Esmolol

Esmolol (Brevibloc®)

Class:
  • Beta-adrenergic blocking agent (Antidysrhythmic Drug Class II)
Actions:
  • Primarily blocks β1 adrenergic receptors on the myocardium (negative chronotropic and negative inotropic agent)
Indications:
  • Supraventricular tachycardias (PSVT, atrial fibrillation, atrial flutter) particularly during operative or cath lab procedures
Pharmacokinetics:
  • Onset: < 5 minutes
  • Peak:  10-20 minutes
  • Half-Life: 9 minutes
Adverse Effects:
  • Hypotension, bradycardia, flushing, cold extremities, heart failure
  • Dizziness, headache, somnolescence, confusion, agitation
  • Pain at injection site
  • Nausea, vomiting
  • Dyspnea, bronchospasms
Signs of Toxicity:
  • Hypotension
  • Bradycardia
  • Bronchospasms
Contraindications:
  • Cardiogenic shock
  • Heart failure
  • 2nd or 3rd degree heart block
  • Bradydysrhythmias
  • Use caution with bronchospastic diseases (e.g., asthma)
  • Safety during pregnancy, lactation or with children not established (Category C).
Dosages & Routes:
  • IV bolus:  500 mcg/kg loading dose (diluted, over 1 minute)
  • IV Infusion: 50-100 mcg/kg/min
Nursing Implications:
  • Drug Interactions:  1) Antagonist to beta adrenergic agents; 2) Esmolol may increase digoxin serum level; 3) Morphine may increase esmolol serum level; 4) Esmolol may prolong neuromuscular blockade with succinylcholine.
  • Drug Incompatibilities:  amphotericin B, procainamide, furosemide, warfarin.
  • Monitor blood pressure and apical pulse prior to administration.
  • Cardiac monitor should be used on patients receiving esmolol therapy.
  • Monitor IV injection site closely for signs of inflammation.

References:

American Heart Association. (2006). Handbook of Emergency Cardiac Care (p. 47). Salem, MA: AHA.

Dirks, J.L. (2010) Cardiovascular therapeutic management.  In L.D. Urden, K.M. Stacy, & M.E. Lough's (Eds.) Critical care nursing: Diagnosis and management (6th ed., p. 545).  St. Louis: Mosby Elsevier.

Lehne, R.A. (2010). Pharmacology for nursing care (7th ed., pp. 167-168, 172-173, 545).  St. Louis: Saunders Elsevier.

Wilson, B.A., Shannon, M.T., Shields, K.M., & Stang, C.L. (2007).  Prentice Hall Nurse's Drug Guide 2007 (pp. 628-629).  Upper Saddle River, NJ: Pearson Prentice Hall.

 

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