Esmolol

Question 1

Brand Name

Answer 1

Brevibloc

Question 2

Broad Category

Answer 2

Negative ionotrope / Antihypertensive / Antiarrythmic

Question 3

Class

Answer 3

Ultrashort-acting selective Beta-1 adrenergic receptor antagonist

Question 4

MOA

Answer 4

Selectively and competitively antagonizes Beta-1 receptors resulting in negative ionotropy and chronotropy

• Dose-dependent selectivity (higher doses inhibit beta-2 in vascular and bronchial smooth muscle)

Question 5

Indications / Clinical Uses

Answer 5

Peri-operative tachycardia
pre-treatment during intubation / extubation
Tachyarrhythmias (nonhypotensive)
- SVT
- a-fib
- a-flutter
ECT (Sympathetic blunting)
Analgesic adjunct

Question 6

IV bolus dosing

Answer 6

10 mg IV

Question 7

Infusion dosing

Answer 7

0.5 mg/kg bolus over 1 min followed by
50 mcg/kg/min titrated up to 200 mcg/kg/min

• increased by 50 mcg q 5 min

Question 8

Concentration (Multidose vials)

Answer 8

10 mg/mL

Question 9

Onset

Answer 9

Rapid 1-2 mins

Question 10

Duration

Answer 10

10-15 mins

Question 11

CV effects

Answer 11

decreased HR
decreased contractility
decreased CO
decreased BP (some) no rebound
hypotension

Question 12

Absolute Contraindications

Answer 12

Bradycardia
Heart blocks (greater than first degree)
Cardiogenic shock
Heart failure (reduced EF or Uncompensated)

Question 13

Precaution

Answer 13

Bronchospastic Disease
- high doses nonselective beta antagonism

Question 14

Metabolism/Elimination

Answer 14

Plasma esterases in cytosol of RBCs

Question 15

Distribution half-life

Answer 15

2 mins

Question 16

Elimination Half-life

Answer 16

9 mins

Question 17

Vd considerations

Answer 17

moderate to large
- lipophillic, but not redistributed due to quick breakdown