Pharma Project - Antiperistaltic.docx

Antiperistaltic Questions to be answered: Why is this category of pharmaceutical administered/prescribed to patients? What are the generic and common drug names for the agents used/relevant in MRI? What are the potential adverse side effects? What are the common and alternative routes for administra...

Antiperistaltic Questions to be answered: Why is this category of pharmaceutical administered/prescribed to patients? What are the generic and common drug names for the agents used/relevant in MRI? What are the potential adverse side effects? What are the common and alternative routes for administration of the medication? Why is this drug category relevant to MRI technologists and how will they interact with it in the MRI department? Interesting facts. Why is it prescribed to patients? chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://mriquestions.com/uploads/3/4/5/7/34572113/state_of_the_art_mr_enterography_technique.pdf Antiperistaltics are prescribed to decrease motion artifact from the bowels in abdominal imaging. https://www.nhs.uk/medicines/buscopan-hyoscine-butylbromide/ It may also be prescribed to relieve stomach cramps resulting from IBS Also soothes bladder and uterine cramps Generic and common drug names for agents used in MRI chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://mriquestions.com/uploads/3/4/5/7/34572113/state_of_the_art_mr_enterography_technique.pdf Glucagon, hyoscine butylbromide (buscopan) Adverse side effects chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://mriquestions.com/uploads/3/4/5/7/34572113/state_of_the_art_mr_enterography_technique.pdf Glucagon may cause nausea in 50% of patients- hours after administration, reduced with slower injection Hyoscine butylbromide may cause dry mouth, tachycardia, blurred vision. Contraindicated for unstable cardiac conditions. Also can be called Cardiac disease https://www.nhs.uk/medicines/buscopan-hyoscine-butylbromide/ Constipation Contraindicated for acute angle closure glaucoma, enlarged bowel, myasthenia gravis, pregnant and breastfeeding patients Patients have an increased risk of side effects if they are taking certain medications at the same time: codeine, antihistamines, amitriptyline (antidepressent), clozapine, amantadine (Parkinson’s), quinidine and disopyramide (heart meds), inhaled asthma medicines. https://www.hey.nhs.uk/patient-leaflet/injection-of-buscopan-in-mri-scans/#:~:text=Buscopan%20is%20given%20as%20a,than%20your%20doctor%20would%20like. Patient concerns: under 18, heart problems/ angina (chest pain), blood pressure problems, thyroid problems, medicines (over the counter and herbal) Rare side effects: small blisters on hands and feet, inability to urinate, low blood pressure, flushing, dilated pupils, increased intraocular pressure, allergic reactions, high blood pressure Developing a painful red eye and loss of vision results from undiagnosed glaucoma Pharmaceutical Categories presentation: Dizziness Common and alternate administration routes. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://mriquestions.com/uploads/3/4/5/7/34572113/state_of_the_art_mr_enterography_technique.pdf IV and intramuscular for MRI Pharmaceutical Categories Presentation: 20mg/ml ampule- 1ml dose is standard for adults. Given slowly over 2 minutes to avoid heart palpitations. Fast Acting and eliminated quickly from the body. https://www.nhs.uk/medicines/buscopan-hyoscine-butylbromide/ May be taken orally through tablets by perscription https://www.medbroadcast.com/drug/getdrug/hyoscine-butylbromide-injection 10mg-20mg IM, IV, or subcutaneous, swallow tablets How does it relate to MRI? Pharmaceutical Categories Presentation Relaxes the muscles of the GI and biliary tracts. Interesting Facts Handbook of MRI Technique pg 230-231 A tech should carefully consider when to administer the antiperistaltic. Peristalsis is required for cine sequences which may be ordered. Also the drug is short acting, and it would be unfortunate if the drug wore off halfway through the scan. Some antispasmodic agents given via Intramuscular injection may cause nausea, but fruit juice given after the study may help alleviate these symptoms Image sources: https://m.media-amazon.com/images/M/MV5BMTQ5NTg3MDkzNl5BMl5BanBnXkFtZTgwMDIyODg1MDI@._V1_.jpg -Yo Gabba Gabba https://www.researchgate.net/publication/262847034/figure/fig14/AS:601598938062861@1520443772874/Motion-artifacts-caused-by-the-peristalsis-of-the-bowel-It-is-impossible-to.png -Peristalsis motion artifact https://k2.kaysmedical.com/assets/images/products/BUS23J.jpg -Buscopan ampule https://upload.wikimedia.org/wikipedia/commons/thumb/2/27/Needle-insertion-angles-1.png/220px-Needle-insertion-angles-1.png -insertion angles https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.superdrug.com%2Fhealth%2Fstomach-digestive-care%2Fibs-treatment%2Fbuscopan-ibs-relief-20-tablets%2Fp%2F141798&psig=AOvVaw2Q1YDIKLoC4ISF_RrQ-v-Y&ust=1711573885780000&source=images&cd=vfe&opi=89978449&ved=0CBIQjRxqFwoTCOC8jOHrkoUDFQAAAAAdAAAAABAT -Buscopan tablets https://media.springernature.com/lw685/springer-static/image/chp%3A10.1007%2F978-3-030-51313-9_14/MediaObjects/34948_5_En_14_Fig5_HTML.png -Biliary tract https://uthealtheasttexas.com/sites/default/files/styles/services_node_image/public/sub-service-images/bladderControl_subservice940x450.png?itok=DRZ2mzh8 -Bladder image https://my.clevelandclinic.org/-/scassets/images/org/health/articles/22467-uterus -Uterus image https://youtube.com/watch?v=6Os-CACRwM8 -Yo Gabba Gabba song https://static.wikia.nocookie.net/categories/images/9/92/Brobee_in_Party_in_My_Tummy.jpg/revision/latest?cb=20220915130358 -Yo Gabba Gabba Green guy Script Mila: Antiperistaltics In MRI. By Hoden and Mila What is Peristalsis? When I was a kid. This man told me that there was a party in my tummy. All that Kraft Mac and Cheese was dancing around, having a blast. But if I didn’t eat my vegetables the broccoli would be sad that they didn’t get to go to that party Now, this isn’t just a dinner party, this is a party where the music is so loud that it shakes the house. The muscles in our GI tract are constantly spasming, or “shaking” if you will, to get that food dancing, and out of the body at a reasonable time. This is called peristalsis. Unfortunately that constant movement is going to create motion artifacts in our MR images of the bowel, decreasing image quality. So we have to call the party police, and administer a type of drug called an antiperistaltic. These drugs relax the muscles of the GI tract for just enough time to acquire our images. The effect is quick and fades quickly. If the radiologist wants a cine image, it should be acquired before the patient is given an antiperstaltic, because we do not want bowel movement to restart halfway through our images, and a cine is interested in peristaltic motion. In Alberta’s hospitals they use hyoscine butylbromide, commonly known as buscopan. Glucagon is another antispasmodic drug sometimes used in enterographies. Historically administration has always been done by nurses. Now however, some technologists in Alberta are seeking training to administer buscopan themselves. The most common administration route is an IV. There are ampules which contain 20mg in 1ml which is given gradually over 2 minutes. If the dose is administered too fast, the patient may experience heart palpitations. Depending on the prescribing physician, antiperistaltics may also be administered intramuscularly and subcutaneously. For uses other than diagnostic imaging which we will touch on later, buscopan may also be taken orally. Hoden: Its important as an MRI technologist to be familiar with these medications and their interactions as it is quite commonly used in certain imaging protocols. These medications can be grouped into 3 different types, Antiperistaltic, antisposmadics and direct smooth muscle relaxants. Each type of medication is used for specific gastrointestinal conditions based on their mechanisms of action. Antiperistaltic medications are drugs that inhibit or slow down the wave-like contractions of the intestines, known as peristalsis, often used to reduce bowel motility. Most common types include: 1.Glucagon also known as the Brand Name: GlucaGen its commonly administered intravenously (IV) or Intramuscular (IM). it inhibits gastrointestinal motility, including peristalsis, which can help improve imaging quality by reducing motion artifacts. 2.Meperidine (MAPERADINE), Brand Name: Demerol, has antiperistaltic effects, slowing down intestinal motility, and is sometimes used to reduce bowel motion in imaging studies it can be administered Orally or Intravenous (IV) 3.Loperamide(loe-PER-a-mide), Brand Name: Imodium (emodium), is an antidiarrheal medication that reduces peristalsis in the intestines, helping to treat diarrhea. It is administered orally Antispasmodic medications are drugs that act on the smooth muscles of the gastrointestinal tract to reduce spasms, cramping, and pain. They work by blocking the action of acetylcholine, a neurotransmitter that stimulates muscle contractions.Most common types are: 1.Hyoscine butylbromide, Generic Name: Scopolamine butylbromide, Brand Name: Buscopan. Hyoscine butylbromide relaxes smooth muscles in the gastrointestinal tract, reducing spasms and cramping. It is administered Route: Intravenous (IV) or Intramuscular (IM), and as mentioned before by a Nurse or a certified trained technologist. Direct smooth muscle relaxants bind to smooth muscle cell receptors, inducing relaxation and reducing spasms. They are used in conditions like gastrointestinal or urinary tract spasms. 1.Baclofen, Brand Name: Lioresal. Is a skeletal muscle relaxant that can also act on smooth muscles, reducing spasticity and muscle contractions. It’s administered Intrathecal (IT) or Orally. Certain makes and models of Baclofen pumps are not MRI safe and should be thoroughly investigated before scanning. 2.Cyclobenzaprine, Brand Name: Flexeril, is a muscle relaxant that can reduce muscle spasms, including those in the gastrointestinal tract. It’s administered orally. Before you give a patient an antiperistaltic, there are a few contraindications to consider. These include Cardiac disease, blood pressure issues, enlarged bowel, myasthenia gravis, glaucoma, thyroid problems, or those who are pregnant or breastfeeding. Predictably, constipation is a side effect of slowing down the GI tract. Other adverse side effects which may occur are dizziness, dry mouth, tachycardia, and blurred vision. 50% of patients who receive glucagon experience nausea hours after the exam, however this can be reduced via slower administration. More rare side effects include small blisters on the hands and feet, an inability to urinate, low blood pressure, high blood pressure, a flushed face, dilated pupils, an allergic reaction, and increased intraocular pressure. If the patient has undiagnosed glaucoma, that could cause a painful red eye and loss of vision. Patients may have an increased risk of side effects if they are taking certain medications at the same time such as: codeine, antihistamines, antidepressants, antipsychotics, Parkinson’s medications, heart medications, and inhaled asthma medicines. Now for some fun facts! Outside of diagnostic imaging antiperistaltics may be prescribed as a treatment for stomach cramps resulting from IBS. And they don’t just affect the intestines, they also relax the biliary tracts and they can soothe bladder and uterine cramps. MRI technologists must understand the significance of antiperistaltic agents in the diagnostic imaging process. Knowledge of these drugs allows technologists to effectively communicate with patients about the purpose and potential side effects of the medication. Moreover, understanding the timing and method of administration can help in planning and executing MRI procedures more efficiently, ensuring high-quality imaging results.