Adenosine
Revision as of 16:38, 19 September 2019 by ClaireLewis (talk | contribs)
See critical care quick reference for drug doses by weight.
General
- Type: Antiarrhythmics
- Dosage Forms: IV
- Common Trade Names: Adenocard, Adenoscan
Indications
- Conversion of reentrant PSVT to NSR
Adult Dosing
Stable, narrow complex tachycardia
- 6mg rapid IV push over 1-2s
- If ineffective can try 12mg 2min later
- If still ineffective can try another 12mg
- Caveat
- For patients taking methylxanthines (ie caffeine, theophylline):
- Blocks adenosine binding at receptor sites (competitive antagonist) and can lead to bronchospasm
- Consider using lower dose (1st 3mg, 2nd/3rd 6mg) in patient taking carbamazepine (Tegretol), diazepam (Valium) or dipyridamole (Persantine) OR with a heart transplant.
- For patients taking methylxanthines (ie caffeine, theophylline):
Pediatric Dosing
PALS guidelines for infants, children, and adolescents[1] See critical care quick reference for drug doses by weight.
- 0.1mg/kg rapid IV/IO push (max 6mg/dose)
- If not effective, increase to 0.2 mg/kg (max 12mg/dose)
Special Populations
Pregnancy Rating
- May use during pregnancy; risk of fetal harm not expected based on limited human data
Lactation
- Cardiac Stress Testing: may use while breastfeeding; no human data available, though risk of infant harm and adverse effects on milk production not expected based on drug properties.
- All other uses: N/A; drug unlikely to be used during breastfeeding based on indication
Renal Dosing[2]
- Adult
- Not defined - not renally eliminated
- Pediatric
- Not defined - not renally eliminated
Hepatic Dosing[3]
- Adult
- Not defined - not hepatically eliminated
- Pediatric
- Not defined - not hepatically eliminated
Contraindications
- Allergy to class/drug
- 2nd, 3rd AV block
- Sick sinus syndrome
- Reentrant SVTs not involving AV node are not terminated
- No effect on anterograde WPW
Adverse Reactions
- Bronchoconstriction (responds to bronchodilators)
- Bradyarrhythmia
- Hypotension(if given too slowly)
Pharmacology
- Kinetics: Onset of action = 20-30s Duration of action = 60-90s
- Half-life: <10 seconds
- Metabolism: vascular endothelial cells
- Excretion:
Mechanism of Action
- Negative inotropic, dromotropic, chronotropic effects
- Transient AV nodal block