Adenosine

Question 1

Generic

Class

Answer 1

Adenosine

Anti arrhythmic
Endogenous nucleoside

Question 2

Mech of action

Answer 2

Slows conduction time through AV node; can interrupt re/entrant pathways through the AV node

Slows sinus rate

Larger doses decrease BP by decreasing peripheral resistance

Question 3

Indication

Answer 3

Conversion of SVT with no known atrial fibrillation or atrial flutter

Undifferentiated regular monomorphic wide complex tachycardia

Question 4

Adverse reaction

Answer 4

CV:Transient dysthymia(systole
Bradycardia, PVC) occur in 55% of pts.(none reported as irreversible) Palpitations, chest pressure, chest pain,hypotension, transient hypertension;facing flushing, sweating
Resp: dyspnea, hyperventilation, tightness in throat, bronchospasm
CNS: lightheadedness, headache, dizziness, paresthesias, apprehension, blurred vision, neck/back pain
GI: nausea, metallic taste

Question 5

Notes of admin

Incompatibilities/ drug interactions

Answer 5

Adenosine is not blocked by atropine

Theophylline and related methylxanthines in therapeutic concentrations decrease effectiveness

Dipyridamole and carbamazepine Block uptake and potentiate effects

Question 6

Adult dose

Answer 6

Initial: 6 mg rapid IV bolus over 1-3 sec

Special ministration procedure: follow immediately with 20 mL normal saline flush
IV site recommended is antecubital fossa (Close to Central circulation) use injection port nearest hub of IV catheter; arm elevated during procedure; Constant ECG monitoring
Repeat: if no response in 1–2 minutes( of each dose, respectively) May repeat 12 g utilizing the same procedure for the repeat those.

Question 7

Route

Onset

Answer 7

Rapid IV push

Seconds

Question 8

Special notes

Answer 8

Dysrhythmias may recur (short half life)

Dysrhythmias appear in 55% of pts at conversion, lasting for a few seconds, do not usually require intervention.

Second dose must be prepared and available

Check for crystallization in cold climates.

Question 9

Contraindications

Answer 9

Sick sinus syndrome 2nd or 3rd degree AV blocks; except in pts with a functioning ventricular pacemaker
Use cautiously in pts with known asthma(has precipitated acute bronchospasm)
Pts on theophylline and related methylxanthines
Pts on dipyridamole(persantine) or carbamazepine
Cardiac transplant pts are more sensitive to adenosine and require only a small dose
Known atrial fibrillation or atrial flutter
Pregnancy

Question 10

Ped dose

Answer 10

Initial: 0.1 mg/kg as a rapid IV bolus
Special administration procedures: follow immediately with 2-3 ml normal saline flush.
Repeat : if no response dose may be doubled 1 time (0.2 mg/kg) using same administration procedures.
Maximum single dose: should not exceed 12 mg
Infants with SVT associated with shock: adenosine may precede cardiovascular if vascular access is available, but cardio version should not be delayed with IV access is achieved.

Question 11

Peak effects

Duration

Arizona drug box minimum

Answer 11

Seconds

10-12 sec (1/2 life 5 seconds)

18 mg