| Name: |
METOPROLOL (LopressorR) |
| 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:
|
| 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.
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