| Name: |
ESMOLOL (BreviblocR) |
| Classification: |
beta 1 selective receptor blocker; ultra short acting
- decreases HR
- decreases systemic vascular resistance
- decreases AV conduction
- decreases myocardial contractility to decrease myocardial oxygen consumption
- can cause bronchoconstriction
|
| Dose: |
- Loading Dose:
- 500 ug/kg IV direct over one minute
- Maintenance Dose:
- 50 ug/kg/min IV infusion
- further partial loading doses of 500 ug/kg with an increase in infusion rate by 50 ug/kg/min may be repeated every 5 minutes to a maximum infusion rate of 300 ug/kg/min
|
| Administration: |
IV Infusion:
5 000 mg/500 ml D5W, NS, or RL (10mg/mL)
|
| Adverse Effects: |
- hypotension
- bradycardia, AV block
- decreased cardiac output
- bronchospasm
- acute pulmonary edema
- increased SVRI
|
| Caution: |
- should be used with caution in patients with asthma, COPD, peripheral vascular disease as beta blockade may cause bronchoconstriction, bradyarrhythmias or AV block
|
| Drug Interactions: |
- esmolol + verapamil = increased hypotension, AV block
|
| Monitoring Therapy: |
- ECG: HR, rhythm, PR interval
- BP
- cardiac index
- urine output
- SVRI (may drop SVRI)
- PWP (may cause increase due to myocardial depression)
- breath sounds, chest xray
- blood glucose
|
| CCTC Protocol: |
- May be administered by IV infusion by an approved nurse in CCTC.
- Continuous infusions must be administered by infusion pump.
- May be titrated by an approved nurse in CCTC.
- Should not be infused through the injectate port of the right heart catheter.
- Patient requires placement of an arterial line if continuous infusion administered.
|
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