Deck 7: Pharmacodynamics of Radiopaque Contrast Media

Question 1

Adverse effects elicited by ROCM can depend on their:

A) blood/tissue iodine concentration.
B) osmolality.
C) calcium-chelating ability.
D) anticoagulation ability.
E) immune system-stimulating ability.

Answer 1

immune system-stimulating ability.

Question 2

For a normal radiograph to reflect the vascular lumen, blood iodine concentration must be within the range of ____ mg/mL.

A) 2 to 8
B) 25 to 180
C) 280 to 370
D) 375 to 520
E) 520 to 780

Answer 2

280 to 370

Question 3

To achieve a high iodine concentration, ROCM must:

A) be injected intravascularly at a rate equal to blood flow.
B) be injected intravascularly at a rate greater than blood flow.
C) be injected slowly to limit early dilutional effects of the cardiovascular system.
D) a and b.
E) b and c.

Answer 3

a and b.

Question 4

The following questions create the case of Mr. Lewis, a patient receiving intravascular ROCM.

-Mr. Lewis receives an intravascular administration of ROCM. A response one might expect to see is:

A) a transient rise in intravascular osmotic pressure.
B) fluid from surrounding tissues drawn into the vascular lumen to dilute osmotically active particles.
C) equalization of pressure between intravascular and extravascular spaces, causing fluid extraction from RBCs and extravascular space.
D) a and b.
E) all of the above.

Question 5

The following questions create the case of Mr. Lewis, a patient receiving intravascular ROCM.

-Mr. Lewis receives intravascular administration of ROCM. After a while, you notice that he is experiencing flushing. This is most likely caused by:

A) a short-term increase in extravascular fluid.
B) the presence of less fluid outside the vessels and more fluid inside the vessels.
C) rapid endothelial swelling.
D) a and c.
E) b and c.

Question 6

The following questions create the case of Mr. Lewis, a patient receiving intravascular ROCM.

-After ROCM administration, Mr. Lewis demonstrates dehydration. This is most likely a result of:

A) cardiovascular dilution of hypoosmolar ROCM, producing an intravascular hyperosmolar state.
B) the inability of extravascular-intravascular spaces to undergo osmolar shifts.
C) osmotic diuresis due to excretion of ROCM into the urine.
D) a and b.
E) b and c.

Question 7

The following questions create the case of Mr. Lewis, a patient receiving intravascular ROCM.

-Finally, Mr. Lewis demonstrates heart failure. If this is a result of intravascular ROCM, it is most therapeutic to administer:

A) furosemide.
B) dobutamine.
C) albuterol.
D) a and b.
E) none of the above.

Question 8

Mast cells are located:

A) in skin, synovium, and mesentery.
B) in bone tissue.
C) in the submucosal layers of the rectum and genitourinary tissues.
D) a and c.
E) all of the above.

Question 9

Anaphylaxis:

A) requires formation of an antigen-antibody complex during a first-time exposure to an antigen.
B) is a type I hypersensitivity reaction.
C) usually occurs when IgE is disabled during sensitization of mast cells during a first exposure.
D) a and b.
E) all of the above.

Question 10

Anaphylactoid reactions:

A) are the same thing as anaphylaxis, except that they occur in response to mast cell sensitization after a first exposure to an intravascular ROCM.
B) mimic anaphylactic reactions but require no prior exposure to ROCM to sensitize the mast cell.
C) are just as lethal as anaphylaxis.
D) a and c.
E) b and c.

Question 11

Patients at risk for acute renal failure (ARF) following IV ROCM include all of the following except those with:

A) preexisting renal compromise.
B) diabetes with concomitant renal dysfunction.
C) dehydration before ROCM.
D) a and b.
E) b and c.

Question 12

In patients with decompensated thyrotoxicosis:

A) thyroid storm may occur after administration of iodine-rich ROCM.
B) the serum thyroid hormone levels are in excess of normal values.
C) the iodine from the ROCM can cause the thyroid to produce amounts of thyroid hormone that exceed tolerant levels.
D) a and c.
E) all of the above.

Question 13

Mrs. Brown has pheochromocytoma. What adverse reaction is she particularly at risk of experiencing?

A) ARF
B) Hypertensive crisis
C) Intractable seizure
D) Anaphylaxis
E) Thyroid storm

Question 14

ROCM that are particularly inclined to form precipitates with other intravenous drugs include:

A) diatrizoate meglumine.
B) ioxaglate.
C) iohexol.
D) a and b.
E) all of the above.

Question 15

Aspiration of barium sulfate can lead to:

A) barium fecaliths.
B) chemically induced appendicitis.
C) nodular granulomas of the lymph node.
D) a and b.
E) all of the above.