RESUMO
Pharmacologic reversal of serious or intolerable side effects (SISEs) from vasodilator stress is an important safety and comfort measure for patients experiencing such effects. While typically performed using intravenous aminophylline, recurrent shortages of this agent have led to a greater need to limit its use and consider alternative agents. This information statement provides background and recommendations addressing indications for vasodilator reversal, timing of a reversal agent, incidence of observed SISE with vasodilator stress, clinical and logistical considerations for aminophylline-based reversal, and alternative non-aminophylline based reversal protocols.
Assuntos
Aminofilina/uso terapêutico , Cardiotônicos/uso terapêutico , Vasodilatadores/efeitos adversos , Aminofilina/provisão & distribuição , Cardiotônicos/provisão & distribuição , Teste de Esforço , Humanos , Imagem de Perfusão do Miocárdio , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
The latest aminophylline shortage has prompted a need for alternative reversal agents for pharmacological stress testing. Cardiac stress testing is common for diagnosis and prognosis in patients with coronary heart disease. Options for pharmacological stress test agents include adenosine, regadenoson, dipyridamole, and dobutamine, whereas aminophylline is the recommended reversal agent. Adenosine and dobutamine can be used as alternatives to regadenoson and dipyridamole to decrease or eliminate the use of aminophylline. Alternatives to aminophylline include theophylline and caffeine. It is important to efficiently identify alternatives during a drug shortage to maintain optimal patient outcomes.
Assuntos
Aminofilina/provisão & distribuição , Cafeína/administração & dosagem , Teste de Esforço/efeitos adversos , Teofilina/administração & dosagem , Vasodilatadores/administração & dosagem , Aminofilina/uso terapêutico , Cafeína/uso terapêutico , Doença das Coronárias/diagnóstico , Uso de Medicamentos/tendências , Teste de Esforço/métodos , Feminino , Humanos , Masculino , Teofilina/uso terapêutico , Vasodilatadores/uso terapêuticoRESUMO
Pharmacologic reversal of serious or intolerable side effects (SISE) from vasodilator stress is an important safety and comfort measure for patients experiencing such effects. While typically performed using intravenous aminophylline, recurrent shortages of this agent have led to a greater need to limit its use and consider alternative agents. This information statement provides background and recommendations addressing indications for vasodilator reversal, timing of a reversal agent, incidence of observed SISE with vasodilator stress, clinical and logistical considerations for aminophylline-based reversal, and alternative non-aminophylline based reversal protocols.
Assuntos
Aminofilina/administração & dosagem , Aminofilina/provisão & distribuição , Antídotos/administração & dosagem , Antídotos/provisão & distribuição , Circulação Coronária/efeitos dos fármacos , Imagem de Perfusão do Miocárdio/efeitos adversos , Vasodilatação/efeitos dos fármacos , Vasodilatadores/efeitos adversos , Esquema de Medicação , Humanos , Imageamento por Ressonância Magnética , Imagem de Perfusão do Miocárdio/métodos , Tomografia por Emissão de Pósitrons , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento , Vasodilatadores/administração & dosagemRESUMO
The cardiovascular effects of theophylline were studied in 11 clinically stable preterm infants. Theophylline was given as aminophylline using a loading dose of 6.8 mg/kg and a maintenance dose of 2 mg/kg every 8 hours intravenously. Cardiac output, stroke volume, and heart rate were measured using a combination of pulsed Doppler ultrasound and M-mode echocardiography. Compared with day 0, an increase was found in both cardiac output (P less than 0.01) and stroke volume (P less than 0.02) on days 1, 2, and 3. By day 7, stroke volume was comparable to pretreatment values, whereas cardiac output was still increased. Heart rate was augmented significantly (P less than 0.01) throughout the treatment period. Mean arterial blood pressure did not change. All but one of the neonates had serum theophylline concentrations between 6 and 13 mg/L. We conclude that both inotropic and chronotropic effects are evident during the first days of theophylline therapy. The metabolic cost of the increased cardiac output in the preterm infant with theophylline therapy deserves further attention.