Hypotension esmolol

Esmolol Hypotension, sinus bradycardia, AV block, heart failure exacerbation... 

Because of its brief half-life and minimal hpid solubihty, the side effects of esmolol are transient and include hypotension, cold extremities, dyspnea (from bronchospasms), bradycardia, nausea, vomiting, and headaches (41). 

Esmolol 10-20 minute <5 minute 2-21 meg /minute Conduction block, hypotension, bronchospasm Rapid onset, short half-life... 

Esmolol hydrochloride 250-500 mcg/kg/minute IV bolus, then 50-100 mcg/kg/minute by infusion may repeat bolus after 5 minutes or increase infusion to 300 mcg/minute 1-2 minutes 10-30 minutes Hypotension, nausea, asthma, first-degree heart block, heart failure Aortic dissection, perioperative... 

The most serious side effects early in ACS are hypotension, bradycardia, and heart block. Initial acute administration of //-blockers is not appropriate for patients presenting with decompensated heart failure. However, therapy may be attempted in most patients before hospital discharge after treatment of acute heart failure. Diabetes mellitus is not a contraindication to //-blocker use. If possible intolerance to //-blockers is a concern (e.g., due to chronic obstructive pulmonary disease), a short-acting drug such as metoprolol or esmolol should be administered IV initially. 

The most frequently reported adverse effects are hypotension, nausea, dizziness, headache, and dyspnea. As with many (3-blocktng drugs, esmolol is contraindicated in patients with overt heart failure and those in cardiogenic shock. 

Esmolol 3l > 2 Intravenous use half-life 10 min Rapid control of BP and arrhythmias, thyrotoxicosis and myocardial ischemia intraoperatively Parenteral only Toxicity Bradycardia hypotension... 

General supportive care should be provided. Aggressive gut decontamination should be carried out using repeated doses of activated charcoal and whole bowel irrigation. Propranolol or other blockers (eg, esmolol) are useful antidotes for B-mediated hypotension and tachycardia. Phenobarbital is preferred over phenytoin for convulsions most anticonvulsants are ineffective. Hemodialysis is indicated for serum concentrations greater than 100 mg/L and for intractable seizures in patients with lower levels. 

BETA-BLOCKERS OPIOIDS 1. Risk of t plasma concentrations and effects of labetalol, metoprolol and propranolol t systemic effects of timolol eye drops 2. t plasma concentrations of esmolol when morphine is added 3. t plasma concentrations of metoprolol and propranolol when dextro-propoxyphene is added 1. Methadone inhibits CYP2D6, which metabolizes these beta-blockers 2. Unknown 3. i hepatic clearance of metoprolol and propanolol 1. Monitor BP at least weekly until stable 2. Monitor BP closely 3. Monitor BP at least weekly until stable. Warn patients to report symptoms of hypotension (lightheadedness, dizziness on standing, etc.)... 

Esmolol causes hypotension, sometimes symptomatic, in up to 44% of patients (1-3). 

Esmolol (Brevibloc, others) is a Pi-selective antagonist with a very short duration of action. It has little if any intrinsic sympathomimetic activity, and it lacks membrane-stabilizing actions. Esmolol is administered intravenonsly and is nsed when P-blockade of short dnration is desired, or in critically ill patients in whom adverse effects of bradycardia, heart failure, or hypotension may necessitate rapid withdrawal of the drug. 

The onset and cessation of P-receptor blockade with esmolol are rapid peak hemodynamic effects occur within 6 to 10 minutes of administration of a loading dose, and there is substantial attenuation of P-blockade within 20 minutes of stopping an infusion. Esmolol may have striking hypotensive effects in normal subjects, although the mechanism of this effect is unclear. 

B. Specific drugs and antidotes. Beta blockers effectively reverse cardiotoxic effects mediated by excessive beta-adrenergic stimulation. Treat tachyarrhythmias or hypotension with intravenous propranolol, 0.01-0.02 mg/kg (see p 496), or esmolol, 0.025-0.1 mg/kg/min (p 443), beginning with low doses and titrating to effect. Because of its short half-life and cardioselectivity, esmolol is preferred. 

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