Adenosine: Action,Uses, Administration and side effects by Nursesnote

 ADENOSINE Action,Uses, Administration and side effects

Pharmacotherapeutic; Cardiac agent, diagnostic aid.

Clinical: Antiarrhythmic.

Uses of Adenosine

Adenocard: Treatment of paroxysmal supraventricular tachycardia (PSVT), including patients associated with accessory bypass tracts (Wolff-Parkinson-White syndrome). 

Adenoscan: Adjunct in diagnosis in myocardial perfusion imaging or stress echocardiography. 

Off label: Acute  vasodilator testing in pulmonary artery hypertension.

Precautions Using Adenosine 

Contraindications: Hypersensitivity to adenosine. Second or third-degree AV block, symptomatic bradycardia, sick sinus syndrome (except in patients with functioning pacemaker). Bronchoconstrictive or bronchospastic lung disease, asthma. Caution: patients with first-degree AV block, bundle branch block; concurrent use of drugs that slow AV conduction (e.g. digoxin, verapamil); autonomic dysfunction, pericarditis, pleural effusion, carotid stenosis, uncorrected hypovolemia; elderly, patients with bronchoconstriction.

Adenosine Action

Slows impulse formation in SA node and conduction time through AV node. Acts as a diagnostic aid in myocardial perfusion imaging or stress echocardiography by causing coronary vasodilation and increased blood flow. 

Therapeutic Effect: Restores normal sinus rhythm.

Pharmacokinetics

Rapidly cleared from circulation via cellular uptake. Metabolizes via phosphorylation or deamination. 

Half-Life: Less than 10 secs.

Lifespan considerations/Adenosine

Pregnancy/Lactation: Unknown if distributed in breast milk. Do not breastfeed until approved by physician. 

Children/Elderly: No age-related precautions note.

Availability of Adenosine

Injection Solution (Adenocard: 3 mg/mL in 2mL, 4mL vials, Injection solution (Adenoscan): 3 mg-mL in 20-mL, 30-mL vials.

Administration of Adenosine

IV

• Administer very rapidly (over 1-2 sec) undiluted directly into vein, or if using IV line, use closest port to insertion site. If IV line is infusing any fluid other than 0.9% NaCl, flush line first.
• After rapid bolus injection, follow with 0.9% Nacl rapid flush, B/P

Indications of adenosine

Paroxysmal Supraventricular Tachycardia (PSVT) (Adenocard) 

Rapid IV Bolus: Adults, Elderly, Children weighing 50 kg or more: Initially 6 mg given over 1-2 sec. If first dose does not convert within 1-2 min, give 12 mg; may repeat 12-mg dose in 1-2 min if no response has occurred. Follow each dose with 20 mL 0.9% NaCl by rapid IV push.

Children Weighing Less than 50 kg: Initially 0.05-0.1 mg/kg. (maximum: 6 mg). If first dose not convert within 1-2 min, may increase dose by 0.05-0.1 mg/kg. May repeat until sinus rhythm is established or up to a maximum single dose of 0.3 mg/kg or 12 mg. Follow each dose with 5-10 mL 0.9% NaCl by rapid IV push.

Side effects of Adenosine

Frequent (18%-12%): Facial flushing, dyspnea. Occasional (7%-2%): Headache, nausea, light-headedness, chest pressure. Rare (1% or less): Paresthesia, dizziness, diaphoresis, hypotension, palpitations, chest, jaw, or neck pain.

Nurses role in Adenosine administration

Assessment: identify arrhythmia per cardiac monitor, 12-lead EKG, and assess apical pulse, B.P.

Assess cardiac performance per continuous EKG. Monitor B/P, apical pulse (rate, rhythm,quality). Monitor serum electrolytes.