Pharmacological Stress Test

Question 1

Other name for dipyridamole

Answer 1

Persantine

Question 2

Pt prep for adenosine and dipyridamole

Answer 2

• NPO 4 hours
• D/C xanthine derivatives (aminophylline, theophylline, caffeine) 12-34 hours prior

Question 3

How does dipyridamole work

Answer 3

Vasodilation

Indirectly increases adenosine

Question 4

Contraindications of dipyridamole

Answer 4

History of bronchospasm or pulmonary disease, active wheezing, low BP, mitral valve disease

Question 5

Reversal of dipyridamole

Answer 5

Aminophylline

Question 6

Aminophylline dose

Answer 6

50-250 mg

50-100 over 30-60 seconds

Question 7

Dipyridamole dose and administration

Answer 7

0.56 mg/kg in 50 ml saline
Infused over 4 minutes

Question 8

When is tracer injected when using dipyridamole

Answer 8

Within 5 minutes AFTER the infusion has ended

Question 9

How does adenosine work

Answer 9

Vasodilation

Directly increases adenosine

Question 10

Contraindications for adenosine

Answer 10

Same as dipyridamole + 2nd or 3rd degree AV block (without a pacemaker)

Question 11

Half life of adenosine and dipyridamole

Answer 11

<2 seconds

Question 12

Reversal of adenosine

Answer 12

Aminophylline

Question 13

Adenosine dose and administration

Answer 13

240 ug/kg

Infused over 6 minutes

Question 14

When is tracer injected with adenosine?

Answer 14

3 minutes into 6 minute infusion

Must have 2 IV lines

Question 15

How does regadenoson work

Answer 15

A2A adenosine receptor that produces coronary vasodilation

Question 16

Maximum plasma concentration of regadenoson

Answer 16

1-4 minutes after injection

Question 17

Regadenson pt prep

Answer 17

• avoid methylxanthines 12 hours prior (caffeine, decaf, theophylline)
• d/c dipyridamole 2 days prior

Question 18

Contraindications for regadenoson

Answer 18

2nd or 3rd degree AV block, sinus node dysfunction, bronchospasm, low BP

Question 19

Reversal of regadenson

Answer 19

Aminophylline

50-250mg (50-100 over 30-60 seconds)

Question 20

Regadenson dose and administration

Answer 20

0.4 mg in 5 ml over 10 seconds

Question 21

When to inject tracer when using regadenoson

Answer 21

10-20 seconds after regadenoson

Question 22

Advantages of combination of low level exercise + pharmacological stress agent

Answer 22

Decrease side effects and subdiaphragmatic uptake

Increase target to background ratio

Question 23

How does dobutamine work

Answer 23

Stimulates B1 receptors

Enhances the force of the hearts contractions and heart rate

Question 24

Which agent is most similar to exercise

Answer 24

Dobutamine

Question 25

Which agent is indicated for pts who are contraindicated for exercise and all other pharmacological agents

Answer 25

Dobutamine

Question 26

Main contraindication of dobutamine

Answer 26

Beta blockers

Question 27

Pt prep for dobutamine

Answer 27

-NPO for 4 hrs prior
-D/C beta blockers for 24-48 hours

Question 28

Reversal of dobutamine

Answer 28

Beta blocker

Question 29

Contraindications of dobutamine

Answer 29

Atrial tachyarrhythmias, v-tach

Question 30

Dobutamine dose and administration

Answer 30

Similar to Bruce protocol

Stepped increases at 3 minute intervals:

10, 20, 30, and 49 ug/kg/min

Question 31

When is tracer injected during dobutamine transfusion

Answer 31

At beginning of last stage