Adenocard

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adenosine

Adenacor (UK), Adenocard, Adenoscan

Pharmacologic class: Endogenous nucleoside

Therapeutic class: Antiarrhythmic

Pregnancy risk category C

Action

Converts paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm by slowing conduction through atrioventricular (AV) node and interrupting reentry pathway. Also used as a diagnostic agent in thallium scanning.

Availability

Injection: 3 mg/ml

Indications and dosages

Adenocard-

PSVT, including that associated with Wolff-Parkinson-White syndrome (after attempting vagal maneuvers, when appropriate)

Adults and children weighing more than 50 kg (110 lb): Initially, 6 mg by rapid I.V. bolus over 1 to 2 seconds. If desired effect isn't achieved within 1 to 2 minutes, give 12 mg by rapid I.V. bolus; may repeat 12-mg I.V. bolus dose as needed. Maximum single dosage is 12 mg.

Children weighing less than 50 kg (110 lb): 0.05 to 0.1 mg/kg by rapid I.V. bolus. If this dosage proves ineffective, increase in 1 to 2 minutes by 0.05 mg/kg q 2 minutes, to a maximum single dosage of 0.3 mg/kg. Maximum single dosage is 12 mg.

Adenoscan-

Diagnosis of coronary artery disease in conjunction with thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately during testing

Adults: 140 mcg/kg/minute by I.V. infusion over 6 minutes, for a total dosage of 0.84 mg/kg. Required dose of thallium-201 is injected at midpoint (after first 3 minutes) of Adenoscan infusion.

Off-label uses

• Diagnosis of supraventricular arrhythmias
• Pulmonary hypertension

Contraindications

• Hypersensitivity to drug
• Second- or third-degree AV block
• Sinus node disease
• Bronchoconstrictive lung disease

Precautions

Use cautiously in:
• asthma, angina
• elderly patients
• pregnant patients
• children.

Administration

• Don't administer through central line (may cause asystole).
• Don't give more than 12 mg Adenocard as a single dose.
• Don't dilute Adenocard. Administer Adenocard by I.V. injection as a rapid bolus directly into vein whenever possible during cardiac monitoring.
• After administering Adenocard, flush I.V. line immediately and rapidly with normal saline solution to drive drug into bloodstream.
• Dilute a single dose of Adenoscan in sufficient normal saline solution to be given by continuous infusion over 6 minutes.

Adverse reactions

CNS: light-headedness, dizziness, apprehension, headache, tingling in arms, numbness

CV: chest pain, palpitations, hypotension, ST-segment depression, first- or second-degree AV block, atrial tachyarrhythmias, other arrhythmias

EENT: blurred vision, tightness in throat

GI: nausea, pressure in groin

Musculoskeletal: discomfort in neck, jaw, and arms

Respiratory: chest pressure, dyspnea and urge to breathe deeply, hyperventilation

Skin: burning sensation, facial flushing, sweating

Other: metallic taste

Interactions

Drug-drug.Carbamazepine: worsening of progressive heart block

Digoxin, verapamil: increased risk of ventricular fibrillation

Dipyridamole: increased adenosine effect

Theophylline: decreased adenosine effect

Drug-food.Caffeine: decreased adenosine effect

Drug-herbs.Aloe, buckthorn bark or berry, cascara sagrada, rhubarb root, senna leaf or fruits: increased adenosine effect

Guarana: decreased adenosine effect

Drug-behaviors.Smoking: increased risk of tachycardia

Patient monitoring

• Monitor heart rhythm for new arrhythmias after administering dose.
• Check vital signs. Assess for chest pain or pressure, dyspnea, and sweating.

Watch for bronchoconstriction in patients with asthma, emphysema, or bronchitis.
• Ask patient if he has recently used aloe, buckthorn, cascara sagrada, guarana, rhubarb root, or senna. If response is positive, notify prescriber.

Patient teaching

• Advise patient to report problems at infusion site.
• Tell patient he may experience 1 to 2 minutes of flushing, chest pain and pressure, and breathing difficulty during administration. Assure him that these effects will subside quickly.
• Advise patient to minimize GI upset by eating small, frequent servings of healthy food and drinking plenty of fluids.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, herbs, and behaviors mentioned above.

adenosine

(a-den-oh-seen) ,

Adenocard

(trade name),

Adenoscan

(trade name)

Classification

Therapeutic: antiarrhythmics
Pregnancy Category: C

Indications

Conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm when vagal maneuvers are unsuccessful.As a diagnostic agent (with noninvasive techniques) to assess myocardial perfusion defects occurring as a consequence of coronary artery disease.

Action

Restores normal sinus rhythm by interrupting re-entrant pathways in the AV node.
Slows conduction time through the AV node.
Also produces coronary artery vasodilation.

Therapeutic effects

Restoration of normal sinus rhythm.

Pharmacokinetics

Absorption: Following IV administration, absorption is complete.
Distribution: Taken up by erythrocytes and vascular endothelium.
Metabolism and Excretion: Rapidly converted to inosine and adenosine monophosphate.
Half-life: <10 sec.

Time/action profile (antiarrhythmic effect)

ROUTEONSETPEAKDURATION
IVimmediateunknown1–2 min

Contraindications/Precautions

Contraindicated in: Hypersensitivity;2nd- or 3rd-degree AV block or sick sinus syndrome, unless a functional artificial pacemaker is present.
Use Cautiously in: Patients with a history of asthma (may induce bronchospasm);Unstable angina; Obstetric / Lactation: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • apprehension
  • dizziness
  • headache
  • head pressure
  • light-headedness

Ear, Eye, Nose, Throat

  • blurred vision
  • throat tightness

Respiratory

  • shortness of breath (most frequent)
  • chest pressure
  • hyperventilation

Cardiovascular

  • facial flushing (most frequent)
  • transient arrhythmias (most frequent)
  • chest pain
  • hypotension
  • palpitations

Gastrointestinal

  • metallic taste
  • nausea

Dermatologic

  • burning sensation
  • facial flushing
  • sweating

Musculoskeletal

  • neck and back pain

Neurologic

  • numbness
  • tingling

Miscellaneous

  • heaviness in arms
  • pressure sensation in groin

Interactions

Drug-Drug interaction

Carbamazepine may ↑ risk of progressive heart block.Dipyridamole ↑ effects of adenosine (dose ↓ of adenosine recommended).Effects of adenosine ↓ by theophylline or caffeine (↑ doses of adenosine may be required).Concurrent use with digoxin may ↑ risk of ventricular fibrillation.

Route/Dosage

Intravenous (Adults and Children >50 kg) Antiarrhythmic—6 mg by rapid IV bolus; if no results, repeat 1–2 min later as 12-mg rapid bolus. This dose may be repeated (single dose not to exceed 12 mg). Diagnostic use—140 mcg/kg/min for 6 min (0.84 mg/kg total).
Intravenous (Children <50 kg) Antiarrhythmic—0.05–0.1 mg/kg as a rapid bolus, may repeat in 1–2 min; if response is inadequate, may increase by 0.05–0.1 mg/kg until sinus rhythm is established or maximum dose of 0.3 mg/kg is used.

Availability (generic available)

Injection: 6-mg/2-mL vial (Adenocard), 3 mg/1 mL in 30-mL vial (Adenoscan)

Nursing implications

Nursing assessment

  • Monitor heart rate frequently (every 15–30 sec) and ECG continuously during therapy. A short, transient period of 1st-, 2nd-, or 3rd-degree heart block or asystole may occur following injection; usually resolves quickly due to short duration of adenosine. Once conversion to normal sinus rhythm is achieved, transient arrhythmias (premature ventricular contractions, atrial premature contractions, sinus tachycardia, sinus bradycardia, skipped beats, AV nodal block) may occur, but generally last a few seconds.
  • Monitor BP during therapy.
  • Assess respiratory status (breath sounds, rate) following administration. Patients with history of asthma may experience bronchospasm.

Potential Nursing Diagnoses

Decreased cardiac output (Indications)

Implementation

  • Intravenous Administration
  • pH: 4.5–7.5.
  • Intravenous: Crystals may occur if adenosine is refrigerated. Warm to room temperature to dissolve crystals. Solution must be clear before use. Do not administer solutions that are discolored or contain particulate matter. Discard unused portions.
  • Diluent: Administer undiluted.Concentration: 3 mg/mL.
  • Rate: Administer over 1–2 seconds via peripheral IV as proximal as possible to trunk. Slow administration may cause increased heart rate in response to vasodilation. Follow each dose with 20 mL rapid saline flush to ensure injection reaches systemic circulation.
  • Intermittent Infusion: (for use in diagnostic testing)Diluent: Administer 30-mL vial undiluted.Concentration: 3 mg/mL.
  • Rate: Administer at a rate of 140 mcg/kg/min over 6 min for a total dose of 0.84 mg/kg. Thallium-201 should be injected as close to the venous access as possible at the midpoint (after 3 min) of the infusion.

Patient/Family Teaching

  • Caution patient to change positions slowly to minimize orthostatic hypotension. Doses >12 mg decrease BP by decreasing peripheral vascular resistance.
    • Instruct patient to report facial flushing, shortness of breath, or dizziness.

Evaluation/Desired Outcomes

  • Conversion of supraventricular tachycardia to normal sinus rhythm.
  • Diagnosis of myocardial perfusion defects.

Adenocard®

A proprietary formulation of adenine for converting arrhythmias to normal sinus rhythm in paroxysmal supraventricular tachycardia (PSVT), including that associated with accessory bypass tracts, such as Wolff-Parkinson-White syndrome (it does not convert atrial flutter, atrial fibrillation, or ventricular tachycardia).
Side effects Facial flushing, shortness of breath/dyspnoea, chest pressure, nausea; post marketing experience includes prolonged asystole, ventricular tachycardia, ventricular fibrillation, transient increase in blood pressure, bradycardia, atrial fibrillation, and torsade de pointes, bronchospasm, seizure activity, including tonic clonic (grand mal) seizures, and loss of consciousness.
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