adenosine (adenocard) - northwestern medicine
TRANSCRIPT
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Adenosine (Adenocard)
McHenry Western Lake County
EMS
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Objectives
• During this session we will discuss:
• Class
• Actions
• Indications
• Contraindications
• Dosing/Routes
• Pharmacokinetics
• How supplied
• PrecautionsSide effects/adverse reactions
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Class:
• Antidysrhythmic
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Actions:
• Slows the conduction through AV node,
can interrupt reentry pathways through the
AV node, and can restore normal sinus
rhythm in patients with paroxysmal
Supraventricular tachycardia. (PSVT).
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Indications:
• PSVT including WPW. Unresponsive to
Vagal maneuvers.
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Dosing/Routes:
• Adults: 6 mg rapid IVP followed by 10 ml
NS rapid flush. Repeat: 12mg rapid IVP
followed by 10 ml NS rapid flush.
• Peds: 0.1 mg/kg rapid IVP (max 1st dose
6mg) followed by 5 ml NS rapid flush.
Repeat dose 0.2 mg/kg followed by 5 ml
NS rapid flush.
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• Use the proximal IV or the one closest to your patient.
• Larger doses may be needed in patients with significant levels of theophylline, caffeine, or theobromide.
• Reduce the dose to 3 mg in patients taking dipyrimadole (Aggrenox) or carbamazepine (Abilify) or with transplanted hearts.
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Pharmacokinetics:
• Cleared from the plasma in <30 seconds.
Half life is 10 seconds. This is why it is
imperative that the flush is given
immediately behind the medication
through the IV port.
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How supplied:
• 6mg in 2ml vial.
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Contraindications:
• Asthma, 2nd and 3rd –degree block, AV
block, sick sinus syndrome. Will not
terminate known AF/A-flutter, but will slow
conduction to identify.
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Precautions:
• Use with caution in patients with reactive
airway disease (may cause
bronchospasm) and heart transplant due
to prolonged asystole has been reported.
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Side effects/adverse reactions:
• GI: Nausea, metallic taste, throat tightness, groin pressure.
• Resp: Dyspnea, chest pressure, hyperventilation, bronchospasm
• CNS: Lightheadedness, dizziness, arm tingling, numbness, apprehension, blurred vision, headache, facial flushing, N/V.
• CV: Chest pain, atrial tachydysrhythmias, sweating, palpitations, hypotention, facial flushing. PVC’s, PAC’s, SB, ST, falling B/P.
• Ref: MWLCEMS Protocol and 2000 Mosby’s Nursing Drug Reference Book.
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Adenosine administration
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Case Study
• You have been called to the scene of a
woman complaining of palpations. You feel
her pulse as you do get her history and
find it to be very rapid at @220. You have
hooked her up to your monitor and she
shows a PSVT at 224.
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Case study continued
• You have tried all of the Vagal maneuvers
and have no success in converting the
rhythm. Your first dose of Adenosine
should be:
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Answer:
• 6mg rapid IVP followed by a 10ml bolus
immediately into the proximal IV site.
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Case Study
• This has not converted your patient and
you need to give a second dose. What
would the repeat dose of Adenosine be:
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Answer
• 2nd dose of Adenosine would be 12mg
rapid IVP followed immediately with a 10
ml bolus of NS.
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REMEMBER!!!
• Cleared from the plasma in <30 seconds.
Half life is 10 seconds. This is why it is
imperative that the flush is given
immediately behind the medication
through the IV port.