ISOPROTERENOL (Isuprel)

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)

• 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

• 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

1. 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). 
2. Select isoproterenol from the infusion pump library and change the Volume to Be Infused (VTBI) to 50 ml.
3. Pharmacy will prepare subsequent doses as standard 5 mg/250 ml bags (20 mcg/ml).

• 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

• isoproterenol + theophylline = decreased serum theophylline levels

• 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

• 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).