ADENOSINE (ADENOCARD)

1. Indications
   1. For termination of episodes of acute supraventricular tachycardia involving the AV-node
   2. Wide complex tachycardia with pulse refractory to ventricular antidysrhythmics

2. Administration
   1. Direct rapid intravenous bolus over 1-2 seconds of 12mg initially, followed immediately by 20 ml saline flush. A second dose of 12 mg may be given after an interval of 1-2 minutes if the tachycardia persists. Total dose should not exceed 24 mg.
   2. Pediatric Dose: rapid IV/IO 0.2 mg/kg initial dose and second dose if SVT persists.
3. Contraindications
   1. Contraindicated in patients with known hypersensitivity to the drug
   2. Patient with second and third-degree heart blocks or sick sinus syndrome

4. Precautions
   1. Adverse effects include flushing, dyspnea, chest pain, anxiety, and occasionally hemodynamic disturbances - all of which are of short duration.

5. Side Effects/Special Notes
   1. Whenever possible establish the IV at the anticubital. The dose of adenosine has been calculated for this IV location.
   2. Adenosine is safe in-patients with Wolf-Parkinson-White Syndrome.
   3. Concomitant use of dipyridamole (Persantine) enhances the effects of adenosine. Smaller doses may be required.
   4. Caffeine and theophylline antagonize adenosine's effects. Larger doses may be required.
   5. Warn patients to expect a brief sensation of chest discomfort.
   6. If patient is hemodynamically unstable, see appropriate tachycardia algorithm.

6. Pharmacology and Actions
   1. Adenosine is an endogenous nucleoside with antiarrhythmic activity.
   2. Because of its short plasma half-life (less than 10 seconds with IV doses), the clinical effects of adenosine occur rapidly and are very brief.
   3. Produces a transient slowing of the sinus rate.
   4. Has a depressant effect on the AV node.