Adenosine

Aka: Adenosine

1. Mechanism
   1. Endogenous purine nucleoside
   2. Slows AV Node conduction
   3. Interrupts AV Nodal Reentry pathways
2. Pharmacokinetics
   1. Rapidly sequestered by Red Blood Cells
   2. Half-life: under 10 seconds
3. Indications
   1. Chemical conversion of AV Node re-entry Tachycardias
      1. Paroxysmal Supraventricular Tachycardia (PSVT)
      2. Wolff-Parkinson-White Syndrome (WPW Syndrome)
   2. Diagnosis in non-reentry Tachycardias
      1. Atrial Flutter
      2. Atrial Fibrillation
      3. Ventricular Tachycardia
4. Dose
   1. General
      1. Rapid IV bolus over 1-3 seconds
      2. Follow dose immediately with saline flush of IV line
      3. Expect brief period of Asystole (under 15 seconds)
   2. Children
      1. 0.1-0.2 mg/kg rapid IV push (Max: 12 mg)
   3. Adults
      1. Initial: 6 mg rapid IV push
      2. Next: 12 mg rapid IV push
   4. Dosing Adjustments for special circumstances
      1. Theophylline: may require higher Adenosine dose
      2. Cardiac Transplant: Small Adenosine dose effective
5. Adverse effects
   1. Transient effects (resolve within 2 minutes)
      1. Flushing
      2. Dyspnea
      3. Chest Pain
   2. Transient arrhythmias following PSVT conversion
      1. Sinus Bradycardia
      2. Ventricular ectopy
6. Drug Interactions
   1. Reduced effect of Adenosine
      1. Theophylline
      2. Methylxanthine (Caffeine, Theobromine)
   2. Potentiated effect of Adenosine
      1. Dipyridamole