Adenosine
Mechanism of Action:
Antiarrhythmic: Slows impulse formation in SA node and conduction time through AV node. Interrupts the re-entry pathways through A-V node
Indications:
1. Rapid reversal of SVT to sinus Rhythm.
2.SVT with aberrant conduction.
3.Aiding diagnosis of narrow or broad complex tachycardias.
| Dosage Forms & Strengths : Adults : injectable solution •6mg/2mL , 12mg/4mL (3mg/ml) Paroxysmal Supraventricular Tachycardia Indicated for conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PSVT), including that associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome) Adenocard: 6 mg IV Push over 1-3 seconds (maybe given IO) followed by rapid flush with 20 mL NS, if no conversion within 1-2 minutes give 12 mg IVP, repeat a second time if necessary (30 mg total) | Dosage Forms & Strengths : Pediatric injectable solution •6mg/2ml, 12mg/4mL (3mg/ml) Paroxysmal Superventricular Tachycardia (per ACLS) <50 kg: 0.05 to 0.1 mg/kg rapid IVP over 1-3 seconds or IO, no more than 0.3 mg/kg/dose, followed by rapid flush with > 5 mL 0.9% NaCl If necessary, may give 2nd dose of 0.2 mg/kg IVP/IO, not to exceed cumulative dose of 12 mg | Geriatric : PSVT (Adenocard) 6 mg IVP over 1-3 seconds (maybe given IO) followed by rapid flush with 20 mL NS, if no conversion within 1-2 minutes give 12 mg IVP, repeat a second time if necessary (30 mg total) | |
| Stress Testing (Diagnostic) Indicated as an adjunct to thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately Adenoscan: 140 mcg/kg/min IV infusion for 6 min | Adenoscan (Diagnostic) Stress testing (Adenoscan): 140 mcg/kg/min IV infusion for 6 min | ||
Cautions & Contraindications:
1.Second and Third – degree AV Block. Sick sinus syndrome.
2.Prolonged QT Syndrome
3.Severe Hypotension
4.Decompensated Heart Failure
5.Asthma
Side- effects:
- Chest pain
- Dyspnea
- Bronchospasm
- Nausea
- Severe Bradycardia
- Choking sensation
- Light Headedness
Metabolism & Half-life :
Rapidly cleared from circulation via cellular uptake. Metabolized via phosphorylation or deamination. Half-life: Less than 10 secs.
Drug Interactions:
- Dipyridamole, nicotine may increase effect.
- Carbamazepine may increase degree of heart block caused by adenosine.
- Avoid caffeine (may decrease effect).
Administration
IV Compatibilities
•Solution: dextrose 5% in LR, D5W, LR, NS
IV Administration
- Adenocard: given as a rapid injection (1-3 sec) by peripheral IV route directly into vein or into IV line close (proximal) to patient and is followed by rapid NS flush after each injection (20 mL for adults, 5 mL or more for pediatrics)
- Place patient in mild reverse Trendelenburg position before giving drug
- Record rhythm strip during administration
- Draw up (separate syringes)
- Adenosine dose
- Flush
- ·Attach both syringes to IV injection port nearest to patient
- Clamp IV tubing above injection port. Avoid drug traveling retrograde.
- Push adenosine as fast as possible (1-3 sec)
- While keeping pressure on adenosine syringe plunger, push NS flush as fast as possible
- Unclamp IV tubing
- Preferred method using a stopcock
- Have adenosine in one port and NS flush in other port
- Simply open stopcock to adenosine and push
- Close stopcock and open port to NS and push
- Eliminates possibility of adenosine traveling retrograde
- May be given via central line or intraosseous
- Adenoscan: given by continuous peripheral IV infusion for 6 minutes
Storage
Store at controlled room temperature of 15-30°C
Do not refrigerate; possible crystal formation
Solution must be clear prior to administration.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Identify arrhythmia per cardiac monitor, 12-lead ECG, and assess apical pulse, B/P.
INTERVENTION/EVALUATION
1.Assess cardiac performance per continuous ECG.
2.Monitor B/P, apical pulse (rate, rhythm, quality). Monitor respiratory rate.
3.Monitor serum electrolytes.
PATIENT/FAMILY TEACHING
• May induce feelings of impending doom, which resolves quickly.
• Flushing/headache may occur temporarily following administration.
• Report continued chest pain, light-headedness, head or neck pain, difficulty breathing
Important points:
1.Ensure the patient is linked to a cardiac monitor or defibrillator.
2.Attempt vasovagal maneuvers prior to administration unless contraindicated.
3.If NO response to the above, start with 6mg IV rapid bolus given through a large vein and flush with 20ml of normal saline.
4.Repeat with 12mg after 1-2 minutes if no response. A further 12mg can be given.
5.Early specialist cardiology advice is warranted if no response to 12mg of adenosine or if adverse signs are present at any stage . E.g., heart failure.
6.Patients should be informed prior to adenosine administration of possible chest pain and the sensation of the heart ceasing to beat.
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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