ADENOSINE (Adenocard®)

CLASS:

• Antiarrhythmic (antidysrhythmic)

• Endogenous Nucleoside

ACTIONS:

• Endogenous Nucleoside found in all cells of the body and is formed from the breakdown of ATP that depresses AV node and Sinus Node activity

• Decrease conduction through the AV node and interrupts AV nodal reentry pathways that cause SVT.

INDICATIONS:

• SVT’s thought to be due to reentrant mechanisms

• ACLS - Effective in terminating those due to reentry involving AV node or SA node.

• ACLS - Wide complex regular tachycardia, thought to be or previously defined to be, reentry SVT.

CONTRAINDICATIONS:

• Drug or fever induced tachycardia

• 2nd or 3rd degree heart block

• Sinus node disease SSS (Sick Sinus Syndrome unless has a functioning pacemaker.)

• A-fib / A-flutter / V-tach

STANDARD PREP:

• 6 mg/2 cc vial

DOSE/ROUTE:

• See ACLS and PALS Tachycardia Algorithm

• 6 mg rapid bolus over 1-3 seconds followed by a 20 cc flush at most proximal site of IV catheter

• If no response within 1-2 min. 12 mg bolus repeat x1

Onset: Immediate — Duration: 10 seconds

• PALS: 0.1mg/kg IV (maximum 1st dose: 6mg) follow immediately with >5ml NS flush

• May give 0.2mg/kg IV for second dose with Subsequent maximum single dose 12mg

SIDE EFFECTS:

• Chest pain

• Hypotension

• Arrhythmias: PAC's, 2nd or 3rd degree heart block, asystole, ventricular ectopy

• Nausea

• Dyspnea

• Headache, lightheadedness and flushing

PRECAUTIONS:

• Patients taking theophyllines, caffeine, or theobromine need higher doses

• Dipirydamole (persantine), carbamazepine (tegretol) prolong effects of adenosine - might want to reduce dose (3mg)

• Use with caution in denervated, transplanted hearts and may require only a small dose

• Reactive airway disease – increase bronchoconstriction

• If administered for wide-complex tachycardia/VT, may cause deterioration (including hypotension)