PHARMACOLOGICAL STRESS TESTS

You can use either adenosine, dobutamine, persantin or an adenosine receptor agonist.

The adenosine receptor agonists that are around are all called "-denoson's".
They all stimulate the 2A subtype of the adenosine receptor, this being the one that is responsible for the coronary vassodilation. It's easy to remember that it's 2A because the drug class is A2A and so there are 2 A's :)

In terms of the other subtypes:
1 commands the AV node
2B is responsible for bronchoconstriction
3 for histamine release

The big study that compared side-effects to Adenosine was ADVANCE MPI (because these drugs were thought to be an "advance". It showed that heart block was not caused and that there was less chest pain, SOB and flushing, but more headache and GI upset.

With regards to Persantin, the dose given is 140mcg per kg per minute for 5 mins. So, this is 600mcg per kg.

You don’t give it if:
- CHB on ECG
- Recent hospitalization for asthma
- Wheezing on chest auscultation