Adenosine "ebove" is a drug from the group of purine nucleotides. Drug administration leads to stabilization of coronary blood flow and normalization of blood clotting. The drug has a metabolic, antiarrhythmic and arteriodilating effect. Adenosine "ebove" is a drug from the group of purine nucleotides. Drug administration leads to stabilization of coronary blood flow and normalization of blood clotting. The drug has a metabolic, antiarrhythmic and arteriodilating effect.
Adenosine is associated with a dose-dependent negative dromo-, chrono-, and also inotropic effect, affecting the heart. Since the drug has a short half-life, a negative inotropic effect is not critical.
Antiarrhythmic action occurs after the rapid introduction of adenosine intravenously, due to the dromotropic effect. It inhibits AV-conductivity, lowers the chemical reaction of calcium cell channels, and also increases the permeability of cardiomyocyte cells for potassium ions. At the same time, it interferes with the action of cyclic AMP in cardiomyocytes, as a result of which a normal heart rhythm is restored in patients with paroxysmal CBT (with the inclusion of the AV node in the pulse re-entry mechanism).
Negative chronotropic effect may cause the development of a temporary sinus bradycardia, which then passes into sinus tachycardia.
Adenosine has no effect in the case of atrial flutter or atrial fibrillation, since the AV node does not enter the mechanism of re-entry of the pulse.
At a dosage of 6-12 mg does not have systemic hemodynamic effects. If the infusion is performed in large doses, the drug may cause a drop in blood pressure.
Use of the adenosine "Ebove" during pregnancy
Since adenosine is a natural component present in all cells of the body, and its half-life is very short, the drug should not have a negative effect on the baby. But, since there is not enough information about the consequences of therapy with this medication, it is recommended to use it during pregnancy only for vital indications.
Among the contraindications to the use of medication:
- Hypersensitivity to adenosine;
- AV-blockade of 2-3 degrees, as well as Short's syndrome (with the exception of patients with pacemakers);
- Obstructive pathologies of the lungs (eg, bronchial asthma);
- Syndrome of long interval QT.
With caution appoint the drug in such cases:
- With CHF in severe form;
- Unstable angina;
- After a recent myocardial infarction;
- TP and AF (in patients with additional conduction pathways, a transient increase in conduction is possible);
- After a recent heart transplant;
- Hypotension in severe form;
- With the available in the anamnesis stops of breathing in a dream;
- When shunting the blood from left to right;
- Concomitant treatment with dipyridamole (in which case adenosine can be administered in small dosages, and only when there is a threat to the patient's life).
Side effects of the adenosine "Ebove"
Among the frequent side effects of the drug: dyspnea, a rush of blood to the skin of the face, bronchial spasm, nausea, a feeling of squeezing in the chest, as well as dizziness.
In addition, there are possible such manifestations: sweating, a feeling of discomfort, a quickening of the heart rhythm, dizziness, increased intracranial pressure, hyperventilation, the appearance of "veils before the eyes," bradycardia, headache, asystole. In addition, there may be pain in the chest, paresthesia, a feeling of drowsiness, back and neck pain, a taste of metal in the oral cavity, as well as pharyngeal symptoms.
In general, these adverse reactions last not for long - less than 1 min.
In rare cases, the consequence of adenosine administration may be a decrease in blood pressure and AF.
Occasionally side effects are longer and potentially life-threatening phenomena (fibrillation and flutter of the ventricles, as well as asystole). In such cases, electrotherapeutic intervention is sometimes required.
Dosing and administration
Adenosine is allowed to be used only for inpatient treatment using equipment that is used for cardiopulmonary resuscitation. During the application of adenosine, it is necessary to monitor the ECG continuously, since there is a risk of arrhythmias.
The first dose is 3 mg; if the tachycardia continues after 1-2 min, a second dose (6 mg) is given; if after another 1-2 minutes no improvement is observed, the third dose (9 mg) is administered; if cessation of tachycardia did not occur after 1-2 min, a fourth dose (12 mg) was administered.
Since the first dose (3 mg) has poor efficacy, adenosine therapy usually begins with the second dose (6 mg).
If the 4th dose (12 mg) did not give the desired result, the solution can be administered again in the same dosage, or increasing it to 18 mg. After this, administer the drug at the same dose or higher is not recommended.
All the above dosages should be reduced if treatment is performed after cardiac transplantation or in combination with dipyridamole. But with treatment in combination with methylxanthine, the dosage of adenosine should be increased.
Adenosine is administered by a bolus injection, which lasts 1-2 sec. It should be inserted into the large peripheral veins, and then it is recommended to immediately inject 0.9% NaCl solution (10 ml).
Use of adenosine in the process of diagnosis of cardiac ischemia.
Radioisotopes and adenosine should be poured into different veins - this is necessary in order to avoid a bolus effect.
In the SPECT process using thallium-201, intravenous adenosine is administered in 6 minutes (the rate is 140 μg / kgCmin). Thallium-201 in this case should be rapidly introduced into the vein 3 minutes after the introduction of adenosine.
To avoid the appearance of a bolus effect, during the adenosine maintenance it is necessary to monitor the blood pressure in the other hand.
Manifestations of drug overdose can be observed in the case of admission in combination with dipyridamole. But, since adenosine has a very short half-life, the symptoms of an overdose occur quickly enough.
But there are also severe cases in which stable bradycardia in severe form can occur, as well as AF and asystole, which require a temporary pacemaker or electrical cardioversion to eliminate (this depends on the type of arrhythmia).
Interactions with other drugs
Dipiridamole reduces the strength of cellular adenosine capture, so it can enhance its effect. As a consequence, in the treatment with dipyridamole, adenosine administration takes place in small doses and only in case of a threat to life.
Caffeine, as well as theophylline and other xanthine derivatives, are adenosine antagonists that reduce the strength of its effect on the body.
Carbamazepine increases the negative dromotropic effect of adenosine.
Adenosine efficiently interacts with other substances that affect AV-conductivity - these are ß-blockers, sodium channel modulators, CCBs, Digitalis preparations, and also the propanorm amiodarone.