RESUMO
AIM: To assess the radiopharmacist's role in a multidisciplinary team focused on the contraindications of regadenoson in order to ensure the safe use of pharmacologic vasodilator stress agents in patients undergoing SPECT-MPI. METHODS: We ambispectively studied its safe use in 1905 patients (54.1% female, mean age: 66.6±11.7 years, range: 20-95 years). Sex, age, medical history, medications, drug allergies, and contraindications for stress testing were registered together with recommendations for the nuclear physician in charge. RESULTS: Detected contraindications and corresponding recommendations were as follows: risk factors for QTc interval prolongation 7.5% - measurement of QTc interval previously to test and monitor ECG; prior stroke or TIA 4.2% - consider carotid stenosis assessment; salicylates/sulfonamides allergy 3.1% - use 99mTc-sestamibi; epilepsy or risk factors for seizures 2.4% - use of adenosine or reconsider test indication; systemic corticosteroid therapy for severe COPD 1.3% - reassessment of patient's condition; acute exacerbation of COPD 0.8% - defer test until acute episode is over; severe asthma 0.4% - do not perform test; methylxanthine ingestion 0.3% - avoid consumption previously; other 6.1% - evaluation of other contraindications. No contraindications were detected in 73.6% of patients. The test was canceled due to absolute contraindications in 2.9% of the requests. CONCLUSIONS: Working in a systematic way, the radiopharmacist was able to detect a high number of issues related to regadenoson, with one out of four patients presenting some clinical contraindication. The recommendations given by the radiopharmacist were well accepted by the nuclear physicians who changed their approach contributing to increase the safety of patients referred for MPI.
Assuntos
Imagem de Perfusão do Miocárdio , Doença Pulmonar Obstrutiva Crônica , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Masculino , Vasodilatadores/efeitos adversos , Imagem de Perfusão do Miocárdio/métodos , Segurança do Paciente , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Doença Pulmonar Obstrutiva Crônica/induzido quimicamenteRESUMO
OBJECTIVE: To assess the safety of regadenoson, a selective agonist of A2A adenosine receptors, combined with low-level exercise in subjects with severe chronic obstructive pulmonary disease (COPD), referred for myocardial perfusion imaging (MPI). METHODS: We studied prospectively 12 male patients with severe COPD. Stress was 4min of low-level exercise with bolus injection of regadenoson (0.4mg) at 1.5min, followed by (99m)Tc-MPI agent injection. Demographics, medical history, lung medications, adverse events, oxygen saturation (SatO2), MPI findings for coronary artery disease (CAD), and changes in systolic blood pressure (SBP), and heart rate (HR) were registered. RESULTS: The observed adverse event profile of regadenoson was similar to that of patients with mild-moderate COPD. There was no clinical exacerbation of COPD. Adverse events were self-limiting: dyspnea (33.3%), fatigue (25.0%), chest pain, headache (16.7%, respectively), and gastrointestinal discomfort, dry mouth, flushing, feeling hot and dizziness (8.3%, respectively). 25.0% of patients did not report any symptoms. We observed significant increases in SBP and HR from baseline (142.6mmHg±22.3 vs 152.5mmHg±18.5, and 80 b.p.m.±18 vs 105 b.p.m.±22, respectively; p<0.05). CONCLUSIONS: Regadenoson combined with low-level exercise is safe and well tolerated in stable patients with severe COPD undergoing MPI.
Assuntos
Agonistas do Receptor A2 de Adenosina/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Purinas/uso terapêutico , Pirazóis/uso terapêutico , Agonistas do Receptor A2 de Adenosina/efeitos adversos , Idoso , Teste de Esforço , Humanos , Masculino , Imagem de Perfusão do Miocárdio , Projetos Piloto , Estudos Prospectivos , Purinas/efeitos adversos , Pirazóis/efeitos adversos , Índice de Gravidade de DoençaRESUMO
We have reviewed the legislation about the quality control of dose calibrator. The importance of verifying the correct work of these instruments, is fundamental in daily practice of radiopharmacy and nuclear medicine. The Spanish legislation establishes to include these controls as part of the quality control of radiopharmaceuticals, and the program of quality assurance in nuclear medicine. We have reviewed guides and protocols from international eminent organizations, summarizing the recommended tests and periodicity of them.
Assuntos
Calibragem/normas , Controle de Qualidade , Doses de Radiação , Compostos Radiofarmacêuticos/administração & dosagem , Medicina Nuclear/legislação & jurisprudência , Medicina Nuclear/normas , Reprodutibilidade dos Testes , EspanhaRESUMO
Objetivos: Evaluar el papel del radiofarmacéutico en un equipo multidisciplinar en la detección de contraindicaciones del regadenosón para su uso seguro en pacientes a los que se solicitó una SPECT de perfusión miocárdica. Métodos: Se estudió ambispectivamente su uso seguro en 1.905 pacientes (54,1% mujeres, edad media: 66,6±11,7 años, rango: 20-95años). Se registraron datos relativos al sexo, a la edad, al historial médico, a la medicación, a las alergias medicamentosas y a las contraindicaciones para el estrés farmacológico, así como las recomendaciones realizadas al médico nuclear responsable. Resultados: Las contraindicaciones detectadas y las correspondientes recomendaciones fueron las siguientes: riesgo de prolongación del intervalo QTc (7,5%): comprobación previa del intervalo QTc y monitorización del ECG; ictus o AIT previo (4,2%): evaluación de estenosis carotídea; alergia a salicilatos y/o sulfamidas (3,1%): empleo de [99mTc]Tc-MIBI; epilepsia o riesgo de convulsiones (2,4%): uso de adenosina o reconsiderar su indicación; tratamiento con corticosteroides sistémicos en EPOC severa (1,3%): reevaluar las condiciones del paciente; EPOC reagudizada (0,8%): posponer hasta la resolución del episodio agudo; asma grave (0,4%): no realizar la prueba; toma de metilxantinas (0,3%): evitar su consumo previo; otras (6,1%): evaluación de cada contraindicación. No se observaron contraindicaciones en el 73,6% de los pacientes. Se anularon el 2,9% de las peticiones debido a contraindicaciones absolutas. Conclusiones: Empleando una metodología de trabajo sistemática, el radiofarmacéutico detectó un elevado número de incidencias, presentando uno de cada cuatro pacientes alguna contraindicación clínica. Las recomendaciones emitidas fueron aceptadas por los médicos nucleares, que modificaron su enfoque, incrementando así la seguridad de estos pacientes.(AU)
Aim: To assess the radiopharmacist's role in a multidisciplinary team focused on the contraindications of regadenoson in order to ensure the safe use of pharmacologic vasodilator stress agents in patients undergoing SPECT-MPI. Methods: We ambispectively studied its safe use in 1905 patients (54.1% female, mean age: 66.6±11.7 years, range: 20-95years). Sex, age, medical history, medications, drug allergies, and contraindications for stress testing were registered together with recommendations for the nuclear physician in charge. Results: Detected contraindications and corresponding recommendations were as follows: risk factors for QTc interval prolongation 7.5% measurement of QTc interval previously to test and monitor ECG; prior stroke or TIA 4.2% consider carotid stenosis assessment; salicylates/sulfonamides allergy 3.1% use 99mTc-sestamibi; epilepsy or risk factors for seizures 2.4% use of adenosine or reconsider test indication; systemic corticosteroid therapy for severe COPD 1.3% reassessment of patient's condition; acute exacerbation of COPD 0.8% defer test until acute episode is over; severe asthma 0.4% do not perform test; methylxanthine ingestion 0.3% avoid consumption previously; other 6.1% evaluation of other contraindications. No contraindications were detected in 73.6% of patients. The test was cancelled due to absolute contraindications in 2.9% of the requests. Conclusions: Working in a systematic way, the radiopharmacist was able to detect a high number of issues related to regadenoson, with one out of four patients presenting some clinical contraindication. The recommendations given by the radiopharmacist were well accepted by the nuclear physicians who changed their approach contributing to increase the safety of patients referred for MPI.(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Segurança do Paciente , Imagem de Perfusão do Miocárdio/métodos , Doença Pulmonar Obstrutiva Crônica/induzido quimicamente , Vasodilatadores/efeitos adversos , Imagem Molecular , Medicina Nuclear , Estudos Retrospectivos , Estudos ProspectivosAssuntos
Calciofilaxia/diagnóstico por imagem , Difosfonatos/farmacocinética , Falência Renal Crônica/complicações , Compostos de Organotecnécio/farmacocinética , Compostos Radiofarmacêuticos/farmacocinética , Tomografia Computadorizada de Emissão de Fóton Único , Parede Abdominal/diagnóstico por imagem , Calciofilaxia/etiologia , Feminino , Humanos , Hiperparatireoidismo Secundário/diagnóstico por imagem , Hiperparatireoidismo Secundário/etiologia , Pessoa de Meia-Idade , Tela Subcutânea/diagnóstico por imagem , Tela Subcutânea/metabolismo , Imagem Corporal TotalAssuntos
Fístula/diagnóstico por imagem , Imagem Multimodal , Doenças Peritoneais/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Adulto , Feminino , Fístula/diagnóstico , Humanos , Diálise Peritoneal , Doenças Peritoneais/diagnósticoRESUMO
Objective. To assess the safety of regadenoson, a selective agonist of A2A adenosine receptors, combined with low-level exercise in subjects with severe chronic obstructive pulmonary disease (COPD), referred for myocardial perfusion imaging (MPI). Methods. We studied prospectively 12 male patients with severe COPD. Stress was 4min of low-level exercise with bolus injection of regadenoson (0.4mg) at 1.5min, followed by 99mTc-MPI agent injection. Demographics, medical history, lung medications, adverse events, oxygen saturation (SatO2), MPI findings for coronary artery disease (CAD), and changes in systolic blood pressure (SBP), and heart rate (HR) were registered. Results. The observed adverse event profile of regadenoson was similar to that of patients with mild-moderate COPD. There was no clinical exacerbation of COPD. Adverse events were self-limiting: dyspnea (33.3%), fatigue (25.0%), chest pain, headache (16.7%, respectively), and gastrointestinal discomfort, dry mouth, flushing, feeling hot and dizziness (8.3%, respectively). 25.0% of patients did not report any symptoms. We observed significant increases in SBP and HR from baseline (142.6mmHg±22.3 vs 152.5mmHg±18.5, and 80 b.p.m.±18 vs 105 b.p.m.±22, respectively; p<0.05). Conclusions. Regadenoson combined with low-level exercise is safe and well tolerated in stable patients with severe COPD undergoing MPI (AU)
Objetivo. Evaluar la seguridad de regadenosón, un agonista selectivo de los receptores adenosínicos A2A, combinado con ejercicio de baja intensidad, en sujetos con enfermedad pulmonar obstructiva crónica (EPOC) severa, en estudios de perfusión miocárdica. Métodos. Se estudiaron de forma prospectiva 12 pacientes con EPOC severa (todos ellos varones). El estrés consistió en la realización de un ejercicio de baja intensidad durante 4min junto con la administración de un bolo de regadenosón (0,4mg) a los 1,5min, seguido de la inyección del radiofármaco tecneciado de perfusión miocárdica. Se registraron los datos demográficos, el historial médico, la medicación para patología respiratoria, los efectos adversos, la saturación de oxígeno (SatO2), los hallazgos de enfermedad coronaria en el estudio de perfusión miocárdica y los cambios en la presión arterial sistólica (PAS) y la frecuencia cardiaca (FC). Resultados. El perfil de efectos adversos de regadenosón fue similar al de pacientes con EPOC leve-moderada. No se produjeron exacerbaciones clínicas de la EPOC. Los efectos adversos experimentados, todos autolimitados, fueron disnea (33,3%), cansancio (25%), dolor torácico, cefalea (16,7%, respectivamente), molestias gastrointestinales, boca seca, rubefacción, calor y mareos (8,3%, respectivamente). El 25% de los pacientes no informaron síntomas. Se observaron aumentos significativos desde los valores basales de la PAS y la FC (142,6mmHg±22,3 vs 152,5mmHg±18,5 y 80l.p.m.±18 vs 105l.p.m.±22, respectivamente; p<0,05). Conclusiones. Regadenosón combinado con ejercicio de baja intensidad es seguro y bien tolerado en pacientes con EPOC severa estable sometidos a estudios de perfusión miocárdica (AU)
Assuntos
Humanos , Masculino , Feminino , Segurança do Paciente/legislação & jurisprudência , Segurança do Paciente/normas , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica , Compostos Radiofarmacêuticos/administração & dosagem , Compostos Radiofarmacêuticos/análise , Vasodilatadores/efeitos adversos , Perfusão/efeitos adversos , Estudos Prospectivos , Pressão Arterial/fisiologiaRESUMO
No disponible
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Calciofilaxia/complicações , Tecnécio/efeitos adversos , Necrose , Fatores de Risco , Tomografia por Emissão de Pósitrons/métodosRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto , Tomografia Computadorizada de Emissão de Fóton Único/instrumentação , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada de Emissão de Fóton Único/tendências , Fístula/diagnóstico , Peritônio/patologia , Peritônio , Tomografia Computadorizada de Emissão de Fóton Único , Fístula , Compostos RadiofarmacêuticosAssuntos
Humanos , Masculino , Adulto , Albumina Sérica , Albumina Sérica/efeitos da radiação , Agregado de Albumina Marcado com Tecnécio Tc 99m , Agregado de Albumina Marcado com Tecnécio Tc 99m/efeitos da radiação , Relação Ventilação-Perfusão/efeitos da radiação , Tecnécio Tc 99m Exametazima/efeitos da radiação , Dispneia/complicações , Dispneia , Dor no Peito , /instrumentação , /métodosRESUMO
Hemos realizado una revisión del control de calidad de activímetros, debido a la importancia de verificar el correcto funcionamiento de estos instrumentos, importantes en la práctica diaria de la radiofarmacia y la medicina nuclear. La normativa española establece la necesidad de incluir estos controles como parte del control de calidad de radiofármacos y del programa de garantía de calidad de medicina nuclear. En el trabajo hemos revisado diferentes guías y protocolos de organismos internacionales de reconocido prestigio, apuntando las principales pruebas que se deben realizar y la periodicidad aconsejada (AU)
We have reviewed the legislation about the quality control of dose calibrator. The importance of verifying the correct work of these instruments, is fundamental in daily practice of radiopharmacy and nuclear medicine. The Spanish legislation establishes to include these controls as part of the quality control of radiopharmaceuticals, and the program of quality assurance in nuclear medicine. We have reviewed guides and protocols from international eminent organizations, summarizing the recommended tests and periodicity of them (AU)