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The
following ancillary pharmaceuticals are used as an adjunct to a
radiopharmaceutical during a Nuclear Cardiac stress test/Myocardial
Perfusion, Renal scan, and Neurologic Vascular scan.

Dipyridamole,
Aminophylline, Acetazolamine, and Furosemide are the pharmaceuticals
that will be described in detail, as the brand name, indications,
contraindications, the study where the pharmaceutical is utilized in,
dosages, side effects, and the correct administration time frame
during the Nuclear Medicine study.

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Discussion

Dipyridamole is also known as Persantine which is the brand name, is
a bronchodilator, vasodilator, and blood thiner, as it can prevent
embolus in some heart surgeries, Myocardial Infractions, and Cerebro
Vascular Accidents (CVA). During a cardiac stress test Dipyridamole
helps expand healthy vessels in the coronary arteries, Dipyridamole
will not be useful with diseased vessels. A cardiac stress test is
done in order to know if the heart is receiving enough blood. This
pharmaceutical is given intravenously (IV) to dilate the vessels, and
it will appear in the areas of the heart supplied by normal arteries
and the ones with diseases, such a blocked artery (Schaper, W. 2005).

Dosage for Persantine is 0.56mg per kilogram (patient weight)
intravenously, with a rate of 0.142mg/kg/minutes, with a half life of
thirty to forty-five minutes, The radiopharmaceutical is then
injected two to five minutes after the Persantine is given,
monitoring the patient for fifteen minutes in case of any adverse
reactions (Schaper, W. 2005).

Patients with hypotension, tachycardia, asthma or lung diseases, are
not good candidates for this drug as it decreases blood pressure,
elevates pulse, and is a vasodilator and bronchodilator, these are
the contraindications for Persantine. Dizziness, difficulty
breathing, headaches, nausea, vomiting, upset stomach, diarrhea,
muscle/joint pain, mild skin rash, and/or tingly feeling under the
skin are some side effects of this drug. An antagonist for Persantine
is the administration of Aminophylline or Theophylline with a dose of
50-250mg intravenously (Javadi, H. Shariati, M. Mogharrabi, M. Asli,
I. Jallalat, S. Hooman, A. & Assadi, M. 2010.)

Aminophylline has three different brand names Truphylline,
Phyllocintin, and Norphyl, is a bronchodilator, and is used to treat
conditions such apnea, acute asthma, and other lung diseases.
Aminophylline is given intravenously to reverse the effects of
Dipyridamole during a cardiac stress test, Adenosine, and
Regadenoson, as it blocks the receptors of these four drugs. It
should not be given if medications such Cognex, Tagamet, Mintezol,
Erythromycin, Enoxacine, are in patient system as these drugs cause
to drop the metabolism and resulting in an increase levels of
Aminophylline. Other drugs to avoid are, Tergetol this medication is
used to treat bipolar disorders, nerve pain, and seizures, also
Luminal which is used to treat certain types of epilepsy. Tergetol
and Luminal increase the Aminophylline metabolism resulting in low
levels of the same (Botvinick, H. 2009).

Dosage of this medication is based on the patient BMI (Body Mass
Index) but when used to reverse effects of Theophylline a recommended
dose goes from 50 to 250mg intravenously. In the other hand, the
contraindications for Theophylline are for patients with porphyria
which is a rare disorder in red blood cell proteins, and the
administration of Aminophylline (Theophylline) should be injected
with a slow push of the syringe to prevent Central Nervous System
(CNS) damage and Cardiovascular problems due to the direct
stimulation of Theophylline, also patients with peptic ulcers because
when is given intravenously has a notable increase of gastric acid
and as well with patients with history of seizure disorders as
Theophylline induce seizures (Lin,
L. &
Cheng,
Cheng-yi. 2014).

Aminophylline has a wide list of side effects such, Central Nervous
System excitement, headaches, restlessness, irritability, seizures,
insomnia, diarrhea, vomiting, tremors, nausea, increased urination,
palpitations, scaly skin, tachycardia, and respiratory distress are
some of the most common side effects of Aminophylline. The correct
time to administer this drug is if the technologist wants to
interfere with the Persantine effects, if the patient is having a
side effect to Persantine an antagonist medication should be
administrated, in this case is Aminophylline, and the technologist
must wait at least sixty seconds after the injection of the
radiopharmaceutical (Botvinick, H. 2009).

Acetazolamine is also known as Diamox or Diamox Sequels this
medication is a diuretic which means that increases the production
and passing of urine for people with fluid retention, when referring
to the tablet is known as the “water pill”. It can also be used
to treat epilepsy, and glaucoma, and altitude mountain sickness as
well (Kilner, T. & Mukerji, S. 2010).

This medication can be applied for tests such Brain perfusion, SPECT
brain imaging. When given intravenously is used for patients with
mini-strokes also known as TIA, cerebrovascular accident, or vascular
problems, this is known as the Vasodilator challenge or as the
Acetazolamine challenge. The dosage for this drug is 1000 milligrams
in a 10 milliliters (1g/10mL) of saline water via intravenously with
a slow push over 2 minutes, the dosage for children change to 14
milligrams per kilogram. The technologist should wait from ten to
twenty minutes before injecting the radio-pharmaceutical, the patient
at this point should empty his/her bladder immediately before
imaging. (Mettler, F. Guiberteau, M. 2012).

A contraindication for avoid Diamox if the patient is allergic to
sulfa, also avoid this medication if the patient had a
cerebrovascular accident within the previous three days of scan
(Mettler, F. Guiberteau, M. 2012). Side effects for Acetazolamine are
tingling or numbing sensation in the mouth and extremities, rash,
flushing, blurred vision, headaches, light headedness, nausea,
vomiting, frequent urination, drowsiness, change in taste, confusion,
and fever. Also more serious side effects can occur such liver
failure, electrolyte imbalance, and seizures.

The fourth pharmaceutical is Furosemide with the brand name as Lasix
is also a diuretic as Acetazolamine, which can treat swelling and
fluid retention due to diseases such liver problems, chronic heart
failure, and renal impairment, also it can treat hypertension as it
removes extra water from the system including salts helping the heart
to pump property (Beckerman,
J. 2017).

This
pharmaceutic is used in renal images such the Renogram. Lasix is
injected intravenously to induce the urine flow so the gamma camera
can detect the radio-tracer direction (Piepsz,
A. Kuyvenhoven, J. Tondeur, M. & Ham, H. 2002). The
dose amount for Lasix is 0.3 milligrams per patient kilogram, this
pharmaceutical should be injected intravenously with a slow rate from
1 to 2 minutes for adults with
an average of 20 to 40 milligrams.
For
children the correct dose is 0.1 milligrams per kilogram
intravenously
over the
same rate which is from one to two minutes. The
injection to image time is immediate
for
both patients adult and children (Mettler,
F. Guiberteau, M. 2012).

Patients
that are dehydrated or with kidney failure should not be treated with
Furosemide. Also patients cannot have a Renogram scan done if an
iodine contrast was given previous the scan. The patient should be
well hydrated unless
contraindicated by the physician, and
with an empty bladder prior the scan to avoid accumulation of tracers
in the bladder during image (Mettler,
F. Guiberteau, M. 2012).

Side
effects of Furosemide include diarrhea, nausea, vomiting, headaches,
hypotension, dehydriation, dizziness, increase
urination, rash, weakness, and stomach pain. More serious side
effects can also occur and these include dark urine, clay-colored
stools, jaundice, rapid weight loss, and loss of appetite but these
side effects are rare (Bolus,
N. & Brady, A. 2011).

Conclusion

The
four pharmaceuticals described on this research are just
a few of many ancillary pharmaceuticals that are essential
in nuclear medicine for
the recording, organ visibility, and to help the patient to improve a
specific area or organ to function in a fast peace in order for the
gamma camera track the radiopharmaceutical tracer through out the
body or certain organ. But
most importantly is to check patient history for medication allergies
and for any drug reaction after injection as this could lead to side
effects or major health risks.

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