| Name: |
PROPRANOLOL (InderalR) |
| Classification: |
beta 1 and beta 2 receptor blocker
- decreases heart rate
- prolongs diastolic time; increases time for coronary perfusion and cardiac filling
- decreases AV conduction; useful in treating rapid supraventricular arrhythmias
- decreases myocardial contractility
- decreases myocardial 02 consumption in angina (decreased rate and contractility); strongly recommended to prevent or manage heart failure post MI
- decreases blood pressure
- can be used as prophylaxis against migraine headaches
- can cause bronchoconstriction
|
| Dose: |
- Bolus:
- 1-3mg IV direct at 0.5mg/min (maximum 0.15mg/kg)
- IV Infusion:
- 0.1-5mg/hour; titrate to effect
|
| Administration: |
IV Infusion:
10mg/100mL D5W, NS, RL (maximum 50mg/100mL)
- should be weaned off
- use in pheochromocytoma should be PRECEDED by an alpha-blocker as peripheral beta-blockade may worsen the alpha induced vasoconstriction
|
| Adverse Effects: |
- bradycardia
- AV blocks
- hypotension
- decreased cardiac output
- bronchospasm
- acute pulmonary edema
- electrolyte imbalances
- may mask tremors and tachycardia associated with insulin induced hypoglycaemia
- may increase systemic vascular resistance
|
| Caution: |
- should be used with caution in patients with asthma or COPD as beta blockade may cause bronchoconstriction
- should be used with caution in patients with peripheral vascular disease, bradyarrhythmias or AV block
|
| Antidote: |
- glucagon (for treatment of overdose only)
|
| Drug Interactions: |
- propranolol + beta sympathomimetics = antagonizes bronchodilation
- propranolol + epinephrine = resistance to epinephrine effect; may result in unpredictable and potentially fatal interaction (hypertension, bradycardia)
- propranolol + lidocaine = increased lidocaine toxicity
- propranolol + procainamide = increased procainamide levels
- propranolol + verapamil = hypotension, AV block
- propranolol + theophylline = mutual antagonism of therapeutic effect
|
| Monitoring Therapy: |
- ECG: HR, rhythm, PR interval
- BP
- cardiac index
- urine output
- blood glucose
- SVRI (may drop SVRI)
- PWP (may cause increase due to myocardial depression)
- breath sounds, SpO2, chest xray
|
| CCTC Protocol: |
- May be administered by IV infusion by an approved nurse in CCTC.
- May be administered IV direct at a rate of 0.5mg/min by an approved nurse in CCTC.
- May be titrated by an approved nurse in CCTC.
- Must be administered via a central line.
- Continuous infusion must be administered via an infusion pump.
- Should not be infused through the proximal injectate port (blue) of the Swan Ganz catheter.
- Patient requires placement of an arterial line to monitor BP.
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