Adenosine

Adenosine

 

Class:
  • Antidysrhythmic agent (parasympathomimetic agent)
Actions:
  • Slows automaticity at the SA node (negative chronotropic)
  • Slows conduction through the AV node
Indications:
  • Narrow QRS tachycardias (PSVT, PAT, SVT) — 1st line drug of choice according to ACLS
Pharmacokinetics:
  • Onset: 20-30 seconds
  • Half-Life: 10 seconds  [Notice how fast this drug works and is inactivated!]
Adverse Effects:
  • Sinus arrest (transient episode of asystole lasting up to 6-12 seconds
  • Flushing, sinus bradycardia, hypotension (transient symptoms)
  • Dyspnea, chest discomfort
Signs of Toxicity:
  • (None due to short half-life)
Contraindications:
  • Pre-existing 2nd or 3rd degree AV blocks
  • Wide QRS tachycardias
  • Not recommended for atrial flutter, atrial fibrillation, or ventricular tachycardia.
  • Safety during pregnancy not established (Category C).
Dosages & Routes:
  • IV bolus:  6 mg rapid IV push through IV port closest to patient in IV site closest to heart.  (2nd and 3rd doses of 12 mg may be given rapid IV push at 1-2 minute intervals.)
Nursing Implications:
  • Drug Interactions:  1) Methylxanthines (aminophylline, caffeine) reduce effects of adenosine.  2) Dipyridamole (Persantine®) and carbamazepine (Tegretol®) potentiate the effect so only 3 mg boluses of adenosine are recommended.
  • Drug Incompatibilities:  Use IV line with no other medications.
  • Monitor blood pressure and apical pulse prior to administration.
  • Cardiac monitor should be used on patients receiving adenosine IV boluses.
  • Flush IV port with flush solution (e.g., normal saline) immediately after IV bolus.
  • Use only clear solutions; discard unused medication.
  • Warn patient of possibility of transient warmth and flushing of skin immediately following injection.
  • Warn other staff that ECG may show transient episode of asystole.
  • Assess for bronchospasms following administration of medication.

 

References:

American Heart Association. (2006). Handbook of Emergency Cardiac Care (p. 45). Salem, MA: AHA.

Dirks, J.L. (2010) Cardiovascular therapeutic management.  In L.D. Urden, K.M. Stacy, & M.E. Lough's (Eds.) Critical care nursing: Diagnosis and management (6th ed., p. 545).  St. Louis: Mosby Elsevier.

Lehne, R.A. (2010). Pharmacology for nursing care (7th ed., p. 548).  St. Louis: Saunders Elsevier.

Wilson, B.A., Shannon, M.T., Shields, K.M., & Stang, C.L. (2007).  Prentice Hall Nurse's Drug Guide 2007 (pp. 24-26).  Upper Saddle River, NJ: Pearson Prentice Hall.

 

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