Esmolol (Brevibloc) ACS Medications

Question 1

Classification:

Answer 1

• Beta adrenergic antagonist
• Class II antiarrhythmic

Question 2

Action:

Answer 2

• Inhibits the strength of the heart’s contractions, as well as HR, resulting in a decrease in cardiac oxygen consumption

Question 3

Indications:

Answer 3

• ACS
• MI
• Acute HTN
• SVT
• Thyrotoxicosis

Question 4

Adverse Effects:

Answer 4

• Hypotension
• Sinus bradycardia
• AV block
• Cardiac arrest
• Nausea/vomiting
• Hypoglycemia
• Injection site reaction

Question 5

Contraindications:

Answer 5

• Acute bronchospasm
• COPD
• Second or third degree heart block
• Bradycardia
• Cardiogenic shock
• Pulmonary edema
• Sick sinus syndrome
• Known sensitivity
• Use w/ caution in Pts w/ pheochromocytoma, Prinzmetal’s angina, cerebrovascular disease, stroke, poorly controlled DM, hyperthyroidism, thyrotoxicosis, renal disease

Question 6

Dosage (Adult):

Answer 6

• 500 mcg/kg (0.5 mg/kg) IV, IO over a 1 minute period, followed by a 50 mcg/kg/min infusion over 4 minute period (Max total: 200 mcg/kg)
• If Pt response is inadequate, administer second bolus 500 mcg/kg over 1 minute period, then increase infusion to 100 mcg/kg/min
• Maximal infusion rate: 300 mcg/kg/min

Question 7

Dosage (Pediatric):

Answer 7

• 500 mcg/kg IV, IO over 1 minute period, followed by infusion at 25-200 mcg/kg/min

Question 8

Special Considerations:

Answer 8

• Half life 5-9 mins
• Any adverse effects caused by administration of esmolol are brief because of the drug’s short half life
• Resolution of effects usually within 10-20 mins