Pharma page 72 75

Adenosine
Brand name:
Adenocard, adenoscan

Drug classes:
Antiarrhythmic

Diagnostic agent

Mechanism of action:
Slows conduction through the AV node; can interrupt the reentry pathways through the AV node and restore sinus
rhythm in patient with paroxysmal supraventricular tachycardias; potent vasodilators that facilitates thallium
uptake

Indications

 Conversion to sinus rhythm of paroxysmal supraventricular tachycardia, including that associated with
accessory bypass tracts (wolff-Parkinson-White syndrome), after attempting vagal maneuvers when
appropriate (Adenocard)
 Assessment of patients with suspected CAD in conjunction with thallium tomography (Adenosacan)
 Orphan drug use: Treatment of brain tumors in conjunction with carmustine

Contraindications

 Contraindicated with hypersensitivity to adenosine; second- or third-degree AV heart block, sick sinus
syndrome (unless artificial pacemaker in place); atrial flutter, atrial fibrillation, ventricular tachycardia
(especially risky in the elderly).
 Use cautiously with asthma (could produce bronchospasm in asthmatic patients), pregnancy.

Dosages
For rapid bolus IV use only.
Adults:

 Conversion of arrhythmia in patients 250 kg: Initial dose, 6 mg as a rapid IV bolus administered over 1-2 sec.
For repeat administration, 12 mg as a rapid IV bolus if initial dose does not produce elimination of the
supraventricular tachycardia within 1-2 min. Twelve-milligram bolus may be repeated a second time if
needed. Doses > 12 mg are not recommended.
 Conversion of arrhythmia in patients <50 kg: 0.05-0.1 mg/kg as a rapid IV bolus; if conversion does not
occur in 1-2 min, another bolus, increased by 0.05-0.1 mg/kg may be given. Continue until sinus rhythm is
established or a maximum 0.3 mg/kg dose is used.
 Assessment of suspected CAD: 140 mcg/ kg/min IV infused over 6 min. Inject thalli um at 3 min.

Pediatric patients:

≥ 50 kg: Use adult dose.

Pharmacokinetics
Route: IV Onset: immediate Peak: 1o sec Duration: 20-30 sec

Metabolism: Hepatic; T2: < 10 sec

Distribution: Rapidly picked up by red blood cells

Adverse effects
CNS: Headache, light-headedness, dizziness, tingling in arms, numbness, apprehension, blurred vision, burning
sensation, heaviness in arms, neck and back pain.

CV: Facial flushing, arrhythmias, sweating, palpitations, chest pain, hypotension.

GI: Nausea, metallic taste, tightness in throat, pressure in groin.

Respiratory: Shortness of breath or dyspnea, chest pressure, hyperventilation.

Nursing considerations Assessment

• History: Hypersensitivity to adenosine, second- or third-degree AV heart block, sick sinus syndrome, atrial flutter,
atrial fibrillation, ventricular tachycardia, asthma (use caution)

• Physical: Orientation; BP, P, auscultation, ECG, R, adventitious sounds

Interventions:

• Assess asthma patients carefully for signs of exacerbation of asthma.

• Monitor patient's ECG continually during administration. Be alert for the possibility of arrhythmias. These usually
last only a few seconds.