Names and pronunciation
(a-den′oh-seen) Adenocard
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Drug reference
(a-den′oh-seen) Adenocard
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Func. class.: Antidysrhythmic
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Chem. class.: Endogenous nucleoside
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ACTION: Slows conduction through AV node, can interrupt reentry pathways through AV node, and can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardia (PSVT)
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USES: PSVT, as a diagnostic aid to assess myocardial perfusion defects in CAD, Wolff-Parkinson-White syndrome
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Unlabeled uses: Wide-complex tachy- cardia diagnosis
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CONTRAINDICATIONS: Hyper- sensitivity, second- or third-degree AV block, sick sinus syndrome, bradycardia, asystole, COPD, asthma, severe respira- tory conditions Precautions: Pregnancy, breastfeed- ing, children, geriatric patients
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SIDE EFFECTS CNS: Light headedness, dizziness, arm tingling, numbness, headache; seizures CV: Chest pain, pressure, atrial tachydys- rhythmias, sweating, palpitations, hypo- tension, facial flushing, AV block, car- diac arrest, ventricular dysrhythmias, atrial fibrillation GI: Nausea, metallic taste RESP: Dyspnea, chest pressure, hyper- ventilation, bronchospasm (asthmatics) MS: Back pain
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INTERACTIONS Increase: risk for higher degree of heart block—carBAMazepine Increase: risk for ventricular fibrilla- tion—digoxin, verapamil; monitor ECG Increase: effects of adenosine—dipyri- damole; adenosine dose may need to be reduced Decrease: activity of adenosine—the- ophylline or other methylxanthines (caf- feine); adenosine dose may need to be increased Drug/Lifestyle Increase: tachycardia, hypertension (smoking) Drug/Herb Increase: adenosine effect—ginger Decrease: adenosine effect—guarana, green tea
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TREATMENT OF OVERDOSE: Defibrillation, vasopressor for hypoten- sion, aminophylline HIGH ALERT
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DOSAGE AND ROUTES Converting paroxysmal supraventricular tachycardia to sinus rhythm • Adult and child >50 kg (110 lb): IV BOL 6 mg; if conversion to normal sinus rhythm does not occur within 1-2 min, give 12 mg by rapid IV BOL; may repeat 12-mg dose again in 1-2 min • Infant and child <50 kg (110 lb): IV BOL 0.1 mg/kg; if not effective, increase dose by 0.05-0.1 mg/kg q2min to a max of 0.3 mg/kg/dose • Neonate: IV BOL 0.05 mg/kg by rapid IV BOL, may increase by 0.05 mg/kg q2min, max 0.3 mg/kg/dose Diagnostic use • Adult/child >50 kg: IV 140 mcg/kg/ min × 6 min (0.84 mg/kg total)
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Available forms: 3 mg/mL sol for injection
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Administer: IV, direct route • Warm to room temperature; crystals will dissolve • Undiluted; give 6 mg or less by rapid injection over 1-2 sec; if using an IV line, use port near insertion site, flush with NS (20 mL), then elevate arm, dose reduc- tion recommended if given by central line • Store at room temperature; solution should be clear; discard unused prod- uct IV intermittent infusion Diagnostic • Use 30-mL vial undiluted (3 mg/mL), give at 140 mcg/kg/min over 6 min (total 0.84 mg/kg) • Thallium-201 should never be given after 3 min of infusion
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Assess: • Cardiopulmonary status: B/P, pulse, respiration, rhythm, ECG intervals (PR, QRS, QT); check for transient dysrhythmias (PVCs, PACs, sinus tachycardia, AV block) • Respiratory status: rate, rhythm, lung fields for crackles; watch for respiratory depression; bilateral crackles may occur in HF patient; increased respiration, increased pulse, product should be discontinued • CNS effects: dizziness, confusion, psy- chosis, paresthesias, seizures; product should be discontinued • Pregnancy/breastfeeding: identify if pregnancy is planned or suspected, or if breastfeeding; use only if benefits out- weigh fetal risk; do not breastfeed
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Evaluate: • Therapeutic response: normal sinus rhythm or diagnosis of perfusion defect
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CLINICAL CONSIDERATIONS A
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Patient and caregiver information: • To report facial flushing, dizziness, sweating, palpitations, chest pain; usually transient; chest pressure may occur immediately after administration • To report IV discomfort • Pregnancy/breastfeeding: to advise prescriber if pregnancy is planned or sus- pected or if breastfeeding; do not breastfeed
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PHARMACOKINETICS Cleared from plasma in <30 sec, half-life 10 sec, converted to inosine/adenosine monophosphate
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• Adult and child >50 kg (110 lb): IV BOL 6 mg; if conversion to normal sinus rhythm does not occur within 1-2 min, give 12 mg by rapid IV BOL; may repeat 12-mg dose again in 1-2 min
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• Adult/child >50 kg: IV 140 mcg/kg/ min × 6 min (0.84 mg/kg total)
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