Adenosine

Provider Level

RN/Paramedic

Class

Antiarrhythmic, endogenous nucleoside

Mechanism of Action

Slows conduction time through the AV node and interrupts AV node reentry pathways to restore normal sinus rhythm.

Indications

Stable, regular, narrow-complex supraventricular tachycardia (SVT). Regular, monomorphic wide-complex tachycardia (as a diagnostic or therapeutic maneuver).

Contraindications

Second- or third-degree AV block or sick sinus syndrome (unless functioning pacemaker is present); known hypersensitivity; asthma or reactive airway disease; poison- or drug-induced tachycardia.

Routes

IV, IO

Onset / Duration

Onset: Immediate. Duration: 10 to 15 seconds. Half-life: Less than 10 seconds.

Adverse Effects

Transient asystole or bradycardia, chest pressure, facial flushing, dyspnea, hypotension, nausea, lightheadedness.

Precautions & Interactions

Patients receiving dipyridamole or carbamazepine may have exaggerated responses. Caffeine and theophylline antagonize the effects. May cause transient bronchospasm in susceptible patients.

Special Considerations

Requires continuous ECG monitoring. Must be administered via a proximal IV site as a rapid push followed immediately by a rapid saline flush. Explain the sensation of impending doom or chest tightness to the patient prior to administration.