adenosine

General

Pronunciation:
a-den-oh-seen


Trade Name(s)

  • Adenocard
  • Adenoscan

Ther. Class.
antiarrhythmics

Indications

  • 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)

ROUTEONSETPEAKDURATION
IVimmediateunknown1–2 min

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity;
  • 2nd- or 3rd-degree AV block or sick sinus syndrome, unless a functional artificial pacemaker is present;
  • Myocardial ischemia/infarction (only when used as diagnostic agent);
  • Lactation: Lactation.

Use Cautiously in:

  • Patients with a history of asthma (may induce bronchospasm);
  • Unstable angina;
  • OB:   Safety not established in pregnancy.

Adverse Reactions/Side Effects

CV: MI, VENTRICULAR TACHYCARDIA, arrhythmias, chest pain, hypotension, palpitations

Derm: facial flushing, burning sensation, sweating

EENT: blurred vision, throat tightness

GI: metallic taste, nausea

MS: neck and back pain

Neuro: numbness, tingling, SEIZURES (ONLY WITH ADENOSCAN), STROKE (ONLY WITH ADENOSCAN), apprehension, dizziness, headache, head pressure, lightheadedness.

Resp: shortness of breath, chest pressure, hyperventilation

Misc: HYPERSENSITIVITY REACTIONS, heaviness in arms, pressure sensation in groin

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

Route/Dosage

IV (Adults and Children  >50 kg): Antiarrhythmic – 6 mg by rapid IV bolus; if no results, repeat 1–2 min later as 12-mg rapid bolus. This dose may be repeated (single dose not to exceed 12 mg).  Diagnostic use– 140 mcg/kg/min for 6 min (0.84 mg/kg total).

IV (Children  <50 kg): Antiarrhythmic– 0.05–0.1 mg/kg as a rapid bolus, may repeat in 1–2 min; if response is inadequate, may ↑ by 0.05–0.1 mg/kg until sinus rhythm is established or maximum dose of 0.3 mg/kg is used.

Availability (generic available)

Solution for injection: 3 mg/mL

Assessment

  • Monitor heart rate frequently (every 15–30 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 sec.
  • Monitor BP during therapy.
  • Assess respiratory status (breath sounds, rate) following administration. Patients with history of asthma may experience bronchospasm.

Potential Diagnoses

Implementation

IV Administration

  • 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.
  • IV Push:   Diluent:  Administer undiluted. Concentration: 3 mg/mL.
  • Rate: Administer over 1–2 sec 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.

Patient/Family Teaching

  • Caution patient to change positions slowly to minimize orthostatic hypotension. Doses >12 mg decrease BP by decreasing peripheral vascular resistance.

    • Instruct patient to report facial flushing, shortness of breath, or dizziness.
  • Advise patient to avoid products containing methylxanthines (caffeinated coffee, tea, carbonated drinks or drugs such as aminophylline or theophylline) prior to myocardial perfusion imaging study

Evaluation/Desired Outcomes

  • Conversion of supraventricular tachycardia to normal sinus rhythm.
  • Diagnosis of myocardial perfusion defects.
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