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Propranolol (Inderal)
class
Sympathetic blocker
-
Propranolol (Inderal)
action
Nonselectively blocks Beta-adrenergic receptors
-
Propranolol (Inderal)
Indication
- Stable, narrow-complex tachycardia
- Rate control in atrial fibrillation or atrial flutter
-
Propranolol (Inderal)
contraindication
- Asthma and COPD
- CHF
- PTs dependent on sympathetic agonists
-
Propranolol (Inderal)
Precautions
- Should not be given concurrently with Verapamil
- Atropine and transcutaneous pacing should be readily available
-
Propranolol (Inderal)
side effects
- Bradycardia
- Heart blocks
- CHF
- Bronchospasm
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Propranolol (Inderal)
adult dose
IV: 1-3mg diluted in 10-30cc of D5W given slowly
-
Propranolol (Inderal)
route
Slow IV bolus
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Propranolol (Inderal)
Ped dose
0.01mg/kg
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Sotalol HCL (Betapace, Sotacor)
Class
Antiarrhythmic (Class II) and Nonselective Beta-adrenergic blocking agent
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Sotalol HCL (Betapace, Sotacor)
Action
- Blocks stimulation of Beta-1 (Myocardial) and Beta-2 (Pulmonary, vascular, and uterine) adrenergic receptor sites
- Suppression of arrhythmias
-
Sotalol HCL (Betapace, Sotacor)
Indications
Hemodynamically-stable monomorphic ventricular tachycardia
-
Sotalol HCL (Betapace, Sotacor)
Contraindications
- Uncompensated CHF
- Pulmonary edema
- Cardiogenic shock
- Bradycardia
- heart block
-
Sotalol HCL (Betapace, Sotacor)
Precautions
- Renal impairment
- Hepatic impairment
-
Sotalol HCL (Betapace, Sotacor)
Side effects
- Fatigue
- Weakness
- Anxiety
- Dizziness
- Drowsiness
- Insomnia
- Memory loss
- Mental depression
- Mental status changes
- Nervousness
- Nightmares
-
Sotalol HCL (Betapace, Sotacor)
Adult Dose
IV: 1.5mg/kg over 5 minutes (slow infusion preferred)
-
Sotalol HCL (Betapace, Sotacor)
route
-
Sotalol HCL (Betapace, Sotacor)
ped dose
not indicated
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Metoprolol (Lopressor)
Class
- Sympathetic blocker (Beta-2 selective)
- Antiarrhythmic (Class II)
-
Metoprolol (Lopressor)
Action
Selectively blocks Beta-2 adrenergic receptors (cardioprotective)
-
Metoprolol (Lopressor)
Indication
- Suspected or definite acute MI in hemodynamically stable PTs
- Stable, narrow-complex tachycardias if rhythm remains uncontrolled or unconverted by adenosine or vagal maneuvers or if SVT is recurrent
- Control ventricular rate in PTs with atrial fibrillation or flutter
- Certain forms of polymorphic VT (associated with acute ischemia, familial Long QT syndrome, catecholaminergic)
-
Metoprolol (Lopressor)
Contraindication
- HR <45BPM
- Systolic BP<100mmHg
- Heart block
- Shock
- History of asthma
-
Metoprolol (Lopressor)
Precautions
- BP, HR, and EKG should be monitored constantly
- Atropine and transcutaneous pacing should be available.
-
Metoprolol (Lopressor)
Side Effects
- Bradycardia
- Heartblock
- CHF
- Depression
- Bronchospasm
-
Metoprolol (Lopressor)
Adult dose
- Initial bolus of 5mg slow IVP
- May repeat 5 mg bolus in 5 minutes if vitals are stable
- May repeat 5mg bolus in 10 minutes if vitals are stable
-
Metoprolol (Lopressor)
Route
Slow IV bolus
-
Metoprolol (Lopressor)
Ped dose
Safety in children has not been established
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Labetalol (Trandate, Normodyne)
Class
Sympathetic blocker
-
Labetalol (Trandate, Normodyne)
Action
Selectively blocks Alpha-1 receptors and nonselectively blocks Beta receptors.
-
Labetalol (Trandate, Normodyne)
Indication
Hypertensive emergency
-
Labetalol (Trandate, Normodyne)
contraindication
- Bronchial asthma
- CHF
- Heartblock
- Bradycardia
- Cardiogenic shock
-
Labetalol (Trandate, Normodyne)
Precautions
- BP, HR, and EKG should be monitored constantly
- Atropine should be available
-
Labetalol (Trandate, Normodyne)
Side effects
- Bradycardia
- Heartblock
- CHF
- Bronchospasm
- Postural hypotension
-
Labetalol (Trandate, Normodyne)
Adult dose
- 20mg slow IV infusion over 2 minutes
- doses of 40mg can be repeated in 10 minutes until desired supine BP is obtained or until 300mg had been given
- 200mg placed in 500cc D5W to deliver at 2mg/min
-
Labetalol (Trandate, Normodyne)
route
IV infusion or slow IV bolus as described earlier
-
Labetalol (Trandate, Normodyne)
ped dose
Safety in children has not been established
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