Adenosine

Question 1

Adenosine
(Adenocard)
Class

Answer 1

Antiarrhythmic, endogenous nucleotide

Question 2

Adenosine
(Adenocard)
Mechanism of Action

Answer 2

Slows conduction time through the AV node; can interrupt re-entrant pathways; slows heart rate; acts directly on sinus pacemaker cells. The drug of choice for re-entry SVT. Can be used diagnostically for stable, wide-complex tachycardias (suspected SVT with aberrancy).

Question 3

Adenosine
(Adenocard)
Indications

Answer 3

Regular tachycardias (narrow and wide). Conversion of PSVT to sinus rhythm. May convert re-entry SVT due to Wolff-Parkinson-White syndrome. Not effective in converting atrial fibrillation/flutter, or V-tach.

Question 4

Adenosine
(Adenocard)
Contraindications

Answer 4

Contraindications: Torsades de Pointes (polymorphic V-tach), second- or third- degree heart block or sick sinus syndrome, atrial fibrillation/flutter, ventricular tachycardia, hypersensitivity to adenosine, poison induced tachycardia.

Question 5

Adenosine
(Adenocard)
Adverse Reactions

Answer 5

Facial flushing, shortness of breath, chest pain, headache, paresthesia, diaphoresis, palpitations, hypotension, nausea

Question 6

Adenosine
(Adenocard)
Drug Interactions

Answer 6

Methylxanthines (theophylline and caffeine-like drugs) antagonize the effects of adenosine. Dipyridamole (Persantine) potentiates the effects of adenosine. Carbamazepine (Tegretol) may potentiate the AV node, blocking the effects of adenosine. May cause bronchoconstriction in asthmatic patients.

Question 7

Adenosine
(Adenocard)
Dosage and Administration
Adult

Answer 7

6 mg over 1 – 3 seconds, followed by a 20 mL saline flush and elevate the patients extremity. If no response after 1 – 2 minutes, administer 12 mg over 1 – 3 seconds; maximum total dose 30 mg.

Question 8

Adenosine
(Adenocard)
Dosage and Administration
Pediatric

Answer 8

Pediatric: 0.1 – 0.2 mg/kg rapid IV; maximum single dose of 12 mg.

Question 9

Adenosine
(Adenocard)
Onset

Answer 9

Onset: Seconds

Question 10

Adenosine
(Adenocard)
Duration

Answer 10

Duration: 12 seconds

Question 11

Adenosine
(Adenocard)
Special Considerations

Answer 11

Short half-life limits side effects in most patients, but arrhythmias including blocks are common at the time of conversion. Should be administered directly into a large bore medication port closest to the patient’s heart and followed by a flush.