Esmolol Inj.(esocard)

Class: Beta-adrenergic blocker Action Blocks beta-receptors primarily affecting cardiovascular system (decreases heart rate, contractility and BP) and lungs (promoting bronchospasm). Indications Short-term management of supraventricular tachyarrhythmias and noncompensatory sinus tachycardia. Unlabeled use(s): Treatment of caffeine toxicity; attenuation of cardiovascular responses to electroconvulsive therapy or induction of anesthesia; adjunct therapy for acute MI and unstable angina; treatment of thyroid storm. Contraindications Sinus bradycardia; second- or third-degree heart block; CHF unless secondary to tachyarrhythmia treatable with beta-blockers; overt cardiac failure; cardiogenic shock. Route/Dosage ADULTS: Usual: IV 500 mcg/kg/min for 1 min; then infusion of 50–200 mcg/kg/min, which has been titrated to desired endpoint (eg, heart rate, BP) in 50 mcg/kg/min increments. Interactions Clonidine: May enhance or reverse antihypertensive effect; potentially life-threatening increases in BP may occur, especially on withdrawal. NSAIDs: Some agents may impair antihypertensive effect. Prazosin: Potential for and degree of orthostatic hypotension may be increased. Verapamil: Effects of both drugs may be increased. INCOMPATIBILITIES: 5% Sodium Bicarbonate Injection. Lab Test Interferences Antinuclear antibodies may develop; usually reversible on discontinuation. May interfere with glucose or insulin tolerance test results. May cause changes in serum lipid levels. Adverse Reactions CV: Hypotension; bradycardia; CHF; cold extremities; pallor; second or third-degree heart block. CNS: Insomnia; fatigue; dizziness; depression; lethargy; drowsiness; forgetfulness. DERM: Rash; hives; fever; alopecia. EENT: Dry eyes; blurred vision; tinnitus; slurred speech; sore throat. GI: Nausea; vomiting, diarrhea; dry mouth. GU: Impotence; painful, difficult or frequent urination. HEMA: Agranulocytosis; thrombocytopenia purpura. RESP: Bronchospasm; shortness of breath; wheezing. OTHER: Weight changes; facial swelling; muscle weakness; inflammation at infusion site. Precautions Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Anaphylaxis: Deaths have occurred; aggressive therapy may be required. CHF: Administer drug in patients with CHF controlled by digitalis and diuretics. Notify physician at first sign or symptom of CHF or other unexplained respiratory symptoms. Diabetes mellitus: May mask signs and symptoms of hypoglycemia (eg, tachycardia, BP changes). May potentiate insulin-induced hypoglycemia. Nonallergic bronchospasm (eg, chronic bronchitis, emphysema): Use caution in patients with bronchospastic diseases. Peripheral vascular disease: May precipitate or aggravate symptoms of arterial insufficiency. Renal/hepatic impairment: Reduced daily dose advised. Thyrotoxicosis: May mask clinical signs (eg, tachycardia) of developing or continuing hyperthyroidism. Abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm. PATIENT CARE CONSIDERATIONS Administration/Storage Avoid concentrations > 10 mg/min in order to minimize venous irritation. 10 mg/ml vial does not need further dilution. Do not administer through butterfly needles. For IV administration, use 250 mg/ml solution diluted in 5% Dextrose Injection and 0.9% or 0.45% Sodium Chloride Injection, Lactated Ringer's Injection, and Potassium Chloride (40 mEq/L) in 5% Dextrose Injection or 0.9% or 0.45% Sodium Chloride Injection. To prepare solution remove 20 ml from 500 ml bottle of suitable infusion fluid and add 2 amps of 250 mg/ml solution of esmolol. Final concentration is 10 mg/ml. Do not mix with sodium bicarbonate. Store diluted solution at room temperature or under refrigeration. Discard after 24 hr. Use of esmolol infusion up to 24 hr is well documented. Limited data indicate that esmolol is well tolerated up to 48 hr. When converting patient to another agent, reduce esmolol infusion rate by 50% ½ hr after first dose of new drug. After second dose of new drug, if patient is stable for 1 hr, discontinue esmolol infusion. Assessment/Interventions Obtain patient history, including drug history and any known allergies. Obtain baseline ECG and measure QT interval. Obtain baseline vital signs and weight. Auscultate and document baseline heart and lung sounds and monitor throughout therapy. Monitor vital signs frequently. Monitor I&O, BUN, creatinine, serum glucose, CBC, liver function tests and bilirubin throughout therapy. Assess patient for rashes, urticaria, shortness of breath, arthralgia and systemic lupus erythematosus syndrome. If reaction develops at infusion site, use alternative site. Notify physician if vomiting, abdominal distention, vertigo, bradycardia, new ventricular arrhythmia, shock symptoms or signs of CHF occur. If patient is receiving digoxin, monitor digoxin levels and observe patient for digoxin toxicity.