Generic Drug Name: adenosine
Brand Names: Adenocard, Adenoscan
Classification:
Therapeutic: antiarrythmics
Pharmacologic: n/a
Indications:
- Conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm (NSR) after failed vagal maneuvers.
- Diagnostic tool to assess myocardial perfusion defects from coronary artery disease
Mechanism of Action:
Interrupts the re-entrant pathways of the AV node in the heart to restore sinus rhythm. Slows AV conduction time. Vasodilates the coronary arteries.
Expected Response: normal sinus rhythm restored
Common Adult Doses: (ALWAYS CHECK YOUR ORDERS)
For PSVT:
IV (Adults and children >50kg): Adenocard – 6 mg by rapid IV bolus, if no response, repeat 1-2 minutes later as 12 mg rapid IV bolus. Adenoscan – 140 mcg/kg/min for 6 minutes
IV (children <50kg): 0.05-0.1 mg/kg as rapid bolus, may repeat in 1-2 minutes if ineffective with increased dose of 0.05-0.1 mg/kg with maximum dose of 0.3 mg/kg
Contraindications:
- Hypersensitivity to adenosine
- 2nd or 3rd degree AV block or sick sinus syndrome, unless functioning artificial pacemaker is present
- Myocardial ischemia/infarction (only Adenoscan)
Side Effects:
Common
- Shortness of breath
- Facial flushing
- Transient arrhythmias
Life-Threatening
- Seizures (only with Adenoscan)
- Stroke (only with Adenoscan)
- Myocardial infarction
- Ventricular tachycardia
- Hypersensitivity reactions
Nursing Considerations:
Assessment
- Monitor heart rate every 15-30 seconds and EKG during drug administration. Short, transient period of 1st, 2nd, or 3rd degree heart block or systole can occur after the injection which resolves quickly due to adenosine’s short duration. Ectopic beats are also common after the return to normal sinus rhythm but should only last a few seconds.
- Monitor blood pressure during drug administration.
- Assess respiratory status (rate and sounds) after administration. Patients with asthma history may experience bronchospasms.
Nursing Diagnoses
- Decreased cardiac output (Indications)
Implementation
- IV Push: Administer medication undiluted (3 mg/ml concentration) over 1-2 seconds via peripheral IV. Follow each dose with a rapid 20 ml saline flush to ensure dose reaches systemic circulation.
- Intermittent Infusion (diagnostic test): Administer 30 ml vial undiluted (3 mg/ml concentration) at a rate of 140 mcg/kg/min over 6 minutes for a total dose of 0.84 mg/kg. Thallium-201 should be injected halfway through the Adenoscan dose (3 minutes in to procedure) as close to the IV site as possible
- Educate patient to
- caution patient to change positions slowly to minimize orthostatic hypotension
- instruct patient to report facial flushing, shortness of breath, or dizziness
- Have patient avoid products with methylxanthines (caffeinated coffee, tea, carbonated drinks, or drugs aminophylline or theophylline) prior to myocardial perfusion imaging study
Expected Outcomes
- Conversion to NSR from PSVT
- Diagnosis of myocardial perfusion defects
Reference
Vallerand, A. H. & Sanoski, C. A. (2019). Davis’s drug guide for nurses. (16th ed., pp. 113-114). F.A. Davis Company.
