Other Names

Adenocard

Classification

Antiarrhythmic

Action

An endogenous purine nucleoside that slows conduction through the AV node, interrupts AV-nodal reentry pathways and can restore normal sinus rhythm in PSVT via modulation of K+ currents and the blunting of catecholamine response

Indications

•Conversion to sinus rhythm of Paroxysmal Supraventricular Tachycardia (PSVT), including that associated with accessory bypass tracts (Wolff-Parkinson-White syndrome)

•To aid in the diagnosis of broad or narrow complex supraventricular tachycardia (Adenosine does not convert atrial flutter, atrial fibrillation or ventricular tachycardia to normal sinus rhythm)

Contraindications

1. •Hypersensitivity to the medication
   

2. •2nd or 3rd degree AV block (except in patients with a functioning artificial pacemaker)
   

3. •Accessory pathways and atrial tachycardias originating above the AV node (i.e. a-fib and
   

4. •Sick Sinus Syndrome where you see the accessory pathway conduct the atrial impulses at rates > 220)
   

Precautions

  Caution advised in patients with:

1. •Sick sinus syndrome (except in patients with a functioning artificial pacemaker)
   

2. •Since Adenosine exerts its effect by decreasing conduction through the AV node, it may produce a short lasting 1st, 2nd, or 3rd degree heart block
   

  At the time of conversion to normal sinus rhythm, a variety of new rhythms may appear on ECG including:

•premature ventricular contractions, atrial premature contractions, sinus bradycardia, sinus tachycardia, skipped beats, AV nodal block (may occur in up to 55% of patients)

1. •Patients receiving Digoxin and/or Verapamil
   

2. •Patients with hx of asthma, COPD
   

Adverse Reactions

1. •Non-cardiac: facial flushing, chest pain, dyspnea, headache, lightheadedness
   

2. •Cardiac: 1st, 2nd or 3rd degree heart block; transient asystole; varied atrial and ventricular arrhythmias
   

3. •1/2 life is 10 seconds. A brief period of asystole (up to 15 seconds) following conversion, followed by resumption of NSR is common after rapid administration
   

Adverse reactions are generally transient, resolve within 1 minute of drug administration, and do not require intervention, nor are they an indication to not attempt a subsequent administration of a higher dose of the same medication.

Interactions/Compatibility/Stability

1. • Store syringes at room temperature as Adenosine will crystallize when stored in refrigerator (will dissolve when warmed to room temperature)
   

2. •Protect from light
   

Special Considerations

1. •The effects of Adenosine are antagonized by methylxanthines, caffeine, theophylline (larger doses may be required to be effective)
   

2. •Direct IV rapid bolus (1 - 2 seconds), preferably via large bore forearm or ACF site due to short half life and followed by NS 10 - 20 ml flush
   

Dosages

Preparation: 3 mg per ml (6 mg or 12 mg preloaded syringes)

Adult: Initial dose is a 6 mg rapid bolus followed by NS 20 ml flush

• If no response within 1 - 2 minutes, a 12 mg repeat dose should be administered followed by NS 20 ml flush

Pediatric: Initial dose is 0.1 mg/kg (to a maximum of 6 mg) IV/IO followed by NS 10 ml flush

• If no response within 1 - 2 minutes, a 0.2 mg/kg (to a maximum of 12 mg) should be administered followed by NS 10 ml flush

Kinetics

Onset           < 60 seconds

Peak             60 seconds

Duration      1 - 2 minutes

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