General
Pronunciation
a-DEN-oh-seen
Trade Name(s)
Adenocard
Adenoscan
Pregnancy CategoryCategory CTher. class.antiarrhythmicsIndications
Conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm when vagal maneuvers are unsuccessful
As a diagnostic agent (with noninvasive techniques) to assess myocardial perfusion defects occurring as a consequence of coronary artery disease
Action
Restores normal sinus rhythm by interrupting re-entrant pathways in the AV node
Slows conduction time through the AV node
Also produces coronary artery vasodilation
Therapeutic Effect(s): Restoration of normal sinus rhythm
Pharmacokinetics
Absorption: Following IV administration, absorption is complete
Distribution: Taken up by erythrocytes and vascular endothelium
Metabolism and Excretion: Rapidly converted to inosine and adenosine monophosphate
Half-life: <10 sec
TIME/ACTION PROFILE (antiarrhythmic effect)
| ROUTE | ONSET | PEAK | DURATION |
| IV | immediate | unknown | 12 min |
Contraindication/Precautions
Contraindicated in:
Hypersensitivity
2nd- or 3rd-degree AV block or sick sinus syndrome, unless a functional artificial pacemaker is present
Use Cautiously in: Patients with a history of asthma (may induce bronchospasm)
Unstable angina
OB: Safety not established
Adverse Reactions/Side Effects
CNS: apprehension, dizziness, headache, head pressure, light-headedness.
EENT: blurred vision, throat tightness.
Resp: shortness of breath, chest pressure, hyperventilation.
CV: facial flushing, transient arrhythmias, chest pain, hypotension, palpitations.
GI: metallic taste, nausea.
Derm: burning sensation, facial flushing, sweating.
MS: neck and back pain.
Neuro: numbness, tingling.
Misc: heaviness in arms, pressure sensation in groin.
*CAPITALS indicates life-threatening.
*italic indicates most frequent.
Interactions
Drug-Drug
Carbamazepine may
risk of progressive heart block
Dipyridamole
effects of adenosine (dosage reduction of adenosine recommended)
Effects of adenosine
by theophylline or caffeine (larger doses of adenosine may be required)
Concurrent use with digoxin may
risk of ventricular fibrillation
Route/Dosage
IV (Adults and Children >50 kg):
Antiarrhythmic6 mg by rapid IV bolus; if no results, repeat 12 min later as 12-mg rapid bolus. This dose may be repeated (single dose not to exceed 12 mg).
Diagnostic use140 mcg/kg/min for 6 min (0.84 mg/kg total).
IV (Children <50 kg):
Antiarrhythmic0.050.1 mg/kg as a rapid bolus, may repeat in 12 min; if response is inadequate, may increase by 0.050.1 mg/kg until sinus rhythm is established or maximum dose of 0.3 mg/kg is used.
Availability
Injection: 6 mg/2-ml vial (Adenocard), 3 mg/1 ml in 30-ml vial (Adenoscan)
Assessment
Monitor heart rate frequently (every 1530 sec) and ECG continuously during therapy. A short, transient period of 1st-, 2nd-, or 3rd-degree heart block or asystole may occur following injection; usually resolves quickly due to short duration of adenosine. Once conversion to normal sinus rhythm is achieved, transient arrhythmias (premature ventricular contractions, atrial premature contractions, sinus tachycardia, sinus bradycardia, skipped beats, AV nodal block) may occur, but generally last a few seconds
Monitor blood pressure during therapy
Assess respiratory status (breath sounds, rate) following administration. Patients with history of asthma may experience bronchospasm
Potential Nursing Diagnoses
Decreased cardiac output (Indications)
Implementation
Do not confuse adenosine (Adenocard) with adenosine phosphate
IV Adminstration:
IV:
Crystals may occur if adenosine is refrigerated. Warm to room temperature to dissolve crystals. Solution must be clear before use. Do not administer solutions that are discolored or contain particulate matter. Discard unused portions
Direct IV:
Diluent: Administer undiluted.
Concentration: 3 mg/ml
Rate:
Administer over 12 seconds via peripheral IV as proximal as possible to trunk. Slow administration may cause increased heart rate in response to vasodilation. Follow each dose with 20 ml rapid saline flush to ensure injection reaches systemic circulation
Intermittent Infusion:
(for use in diagnostic testing) Diluent: Administer 30-ml vial undiluted.
Concentration: 3 mg/ml
Rate:
Administer at a rate of 140 mcg/kg/min over 6 min for a total dose of 0.84 mg/kg. Thallium-201 should be injected as close to the venous access as possible at the midpoint (after 3 min) of the infusion
Y-Site Compatibility:
» abciximab
» Thallium-201
Patient/Family Teaching
Caution patient to change positions slowly to minimize orthostatic hypotension. Doses >12 mg decrease blood pressure by decreasing peripheral vascular resistance
» Instruct patient to report facial flushing, shortness of breath, or dizziness
Evaluation/Desired Outcomes
Conversion of supraventricular tachycardia to normal sinus rhythm
Diagnosis of myocardial perfusion defects
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