METOPROLOL (Lopressor)

Name:	METOPROLOL (Lopressor^R)
Classification:	*beta 1 and beta 2 selective 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 cause bronchoconstriction
Dose:	Acute Myocardial Infarction: 5 mg IV direct q2min x 3 doses Atrial Fibrillation: 2.5-5mg IV direct q2-5min as IV push to a maximum of 15 mg over 15 minutes Intermittent bolus: 5-15mg IV direct q4-8h
Adverse Effects:	bradycardia AV blocks hypotension decreased cardiac output bronchospasm acute pulmonary edema electrolyte imbalances may mask tremors and tachycardia associated with insulin induced hypoglycemia may increase systemic vascular resistance
Administration:	IV direct at a rate of 2.5 mg/min
Caution:	*should be used with caution in patients with asthma, COPD, peripheral vascular disease as beta blockade may cause bronchoconstriction, bradyarrhythmias or AV block* Reduce dose in hepatic dysfunction
Drug Interactions:	metoprolol + beta sympathomimetics = antagonizes bronchodilation metoprolol + lidocaine = increased lidocaine toxicity metoprolol + procainamide = increased procainamide levels metoprolol + verapamil = hypotension, AV block
Monitoring Therapy:	continuous heart rate and rhythm PR interval blood pressure urine output blood glucose liver function
Adult Critical Care Protocol:	May be administed IV direct or by IV infusion by a nurse in Adult Critical Care Continuous infusions must be administered by infusion device with pump library enabled.