ESMOLOL (Brevibloc)

Name:	ESMOLOL (Brevibloc^R)
Classification:	*Beta 1 selective receptor blocker; ultra-short acting* Decreases HR Decreases AV conduction Decreases myocardial contractility to decrease myocardial oxygen consumption Ultra-short half-life beneficial to treat perioperative tachycardia and hypertension. Short-term control of supraventricular tachycardia or to test response to beta blockade prior to use of longer acting agents. An alpha blocking agent must be used with esmolol prior to excision of a pheochromocytoma; initiate alpha blocker prior to starting beta blockade.
Dose:	Ultra-short half-life with onset of action 2-10 minutes after bolus dose, which is maintained for 10-30 minutes. 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, titrate to effect
Administration:	IV Infusion: 2,500 mg/250 ml dextrose 5%, sodium chloride 0.9% or Ringer's Lactate (10mg/mL) Should be weaned off
Contraindications:	Use of inotropes and/or vasopressors to maintain BP Hypotension Heart block RV failure secondary to pulmonary hypertension Cardiac failure/cardiogenic shock Hypersensitivity to esmolol or its components Caution: *In patients with asthma, COPD or peripheral vascular disease (although selective B₁ blockers less likely to cause bronchoconstriction).*
Adverse Effects:	Hypotension Bradycardia, AV block Decreased contractility Heart failure Bronchoconstriction Hypoglycemia Raynaud's, peripheral vasoconstriction Nausea, vomiting Dizziness, somnolence, confusion, lethargy, depression, headache Phlebitis, skin necrosis
Drug Interactions:	esmolol + verapamil = increased hypotension, AV block
Monitoring Therapy:	IV site Continuous heart rate and rhythm PR interval Blood pressure Urine output Blood glucose Breath sounds
Adult Critical Care Protocol:	May be administered by IV infusion by a nurse in Adult Critical Care IV direct by physician only Should be administered via central venous line whenever possible Continuous infusions must be administered by infusion device and the pump library must be enabled. Intra-arterial pressure monitoring is preferred for patients requiring a continuous infusion of esmolol.