DRUG

INTERACTIONS
◦ While the radiographer May 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 equals 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.
◦ 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 REACTION
◦ When a drug produces an effect that is more severe or life-threatening.
◦ 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.
◦ 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 toxic reaction does not include an allergic reaction or anaphylactic shock, which is classified as an adverse
reaction.
◦ 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.
DRUG IDIOSYNCRASY
◦ An unexpected or exacerbated effect from a drug
◦ 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.
SIX 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
◦ 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.
PRECAUTIONS IN
DRUG
ADMINISTRAION
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.
 SPECIAL
CONSIDERATIONS
IN DRUG
ADMINISTRAION
 Age group Physiologic Changes Precautions

Pregnant women Many drugs cross the placental barrier. Drug Drugs during pregnancy must be avoided or
effects depend on fetal age and can result in administered only to women who absolutely require
harm to the fetus. treatment. If in doubt, inform patient’s physician of
possible pregnancy before administering any drug.

Infants Lack well-developed muscle mass; lack the Only persons educated in drug administration to
protective mechanisms of older children and infants must administer medications to them.
adults. Skin is thin and 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 Infants May have all drugs in maternal circulation Mothers who are breastfeeding may be advised by the
transferred to colostrum and breast milk. physician to cease 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 Patients At 1 year of age, liver metabolizes Children are not small adults. Physiologic
more rapidly than in adults, renal differences vary and olny those experienced
function may be more rapid than in medicating children must administer rugs
adults. Standard dosage for children to them. Topical drugs and solutions,
depends on child’s weight or body including antiseptics can cause poisoning in
surface. Topical drugs are more easily children. Cleanse only with soap and water.
absorbable through the skin.
Elderly Patients Blood-brain barrier is more easily penetrated Drugs affecting the CNS and cardiovascular
with increasing rate of dizziness and confusion. system must be given with extreme caution.
Reduced baroreceptor response increases Patients must be monitored closely and assisted
hypotensive effects of some drugs. Liver size,
with ambulation to prevent falls. Do not allow
blood flow and enzyme production decrease,
elderly patients who have been given drugs to
increasing the half-life of some drugs and
leading to possible toxic reactions. Increased leave the area unattended.
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 1,000 g or in
nonmetric terms, 2.2 lb.