ISOPROTERENOL (Isuprel)

Name:	ISOPROTERENOL (Isuprel^R)
Classification:	sympathomimetic stimulates beta adrenergic receptors positive inotrope positive chronotrope positive dromotrope bronchodilator causes vasodilation resulting in reduced peripheral vascular resistance (unlike epinephrine, has no alpha properties)
Dose:	Bolus dose: 0.05 - 0.2 mg IV direct Infusion: 0.05 - 0.2 mcg/kg/min (approx. 1 - 4 mcg/min), titrate to effect
Administration:	IV Direct: dilute 1 mL of 1:5000 (0.2 mg/mL) to a volume of 10 mL with dextrose 5% or sodium chloride 0.9% ((final concentration of 20 mcg/mL) IV Infusion: 1 mg/50 mL (20 mcg/ml) in D5W for initial infusion; prepared by RN as described below 5mg/250 mL dextrose 5%, normal saline 0.9% or Ringer's Lactate (20 mcg/ml) by pharmacy Hypovolemia, acidemia, and hypoxemia should be corrected concurrently with initiation of therapy Should be weaned off RN Bedside Preparation of Initial Isoproterenol Infusion Inject 1 mg isoproterenol into a 50 ml D5W minibag to make a 20 mcg/ml concentration (1 mg isoproterenol requires 5 X 0.2 mg vials of isoproterenol). Select isoproterenol from the infusion pump library and change the Volume to Be Infused (VTBI) to 50 ml. Pharmacy will prepare subsequent doses as standard 5 mg/250 ml bags (20 mcg/ml).
Adverse Effects:	tachycardia arrhythmias hypotension (due to vasodilation) or hypertension (due to chronotropic, inotropic effect) increased myocardial oxygen consumption increased blood glucose when using to correct bradyarrhythmias or as an inotrope, monitor carefully for hypotension
Drug Interactions:	isoproterenol + theophylline = decreased serum theophylline levels
Monitoring Therapy:	IV site continuous heart rate and ECG rhythm blood pressure urine output central or mixed venous oxygen saturation lactate blood gases cardiac output if monitored blood glucose electrolytes
Adult Critical Care Protocol:	May be administered IV direct or by IV infusion by a nurse in Adult Critical Care. May be titrated by a nurse in Adult Critical Care. Must be administered via central venous access device; in emergency situations may be temporarily infused through a peripheral vasuclar access device until a central venous line can be established. Patient requires placement of an arterial line to monitor BP. Continuous infusions must be administered by infusion device and the pump library must be enabled. Should not be infused via the proximal injectate port (blue) of a pulmonary artery catheter. If this is the only available central venous line, it may be administered through the proximal injectate port but thermodilution cardiac output measurements must not be measured during infusion).