiopaque contrast agent. If metformin is not held, the patient is put at
increased risk for severe metabolic acidosis secondary to metformin metabolite
-accumulation, in the event renal dysfunction is caused by the radiopaque contrast agent.

Thyroid medication is used to treat hypothyroidism that is either primary

because of a lack of endogenous thyroid hormone production or
secondary to removal or obliteration of the thyroid gland. Thyroid
hormone is a basic regulator of many metabolic processes in the body;
either a lack or and an excess of this hormone can present as many
different types of pathology. Common hormone preparations designed to
enhance thyroid function include levothyroxine, thyroxine, liothyronine,
and desiccated thyroid. Common preparations designed to block or inhibit
thyroid function include methimazole and propylthiouracil.

CENTRAL NERVOUS SYSTEM MEDICATIONS

Many drugs have direct effects on the central nervous system (CNS). We believe the
CNS medications described and listed here are most important to understand from
the perspective of the imaging technologist.

Antiseizure (anticonvulsant) medications are used to prevent and to treat seizure

disorders. Some patients require multiple antiseizure medications to prevent
frequent attacks, which can become fatal if the patient loses the ability to oxygenate
for long periods. Goals of treatment for these medications are to stop the seizure
activity and to prolong the interval between each seizure event. Examples include
phenytoin, fosphenytoin, ethotoin, metphenytoin, diazepam, clonazepam,
lorazepam, valproic acid, divalproex, topiramate, carbamazepine, oxcarbazine,
phenobarbital, amobarbital, pentobarbital, secobarbital, ethosuximide,
methsuximide, felbamate, gabapentin, lamotrigine, tiagabine, zonisamide,
and levetiracetam.

CENTRAL NERVOUS SYSTEM MEDICATIONS

Antipsychotic medications are used to treat psvchotic episodes and disorders
such as schizophenia. paranoid behaviors. hallucinations. delusions. bipolar
affective disorder. acute agitation. antisocial behaviors, and mania. These
medications generally take weeks to months to reach their full effects, so you
may have patients with some paranoid delusions while presenting to your
radiology department.

Keep in mind that this may be part of their normal behavior as well as new-onset
CNS pathology. Some common antipsychotic medications include haloperidol,
valproic acid, divalproex, olanzapine, clozapine, quetiapine, aripiprazole,
chlorpromazine, fluphenazine, triflupromazine, loxapine, mesoridazine,
thioridazine, amoxepine, perphenazine,risperidone, ziprasidone,
thiothixine, and pimozide.

Antianxiety medications are used for treatinq acute and chronic anxiety_ states. Radiologic
technologist frequently encounter this class because patients require sedatives to alleviate the
anxiety secondary to claustrophobia when undergoing computed tomography (CT) and
magnetic resonance imaging (MRI) scans. These medications generally act on the limbic
system in the brain by enhancing the effect of the sedative neurotransmitter gamma-
aminobutyric acid and in some cases, serotonin. Drugs in this class include diazepam,
lorazepam, midazolam, alprazolam, chlordiazepoxide, clonazepam, and buspirone.

ANTIINFECTIVE AGENTS
Antibiotics are therapeutic agents used to kill or suppress pathologic
microorganisms responsible for causing infectious diseases. Antifungals are agents
used to kill mycotic (fungal) organisms, and antivirals are used to suppress and limit the
spread or shedding of viruses that invade the human body. Generally, these three
medication subclasses act at the cellular level to destroy inhibit, or suppress the cell wall,
enzymatic activity, or ribosomal or deoxyribonucleic acid (DNA) function of an invading
microorganism.

Antibiotics include the penicillins (oxacillin, cloxacillin, nafcillin, ampicillin, ticarcillin,

piperacillin), cephalosporins (cefazolin, Gefuroxime, ceftriaxone, cefpodoxime, cefotetan,
cefamandole, cefaclor, cefalexin, cefadroxil, ceftazidime, cefipime), carbapenams
(meropenam, imipenam, ertapenam), tetracyclines (tetracycline, minocycline, doxycycline),
macrolides (erythromycin, clarithromycjn, azithromycin), lincosamides (clindamycin), and
nitroimidazoles (metronidazole).

Antifunqals include amphotericin B, fluconazole, voriconazole, caspofungin,

clotrimazole, flucytosine, itraconazole, miconazole, ketoconazole, nystatin, and
terbinazine.

Antiviral agents include acyclovir, famciclovir, ganciclovir, ribavirin, valacyclovir,

valganciclovir, rimantidine, foscarnet, and interferon.

CHEMOTHERAPY AGENTS
Chemotherapy drugs are extremel toxic com ounds desi ned to kill off ra idl
qrowinq (e.q., cancerous) cells of the human bodv bv alterinq or destrovinq the
various stages in cellular division. These agents are toxic to all cells that are in a
growth stage, not only cancerous cells. Special precautions should be taken with all
chemotherapy patients so that no medication touches the unexposed skin of a
health care worker.

Coming into physical contact with these medications can put the health care worker
at risk of serious side effects, including the stimulation of a cancerous condition.
Even coming into contact with bodily fluids into which the chemotherapy is secreted,
such as urine, can pose a potential threat to the clinician. Universal precautions and
special gloves and gowns should be worn when dealing with chemotherapy.
include Examples adriamycin, etoposide, vincristine, VP-16, cyclophosphamide, bleomycin,
flurouracil, doxirubucin, paclitaxel, docetaxel, methotrexate, and nitrogen mustard.

HERBAL PRODUCTS
Self-treatment using herbal products has become relatively common in the current health
care market. From weight loss to depression, their scope can be somewhat broad, and
herbal self-treatment can be associated with dangers that the consumer frequently does
not understand.
Medical professionals should not overlook the possibility that their patients are using
these products. On taking accurate medication histories. practitioners should ask about at
least the following herbal products, since they have documented pharmacologic effects
associated with them:
Black cohosh, coenzyme QIO, danshen, dong quai, ephedra (Ma Huang), garlic, Ginkgo
biloba, ginseng, glucosamine, grapefruit juice extract, guarana, kava kava, St. John's
wort.
Various adverse effects as well as serious drug-drug interactions can affect the
cardiovascular, gastrointestinal, and central nervous systems when these herbal products
are taken in excess or when the product is not standardized with regard to content. For
example, many weight loss products historically contained Ma Huang (ephedra alkaloids),
which can lead to serious hypertension, cardiac dysrhythmias, and death (ephedra
alkaloid is very potent and can be similar to the amphetamine class of drugs).
CATHARTIC DRUGS
Cathartic is a substance that accelerates defecation. This is similar to a laxative, which
is a substance that eases defecation, usually by softening feces. It is possible for a
substance to be both a laxative and a cathartic. However, agents such as psyllium seed
husks increase the bulk of the feces.

Saline cathartics - Examples include magnesium citrate magnesium sulfate, sodium

sulfate, and magnesium hydroxide Phillips Milk of Magnesia@. Disaccharides - An
example is sorbitol which increases stoo bulk through fermentation in the bowel.

Castor Oil (3040 cc.)

Take medication by mouth on an empty stomach. It may take 6 to 12 hours before this
medication causes a bowel movement.

Side Effects
Stomach/abdominal pain or cramping, nausea diarrhea, or weakness may occur.
Precaution

Before using this medication, tell the doctor of your medical history, like allergy (rare)
especially of: appendicitis or symptoms of appendicitis (such as nausea/vomitinq, sudden or
unexplained stomach/abdominal pain), a sudden change in bowel habits that lasts for longer
than 2 weeks, bleeding from the rectum, intestinal blockage.

Dulcolax (bisacodyl) is a laxative that stimulates bowel movements.

Used to treat constipation or to empty the bowels before
surgery, x-rays, or other intestinal medical procedure.

Dulcolax tablets is taken by mouth and generally produce a bowel movement in 6

to 12 hours. Do not crush, chew, or break a Dulcolax tablet. Swallow the tablet
whole with a full glass of water.

Dulcolax suppositories is for use in the rectum and generally produces bowel
movements in 15 minutes to I hour. Overuse of laxatives can cause your bowels to
function improperly, or can make you dependent on laxative use.
Try to empty the bladder just before using Dulcolax in the rectum.
Wash your hands before and after using rectal Dulcolax.

To use the rectal suppository:

• Remove the wrapper from the suppository. Avoid handling the suppository
too long or it will melt in your hands. If the suppository is soft, you may hold
it under cool running water or refrigerate it for a few minutes.
• Lie on your left side with your right knee up toward your chest. Gently
insert the suppository into your rectum about 1 inch, pointed tip first.
• Stay lying down for a few minutes. The suppository will melt quickly and
you should feel little or no dis
holding it in.

Do not use more than one rectal suppository per day.

Usual Adult Dose for Bowel Preparation:

5 to 15 mg (1 to 3 tablets) orally once a day as needed or
10 mg (I suppository) rectally once a day as needed or
10 mg rectal liquid once a day as needed.

ANTIDIARRHEAL DRUGS
is any medication which provides symptomatic relief for diarrhea - the condition
of having at least three loose, liquid, or watery bowel movements each day.

Antidiarrheal drugs
Loperamide (1 brand name: Imodium).
Bismuth subsalicylate (2 brand names: Kaopectate, Pepto-Bismol). slows the
movement of food through the intestines, which lets the body absorb more liquid.

Diatabs is used for the control of acute nonspecific diarrhea and/or chronic
diarrhea associated with inflammatory bowel disease.
UNILAB, Inc. Loperamide hydrochloride. Each capsule contains: Loperamide
Hydrochloride 2 mg. This medicine contains loperamide, an antidiarrheal agent
which slows intestinal movement and reduced fluid and salt loss in the intestines,
resulting in improved stool consistency.

• Electrolyte solutions, while not true antidiarrheals, are used to replace lost fluids
and salts in acute cases.

• Bulkinq aqents like methylcellulose, quar qum or plant fibre (bran, sterculia, isabqol, etc.)
are used for diarrhea in functional bowel disease and to control ileostomy output

• Absorbents absorb toxic substances that cause infective diarrhea, methylcellulose is an

absorbent.

• Anti-inflammatory compounds such as bismuth subsalicylate.

• Anticholinergics reduce intestinal movement and are effective against both diarrhea and
accompanying cramping.

• Opioids' classical use besides pain relief is as an anti-diarrhoeal drug. Opioids

have aqonist actions on the intestinal opioid receptors, which when activated
cause constipation.

• Drugs such as morphine or codeine can be used to relieve diarrhea this way. A notable
opioid for the purpose Of relief Of diarrhea is loperamide which is only an agonist Of the u
opioid receptors in the large intestine and does not have opioid affects in the
nervous svstem

• Octreotide (somatostatin analogue) may be used in hospitalized patients to treat secretory

diarrhea.

DIURETICS
Diuretics, sometimes called water pills, help rid the body of salt (sodium) and
water. Most of these medicines help the kidneys release more sodium into the
urine. The sodium helps remove water from the blood, decreasing the amount
of fluid flowing through the veins and arteries.

Aldactone (spironolactone)
Bumex (bumetanide)
Demadex (torsemide)
Esidrix (hydrochlorothiazide)
Lasix (furosemide)
Zaroxolyn (metolazone)
the herbs hawthom,
corn silk, and Parsley

Side effects
Dizziness.
Headaches.
Dehydration.
parsley
Muscle cramps.
Joint disorders (gout)
Impotence.

SEDATIVE DRUGS
Sedatives or tranquilizers can be used to produce an overly-calming effect
(alcohol being the most common sedating drug). The term sedative describes drugs
that serve to calm or whereas the term hypnotic describes
whose main purpose is to initiate, sustain, or lengthen sleep. Because these two
functions frequently overlap, and because drugs in this class generally produce
dose-dependent effects (ranging from anxiolysis to loss of consciousness) they are
often referred to collectively as sedative-hypnotic drugs.

barbiturates,
benzodiazepines,
gamma-hydroxybutyrate (GHB),
opioids and
sleep inducing drugs such as zolpidem
(Ambien) and eszopiclone (Lunesta).
Ativan (lorazepam),
Valium (diazepam),
Klonopin (clonazepam), and
Xanax (alprazolam).

HYPNOTIC DRUGS
Hypnotics are medications used to induce, extend, or improve the
quality of sleep, and to reduce wakefulness during sleep.

Prescription Insomnia Drugs (UPDATED)

Ambien (zolpidem)
Belsomra (svvoreyent)
Z Butisol (but*arbitalj)
Doral (quazepam)
Edluar (zolpidem)
Estazolam.
Flurazepam.
Halcion (triazolam)

Side Effects of Sedatives

The effects of using sedatives can resemble those of alcohol. In addition
to their desired calming effects, sedative use can cause:

Drowsiness, dizziness, and confusion

Problems with movement and memory
Slowed heart rate and breathing, which may be worsened if
combined with alcohol
Increased risk of falls and injury
Worsening of depression and anxiety symptoms
Impaired attention and judgment
Mood swings and inappropriate behavior
Risk of dependence and addiction
Risk of death from overdose, either intentional or unintentional
VASODILATORS AND VASOCONSTRICTORS

Vasodilators are medications that open (dilate) blood vessels. They affect the muscles in
the walls of the arteries and veins, preventing the muscles from tightening and the walls
from narrowing. As a result, blood flows more easily through the vessels.

Vasodilators are medicines that dilate (widen) blood vessels, allowing blood to flow more easily
through.
ACE inhibitors
Minoxidil
benazepril (Lotensin)
Alprostadil IV
captopril (Capoten)
Corlopam
enalapril (Vasotec, Epaned)
Deponit
Fenoldopam
fosinopril (Monopril)
lisinopril (Prinivil, Zestril)
Glyceryl tri nitrate transdermal
moexipril (Univasc)
Hydralazine
perindopril (Aceon)
Loniten
quinapril (Accupril)
Minitran

Side effects include:

Rapid heartbeat (tachycardia)
Heart palpitations.
Fluid retention (edema)
Nausea.
Vomiting.
Headache.
Excessive hair
growth.
Joint pain.

Prescribe vasodilators to prevent, treat or improve symptoms in a

variety of conditions, such as:
High blood pressure.
High blood pressure during pregnancy or childbirth (preeclampsia or eclampsia)
Heart failure.
High blood pressure that affects the arteries in the lungs (pulmonary hypertension)

Contraindications
Intolerance to nitrates (e.g., severe headache) may limit use.
Hypotension may occur if administered to patients with an inadequately low
ventricular filling pressure. A rare patient may experience sinus bradycardia and sinus arrest.
Diabetes or kidney problems.
If one have taken a drug that has sacubitril in it in the last 36 hours.
breastfeeding.

VASOCONSTRICTORS
Vasoconstrictors are useful additives to local anesthetic solutions. They can
enhance the duration and quality of the anesthetic block while also decreasing
surgical blood loss. Precautions must be taken, however, when using
vasoconstrictors with certain patients, especially those with cardiovascular disease.

• alpha-adrenoceptor agonists.
• vasopressin analogs.
• epinephrine.
• norepinephrine.
• phenylephrine (Sudafed PE)
• dopamine.
• dobutamine.
• migraine and headache medications (serotonin 5-hydroxytryptamine agonists or triptans)

Side Effects of vasodilators may include:

•Chest pain.
•Heart palpitations (fluttering or pounding heartbeat)
•Rapid heartbeat.
•Fluid retention.
•Nausea or vomiting.
•Dizziness.
•Headache.
•Flushing.

Legal Aspects Of IV Contrast Media and Medication Administration

(As Radiologic Technologist)

1. Laws and regulations

Although by virtue of R.A. 7431 have a required certificate or licensure law, the majority of these
laws do not specifically address venipuncture or drug administration by radiologic technologists.

Is the "scope of practice" as defined includes venipuncture or drug administration by

radiologic technologists?

The number of technologists performing venipuncture and subsequent pharmaceutical

administration is increasing, which also increases the possibility of litigation against
technologists. It is incumbent on the medical imaging community to address these issues
productively through increased levels of education and documented clinical competence.

STANDARD OF CARE
Medical negligence is the failure to do something that a reasonable person Of ordinary
prudence would do in a certain situation, and medical 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.
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.

Professional Standard
The standard established to determine the appropriate professional practice is generally the
standard recognized by the discipline's national professional organization. Individuals practicing
in these fields should be familiar with these professional requirements and should upgrade their
knowledge of professional practice as the standards change and develop.
Professionals who become stagnant or refuse to change the way they practice may be
personally liable if they fail to meet the recommended standards of the profession. Many believe
that if they learned a procedure in school, it is the right thing to do. Reminder: just because
something was learned in school does not mean it is still appropriate practice 10 or 20 years
later. People expect their physicians to be current in their practice, and the same is expected of
medical imaging specialists.

The imaging sciences are changing rapidly and dramatically. It is incumbent on

those who practice in these specialized fields to remain current. The courts
generally do not consider inadequate time and money as good reasons for being
unprepared for changes in a field.

The standard of care recognized by the law should be the level of care that a patient
can expect and receive when entering a health care facility for professional service.
When the technologist is expected to perform procedures not found in the
professional scope of practice, the technologist is ethically responsible to refuse to
perform the procedures and lobby the employer for training in these procedures.
The facility should then provide documentation that the employees providing these
services have met minimum qualifications needed to perform them.
 Civil Liability
When health care providers are alleged to have failed to observe the legal
principles and standards concerning the care of patients, civil litigation may
result. The most common and potent basis of civil liability for medical
malpractice cases is negligence. Claims must prove four things in
court: duty, breach, causation, and damages/harm. Generally speaking,
When someone acts in a careless way and causes an injury to another
person, under the legal principle of "negligence" the careless person Will be
legally liable for any resulting harm.

Tort or "malpractice."- Medical torts are triggered when a healthcare

professional or organization causes patient injury. The aggrieved party files a
suit and asks for compensation due to the damage. There are variety of
specific torts including assault. battery. trespassing. neqliqence. product
liability: and intentional infliction of emotional distress. In the healthcare
setting, "wrongful death" is the name of the tort where the loss of life is due to
medical negligence.
HOSPITAL SITUATION

The injection went smoothly, and the ER physician returned to her exceptionally busy night
of accident victims and coughing infants. Following the initial film, the young female patient
and the radiologic technologist (RT) were talking about the previous night's award show on
television. Then the grand mal hit. Its intensity peaked so rapidly that the RT had to grab the
girl to keep her from vibrating off the table. The reaction tray was nearby, but the telephone
was 10 feet away. "The emergency room is just down the hall," thought the technologist.
"And
the ordering ER physician knows where we are." The patient's strength was immense. Her
gurgled sounds were worse in the technologist's ears. The RT's calls for help were
smothered by the enclosed room. "The 'crash cart' is just outside the door," she mumbled.
"So what! I wouldn't know what to give her anyway." Then the tremors ceased as quickly as
they had begun, being replaced by stillness and quiet. The RT raced to the telephone, calling
the code.

INTRODUCTION

The preceding recreation of an actual event creates extreme discomfort for most imaging
professionals. What would you do in this case? In the Philippines, medications must be
prescribed by physicians or dentists.

A technologist, however, may administer various drugs for diagnostic

procedures once they are prescribed. These include medications for
sedation and pain management, contrast media, and emergency drugs
for reactions to contrast. Too often, the technologist (diagnostic,
nuclear medicine, angiography, computed tomography, ultrasound,
radiation therapy, or magnetic resonance imaging) is asked to
administer these dangerous, often life-threatening drugs with little or no
training in drug actions. dose calculation. methods Of administration. or
emergency drug therapy techniques.

Civil Liability
When health care providers are alleged to have failed to observe the legal
principles and standards concerning the care of patients, civil litigation may
result. The most common and potent basis of civil liability for medical
malpractice cases is negligence. Claims must prove four things in
court; duty, breach, causation, and damages/harm. Generally speaking,
when someone acts in a careless way and causes an injury to another
person, under the legal principle the careless person will be
legally liable for any resulting harm

Tort or "malpractice. Medical torts are triggered when a healthcare

professional or organization") causes Patient injury. The aggrieved party files a
suit and asks for compensation due to the damage. There are variety of
specific torts including assault. battery. trespassing. negligence. product
liability, and intentional infliction of emotional distress. In the healthcare
setting, "wrongful death" is the name of the tort where the loss of life is due to
medical negligence.
Can hospitals be held liable?
The liability of a hospital to a patient is most often determined Within the framework of the
negligence action. As is the case with any person or institution, a hospital maybe liable
because it has been sub-standard in carrying out a duty it owes to a patient, or it maybe
liable for the negligence of another on the basis of vicarious liability.

What is Vicarious liability of hospital in medical negligence?

Vicari6us liability means the liability oran employer for the negligent act of its
employees. An employer is responsible not only for his own acts Of commission and
omission but also for the negligence of its employees, so long as the act occurs within the
course and scope of their employment.

The Most Common Medical Errors

1.Misdiagnosis. Error in diagnosis is a common medical error.
2. Delayed Diagnosis. A delayed diagnosis can be as detrimental as a misdiagnosis.
3.Medication Error. One Of the most common mistakes that occurs in the course Of medical
treatment is an error in medication.
4.Infection
5.Bad medical devices.

There are four pillars of medical ethics which are defined as

follows:
1. Autonomy — respect for the patient's right to self- determination.

2. Beneficence — the duty to 'do good'

3. non-Maleficence — the duty to 'not do bad'

The principle of nonmaleficence holds that there is an obligation not to inflict harm on others.
Itis closely
associated with the maxim primum non nocere (first do no harm).

4. Justice — to treat all people equally and equitably.

BENEFICENCE
• The ethical principle that means the duty to promote good and
to prevent harm.
• Doing good, kindness and charity
• There are two elements of beneficence
1. Providing benefit
2. balancing benefits and harm
Liability — is an obligation one has incurred or might incur
through any act or failure to act.

Malpractice — refers to the behavior of a professional person's wrongful conduct, improper

discharge of
professional duties, or failure to meet the standards of acceptable care, which in harm to
another person,
Negligence (breach of duty) is a failure of an individual to provide care that a reasonable
person would
ordinarily use in similar circumstance.

NEGLIGENCE CASES ARE SOMETIMES CLASSIFIED AS:

• Malfeasance - Unlawful act or misconduct
• Misfeasance - lawful act that is done incorrectly
• Nonfeasance - Failure to perform an act that is one's required duty or required by the law.
• GROSS NEGLIGENCE - Acts that demonstrate reckless disregard of life.
• CONTRIBUTORY NEGLIGENCE - Instance in which the injured person is a contributing
part to the injury.

-in other words, action that contrary to the conduct of a

reasonable person and results in harm is considered to be
negligent behavior.

Proof of liability depends on four element

1. Duty — is an obligation created either by law or contract or by any voluntary action. It is

the element that must be proved for malpractice

2. Breach of Duty — occurs when radtech or nurse fails to act in accord with the standard of
care. An act of commission or omission of the radtech or nurse may constitute a breach of
the standard of care

3. Injury must be demonstrated by the person making the claim to prove negligence.
Damages is the money or other compensation awarded by the court to the plaintiff

4. Causation is the breach of duty that must be proved to have legally caused the injury. A
cause and effect relationship must be clearly established
 PREVENTION OF LIABILITIES AND AVOIDING MEDICATION ERRORS

As in all medications, this potential for error in I.V. administration is serious because of
rapid drug absorption. To minimize the risks of errors follow the (10 ) Rules of Medication
Administration. In addition
observe the following precautions:

1. Stick to accepted standards arid documents. Before administering drugs, check on past
allergies of patient.
2. Review medication orders.
3. Administer medications on scheduled time; follow up after on intended effect.
4. Medical Orders should not ambiguous and must be complete. Order less than one (1)
should be preceded by zero (0). Ex. 0.5gm. To avoid mistakes.
5. Listen to patients who question or object to the drug. If patient had an allergenic
reaction in the past, be cautious, especially when starting a new
drug.

CAUSES OF LIABILITY• Failure to act in these or in similar situations such as :

• Failure to assess, to oserve patient closely and take appropriate action.
• Failure to document ertinent information and communicate this to the doctor.
• Failure to report knwn or suspect deviation from standards or accepted practice.
• Failure to ensure rmoval of all foreign objects left in patient's body like tip of cannula.
FAILURE TO ACT IS AS RISKY AS ACTING INCORRECTLY

MEDICO-LEGAL LIABILITY:

Ignorance is not an Excuse!

We are liable, if we do not know what we must know!

Informed Consent - law regarding inform consent protect the clients right to self-
determination,
- a client is able to make an nformed decision about
consenting to or refusing å'åreatment regimen only if
adequate information has been presented.

Consent — a voluntary act by which a person agrees to allow

someone else to do something.

Informed Consent means that the client understands the

reason for the proposed intervention, and its benefits and
risk and agrees to the treatment by signing a consent.

Order by priority when consenting to medical

1. Any competent adult, age 18 or older, for himself
2. Any parent, whether an adult or minor, for his minor child.
3. Any married person, whether adult or minor, for his/her spouse if spouse is unable to
consent.
4. Any person temporarily standing in place of a parent.

LEGAL ASPECT AND THE RADIOLOGIC TECHNOLOGIST

DOCTRINE OF FORCE MAJEURE

• Act of God
• An irresistible force, one that is unforeseen or inevitable
• Under Civil Code Of the Philippines, no person shall be responsible for those events which
could not be foreseen or for which, though foreseen, were inevitable, except in cases
expressly
specific by la
• Examples: flood, earthquake, fire & accident
DOCTRINE OF RESPONDENT SUPERIOR
• Let the master answer
• Master-servant rule
• Let the master answer for the acts of the subordinate
• The liability is expanded to include the liability from the employee to the master
• In many circumstances all employer is responsible for the actions of employees performed
within the course of their employment

B. INTENTIONAL MISCONDUCT
Assault — patient is apprehensive about being injured.
- imprudent conduct of radiographer that causes fear in patient is
grounds for an allegation of civil assault

Battery - unlawful touching or touching without consent.

- harm resulting from physical contact with radiographer.
- may also include radiographing the wrong patients, the
wrong body part, or performing radiography against a patient
will.
• False imprisonment—unjustified restraint of a person.
- care must be taken when using restraint straps or having
other individuals assist with holding a patient still.
• Invasion of privacy — violation of confidentiality of
information.
• unnecessarily or improperly touching a patient body.

- photographing patients without their permission.

THE LEGAL Radiologic Request

A valid request or order for a radiologic examination must have the following components:
1. Patient name, room number or address, and identification numbers
2. Desired anatomical area
3. Projection/s (view/s)
4. Reason
5. Patient history
6. Date order is written
7. Requesting physician's signature

An order for radiologic examination/procedure is a legal document

admissible in a court of law. An important note for consideration is that
a verbal order does not necessarily constitute a valid request.