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63 Cards in this Set
- Front
- Back
what is nuclear pharmacy?
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-first specialty in pharmacy recognized in
1978 by the Board of Pharmaceutical Specialties -focuses on the safe and effective use of radioactive drugs -has become highly specialized and contributed positively to the practice of nuclear medicine |
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what is radiation?
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Radiation is energy traveling through space or material in the form of waves or particles
-- atoms -- stable -- unstable |
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three types of radiation decay
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– ALPHA
– BETA – GAMMA |
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why is the type of emission important?
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Type of emission that is given off will determine whether or not the
radionuclide will be useful for imaging or treating a patient |
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what is tagging?
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“Tagging” the radioactive source to some compound that is known to
localize in a specific area of the body, the compound will carry the radioactive material to the desired site |
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why do you use a specific detection device?
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By using a specific detection device it is possible to detect the
emissions given off by the radioactive material and create images of the relative distribution of the radioactive source in the body |
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what is physical half life?
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-time required for ½ atoms to transform
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what is biological half life?
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-time required for ½ material to clear body
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what is effective half life?
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-combines atomic and biological for clearance
post intake |
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Decay equation
** It represents every aspect of radiation decay law |
A(f) = A(i) x e (-kt)
A (f) = Final activity A (I) = Initial activity K = ln (2)/ t1/2 = .693 / t1/2 A(f) = A(i) x (decay constant) |
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Ideal Diagnostic Radiopharmaceutical
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Easy to produce and distribute
• Short effective Half-Life • Gamma or x-rays • No pharmacologic action • Minimal disposal problems • High yield in photon emission of about 150 kev • Units of measurement Curie>mCi>uCi |
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radiopharmaceuticals
how many products available? |
more than 100
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radiopharmaceuticals
two components: |
drug and radioactive components
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radiopharmaceuticals
There is a vital distinction between radioactive and traditional drugs |
true
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radiopharmaceuticals
what percent are labeled with Tc-99m (technetium) |
80%
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radiopharmaceuticals
what percent are diagnostic |
90%
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radiopharmaceuticals
routes of administration |
Intravenous, inhalation, oral
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radiopharmaceuticals
uses: |
– Asses physiologic function
– Evaluate patient response to drug therapy and surgery – Helps monitor drug therapy and toxicity – Treatment of disease – Stage disease |
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radiopharmaceuticals
two major areas- Diagnostic |
• Diagnostic –Well established
– Largest applications in cardiology, oncology, neurology – Infection imaging and nephrology |
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radiopharmaceuticals
two major areas- Therapeutic |
• Therapeutic – Evolving
– Thyroid Cancer, Graves Dx, Hyperthyroidism, Bone Pain Palliation |
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radiopharmaceuticals and their uses
Diagnostic agents for cancer |
Tl201-Cl
Tc99m Sestamibi |
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radiopharmaceuticals and their uses
Diagnostic agents for bone |
Tc99m-Medronate
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radiopharmaceuticals and their uses
diagnostic agents for inflammation |
Ga67 Citrate
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radiopharmaceuticals and their uses
diagnostic agents for Liver & Lymphoscintgraphy |
• Tc99m-Sulfur Colloid
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radiopharmaceuticals and their uses
diagnostic agents for lung |
Tc99m-Macroaggregated Albumin
Xe133 |
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radiopharmaceuticals and their uses
diagnostic agents for Neuroendocrine Tumors |
In111-Pentetreotide
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radiopharmaceuticals and their uses
diagnostic agents for brain and tumor |
F18-FDG
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radiopharmaceuticals and their uses
therapeutic agents for Thyroid function Hyperthyroid, & Thyroid Cancer |
Na-I131
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radiopharmaceuticals and their uses
therapeutic agents for pain palliation of bone metastases |
Sm153
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radiopharmaceuticals and their uses
therapeutic agents for non-hodgkin's lymphoma |
Y90-Ibritumomab Tiuxetan
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Tc-99m Sulfur Colloid
Lymphoscintigraphy |
see slide 12 and 13
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Technetium-99m
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– Gamma emitter w/o hazardous effects of beta particles
– Flexible chemistry profile – Used as a radiolabel for various compounds • Compartmental localization – Tc-99m RBC in MUGA studies 6 hour t 1/2 |
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Thallous-201 Chloride (Tl-201)
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– Available as a sterile, nonpyrogenic solution for
intravenous administration – Half life - 73.1 hours – Undergoes rapid active transport into the myocardium – Visualizes myocardial infarction and ischemic Heart Dx – Undergoes fast redistribution; No uptake>infarct |
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Gallium-67 (Ga-67)
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– Available as a sterile, pyrogen-free aqueous solution
– Half life – 78 hours – Localizes in primary and metastatic tumors & focal sites of infection • E.g.. Sarcoidosis, abscesses and pyelonephritis – Aids in the diagnosis and monitoring of Pneumocystis Carinii of AIDS and Fever Of Unknown Origin. – Ferric Ion increases Ga-67 renal excretion |
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Indium-111 Chloride
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– Popular for label of MABs
• Antigen-antibody complex formation – Arcitumomab (CEA-SCAN) – Satumomab pendetide (Oncoscint) – Capromab penditide (ProstaScint) – Long half life – Lacks beta emission |
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therapeutic radiopharmaceuticals
Strontium-89 Chloride (Metastron) |
– Sterile, non pyrogenic aqueous solution for intravenous
use; no preservatives – Beta emitter; Half Life of 51 days – Very harmful to skeletal tissue – Used for Bone pain Palliation associated with tumors and metastasis – Caution w/ patients of platelet counts below 60,000 and WBC counts below 2400 |
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Therapeutic radiopharmaceuticals
Samarium-153 (Sm-153) |
– Short half life – 46.3 hours (1.9 days)
– Difficult in manufacturing and delivery – Low energy beta emitter – Dose = 1 mCi/kg administered intravenously over 1 minute – Toxicity • Limited to bone marrow suppression manifested by decreased leukocyte counts and thrombocytopenia • Nadir =4 weeks; Recovery = Normal levels in 6 weeks |
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Therapeutic radiopharmaceuticals
Yttrium-90 (Y-90) |
– Trivalent radioactive metal
– Half Life – 64.2 hours = 2.68 days – Sterile, pyrogen free – Therapeutic application in solid large tumors and lymphomas |
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monoclonal antibody imaging
In-111 or Y-90 |
– Ibritumomab Tiuxetan, ZEVALIN
• First FDA approved radio immunotherapy agent • Intended for the treatment of patients with relapsed or refractory low-grade, follicular b-cell non-Hodgkin’s lymphoma • In-111 label: Biodistribution step • Y-90 label: Therapeutic step • Very involved process with oncology, nuclear medicine and radio pharmacy |
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therapeutic radiopharmaceuticals
Sodium Iodide-131 (I-131) |
– Volatile solution
– Oral capsule or solution – Localization • Active Transport – Small amounts – uCi or 2-5mCi • Used for thyroid function tests or thyroid uptake tests – Large amounts – 5-200mCi • Used for carcinoma, masses, ablation |
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role of radioiodine in thyroid disease
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see slide 23
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Localization
passive diffusion |
– Xe-133, Tc-99m DTPA, In-111 DTPA
|
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localization
ion exchange and transport |
– MDP uptake in bone, Tc-99m thyroid trapping
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localization
capillary blockade |
– MAA in lung
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localization
phagocytosis |
– SC removal by RES
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localization
cell sequestration |
– Removal of denatured RBC by spleen
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localization
metabolism |
– F-18 FDG uptake in the heart or brain
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localization
receptor binding |
– Somatostatin analogue binding to soft tissue tumors
– Apcitide binding to activated platelets |
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imaging procedures
dynamic |
Provides useful information through the
rate of accumulation and removal of the radiopharmaceutical from a specific organ |
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imaging procedures
static |
Provides perfusion and morphologic
information, such as assessing adequacy of blood flow; organ size, shape and position; lesions |
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diagnostic imaging
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Some radiopharmaceuticals are formulated to
be placed within a target organ e.g.. I-131 Dx • Some radiopharmaceuticals are useful to evaluate a patient’s response to drug therapy and surgery e.g.. Tc-99m MAA • Some radiopharmaceuticals also find utility to help monitor drug therapy, including drug toxicity e.g.. Tc-99m MUGA |
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Non Radioactive Pharmaceutical Use
in Nuclear Medicine dipyridamole (persantine) |
– Vasodilator, longer t1/2 15-30min, increased side effects
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Non Radioactive Pharmaceutical Use
in Nuclear Medicine Adenosine (Adenocard) |
– Vasodilator, ultra short t1/2 <10secs,
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Non Radioactive Pharmaceutical Use
in Nuclear Medicine Aminophylline |
Reverses effects of the above drugs to relieve side
effects |
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Non Radioactive Pharmaceutical Use
in Nuclear Medicine Shilling's test |
– Determines patients ability to absorb Vitamin B12
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Positron Emission Tomography (PET)
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– PET Camera
– Exposure rates are 6 x greater – PET Imaging Drugs • Rb-82 Rubidium Chloride • F-18 FDG Fluorodeoxyglucose – 110 min • F-18 Dopa • O-15 Water – 2min • N-13 Ammonia – 10 min |
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• Imaging applications of PET
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– Mapping regional blood flow and volume
– Oxygen metabolism – Receptor density – Cell proliferation – Tumor receptor density – Receptor gene expression |
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• FDG-18; Flurodeoxyglucose
half life |
110 minute
|
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• FDG-18; Flurodeoxyglucose
useful in diagnosis of various cancers |
» Lung, colorectal, melanoma, lymphoma, head and neck
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• FDG-18; Flurodeoxyglucose
most widely used because: |
» Useful in tracing glucose metabolism
» Useful in detecting malignant tissue » Useful in quantifying changes in tumor glycolysis during and after treatment |
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• FDG-18; Flurodeoxyglucose
uses have expanded |
» Cerebral – maps normal brain metabolic activity
» Myocardial – identifies regions in which glucose metabolism increases » Tumor – Glucose metabolism increases in tumor tissue |
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F-18 FDG Fluorodeoxyglucose
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• Radio labeled glucose molecule
• Shows metabolism – Therefore able to image • Epilepsy • Cancers • Altered metabolism relative to normal tissue • Can show disease before structural changes can be picked up |
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white blood cell labeling
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Label white blood
cells with radioactive drug that is lipophillic – It enters and gets trapped in the cell • WBC’s are suspended in 3 ml of plasma. It is reinjected back into the patient • Follows strict needless procedure • Accurate patient ID |