Pharm
Isoproterenol
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Isoproterenol
Pathophysiology
Synthetic
Sympathomimetic
amine
Pure
Beta Adrenergic Agonist
Potent Chronotropic effects
Increases
Heart Rate
Potentiates AV conduction
Potent Inotropic effects
Increases cardiac contractility
Markedly increases
Cardiac Output
Causes Peripheral vasodilatation
Decreases Diastolic pressure
Causes Bronchodilation
Markedly increases myocardial oxygen demand
May provoke
Myocardial Ischemia
May decrease coronary perfusion
Pharmacokinetics
Very short half-life (<1.5 minutes)
Indications
Other inotropic agents preferred over Isoproterenol
Dobutamine
Amrinone
Hemodynamically significant
Bradycardia
(pulse present)
Specific Uses
Heart Block
Bradycardia
in denervated transplanted heart
Unresponsive to other measures
Atropine
Epinephrine
Transcutaneous pacing or transvenous pacing
Dopamine
Contraindication
Ischemic Heart Disease
Pediatric Infusion (Same as Epinephrine preparation)
Preparation
Draw up "x" mg of Isoproterenol
Where "x" = 0.6 x Weight in Kilograms
Add enough D5W or NS for 100 ml total
At this dilution:
Infusion rate of 1 ml/h provides 0.1 ug/kg/min
Start Dose: 10 ml/hour (10 ug/kg/min)
Titrate to clinical response, adjusting every 5 min
Adult Infusion
Preparation
Dissolve 1 mg Isoproterenol in 250 ml D5W
Final Concentration: 4 ug/ml
Start Dose: 2 ug/min
Titrate: 2-10 ug/min to clinical response
Heart Rate
over 60 beats per minute
Precautions
Decreases Diastolic
Blood Pressure
No alpha adrenergic effect
Increases
Heart Rate
(less diastolic filling time)
May precipitate
Myocardial Ischemia
Increases myocardial oxygen demand
Decreases coronary perfusion
Induces
Arrhythmia
s
Ventricular Tachycardia
Ventricular Fibrillation
Exacerbates tachyarrhythmias due to
Digitalis Toxicity
Precipitates
Hypokalemia
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