isoproterenol (Isuprel®)
Sympathomimetic
Isoproterenol is a synthetic catecholamine that stimulates both beta1 and beta2 adrenergic receptors (no alpha receptor capabilities).
The drug affects the heart by increasing inotropic and chronotropic activity. In addition, isoproterenol causes arterial and bronchial dilation, and is sometimes administered via aerosolization as a bronchodilator to treat bronchial asthma and bronchospasm.
1-5 minutes
15-30 minutes
Hemodynamically significant bradycardias unresponsive to atropine, TCP, dopamine and epinephrine.
Management of torsades de pointes.
Hypotension (non-rate related).
Cardiac arrest.
Ischemic heart disease.
Dysrhythmias
Hypotension
Precipitation of angina
Facial flushing
MAO inhibitors and bretylium potentiate the effects of catecholamines.
Beta adrenergic antagonists may blunt inotropic response.
Sympathomimetics and phosphodiesterase inhibitors may exacerbate dysrhythmia response.
5 ml (0.2 mg/ml) vial
Insulin may be administered SQ, IM or IV and dosage is governed by the clinical presentation of the patient and varies greatly. A standard dose of insulin adminstration in diabetic coma follows:
Infusion: 2-10 mcg/min titrated to increase HR and perfusion. Typical preparation: dilute 1 mg in 250 ml for a concentration of 4mcg/ml)
Infusion: 0.5 mcg/kg/min titrated to increased HR and perfusion. Typical preparation: dilute 0.6 mg/kg to create 100 ml solution.
Pregnancy Safety: Category C
Isoproterenol increases myocardial oxygen demand, and can induce serious dysrhythmias (including VT and VF).
Administer via infusion pump to ensure precise flow rates.
May exacerbate tachydysrhythmias due to digitalis toxicity or hypokalemia.
Newer inotropic agents have replaced isoproterenol in most clinical settings.
If electronic pacing is available, it should be used instead of isoporterenol, or as soon as possible after the drug has been initiated.