Isoproterenol
Kelas obat: Agen Antineoplastik
Panganggone Isoproterenol
Aritmia Jantung lan Penangkapan Jantung
Digunakake kanggo perawatan blok jantung lan serangan Adams-Stokes. Uga wis digunakake kanggo perawatan aritmia ventrikel sekunder kanggo blok nod AV lan hipersensitivitas sinus karotid. Nanging, bukti sing ndhukung manfaat ing pasien karo aritmia jantung umume kurang; alternatif sing luwih aman lan efektif kayata pacing jantung lan terapi obat liyane kasedhiya.
Wis digunakake ing perawatan saka serangan jantung nganti defibrillation utawa terapi pacemaker darurat bisa digunakake. Nanging, para ahli nyatakake yen isoproterenol dudu obat pilihan ing ACLS lan mung kudu dianggep ing setelan iki kanggo perawatan bradikardia gejala sing ora responsif marang atropin utawa minangka langkah sementara nganti terapi pacemaker bisa ditindakake. Ora bisa digunakake kanggo resusitasi ing pasien kanthi serangan jantung utawa hipotensi amarga bisa nyebabake efek mbebayani (umpamane, exacerbation saka iskemia, aritmia, vasodilatasi perifer).
Ora kudu diwenehake kanggo pasien kanthi bradikardia sing disebabake dening acetylcholinesterase; Nanging, bisa uga migunani ing dosis dhuwur ing bradikardia refrakter sing disebabake dening agen pamblokiran β-adrenergik.
Kejut
Digunakake minangka terapi adjunctive kanggo ngasilake stimulasi jantung lan vasodilatasi ing perawatan kejut.
Nilai terapi isoproterenol ing kejut wis ditakokake amarga obat kasebut nambah kabutuhan oksigen. ing miokardium lan jaringan liyane nganti tingkat sing ora bisa ditemokake kanthi aliran getih sing tambah. Efikasi kanggo nyuda mortalitas ing kejut refraktori ora dituduhake.
Vasopresor kayata norepinefrin lan epinefrin umume dianggep minangka obat pilihan kanggo manajemen kejut hemodinamik sing efektif.
Isoproterenol umume ora dianjurake kanggo kejut kardiogenik; mundhak konsumsi oksigen miokardium lan beban kerja jantung biasane luwih gedhe tinimbang keuntungan, lan aritmia bisa kedadeyan luwih gampang.
Ora bisa digunakake ing pasien sing nandhang kejut distributif amarga obat; bisa nambah hipotensi kanthi nyuda resistensi pembuluh darah sistemik.
Bronkospasme
Isoproterenol IV bisa migunani kanggo bronkospasme sing kedadeyan sajrone anestesi nanging kudu ditindakake kanthi ati-ati, yen kabeh, ing pasien sing nampa anestesi umum cyclopropane utawa hidrokarbon halogenated.
Wis digunakake minangka bronkodilator kanggo perawatan gejala asma bronkial lan bronkospasme sing bisa dibalikake sing bisa kedadeyan karo bronkitis kronis, emfisema paru, bronchiectasis, lan gangguan paru obstruktif kronis liyane. Nanging, preparat obat inhalasi oral, sublingual, lan oral ora kasedhiya kanggo komersial ing AS.
Pulmonary Embolism
Wis digunakake dening infus IV kanggo mbalikke nyuda output jantung lan sirkulasi volume getih pulmonal lan kanggo mbalikke mundhak ing tekanan arteri pulmonary lan resistensi vaskular paru sing kedadeyan nalika emboli paru† [off-label ].
Diagnosis CAD lan Abnormalitas Jantung Liyane
Wis digunakake minangka bantuan kanggo diagnosa CAD† [off-label]. Uga digunakake kanggo diagnosa CAD kanthi nambah konsumsi oksigen miokardium lan nambah gejala iskemia.
Wis digunakake minangka bantuan kanggo diagnosa etiologi regurgitasi mitral† [off-label].
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Carane nggunakake Isoproterenol
Umum
Administrasi
Biasane ngatur IV.
Bisa ditindakake kanthi injeksi intracardiac ing kahanan darurat sing ekstrim (ing wong diwasa). Ing kahanan sing kurang urgent, injeksi IM utawa sub-Q awal luwih disenengi.
Encerake injeksi isoproterenol hidroklorida sing kasedhiya sacara komersial sadurunge administrasi IV. Kanggo injeksi IM, sub-Q, utawa intracardiac, wenehake solusi injeksi sing ora diencerake.
Administrasi IV
Kanggo informasi kompatibilitas solusi lan obat, deleng Kompatibilitas ing Stabilitas.
Administrasi kanthi injeksi langsung ("bolus") IV utawa infus IV.
PengenceranKanggo nyiapake solusi sing diencerke kanggo injeksi IV langsung, tambahake 1 ml injeksi sing ngemot isoproterenol hidroklorida 0,2 mg/mL nganti 9 mL saka 0,9 % injeksi natrium klorida utawa injeksi dextrose 5%.
Kanggo nyiapake solusi sing diencerke kanggo infus IV, tambahake 10 ml injeksi sing ngemot isoproterenol hidroklorida 0,2 mg/mL nganti 500 mL injeksi dekstrosa 5%.
Tingkat AdministrasiNalika obat kasebut diwenehake kanthi infus IV, utamane minangka tambahan kanggo perawatan kejut, atur tingkat infus adhedhasar denyut jantung pasien, tekanan vena pusat, tekanan darah sistemik, lan aliran urin.
Yen detak jantung> 110 dhetik / menit utawa yen jantung prematur deg-degan utawa owah-owahan ing ECG berkembang, nimbang tingkat kalem infus utawa mandhegake infus kanggo sementara.
Dosis
Kasedhiya minangka isoproterenol hidroklorida; dosis ditulis ing syarat-syarat uyah.
Pasien Pediatrik
Aritmia Jantung lan Penangkapan Jantung IVOra ana studi sing dikontrol kanthi apik ing pasien pediatrik kanggo ngandhani dosis; Nanging, AHA nyaranake tingkat awal 0,1 mcg/kg saben menit ing bocah† [off-label] lan tingkat sakteruse umume mulai saka 0,1–1 mcg/kg saben menit.
Kanggo manajemen blok jantung lengkap sawise penutupan cacat septum ventrikel, dosis IV 0.01-0.03 mg wis diwenehake ing bayi.
Dewasa
Aritmia Jantung lan Penangkapan JantungSanajan pabrikan menehi rekomendasi dosis kanggo pasien sing nandhang serangan jantung. , paling ahli nyatakake yen isoproterenol ora bisa digunakake kanggo resusitasi kardiopulmoner. (Deleng Aritmia Jantung lan Penangkapan Jantung ing Panggunaan.)
Infus IVProdusen nyaranake dosis awal 5 mcg/menit (1,25 mL larutan sing diencerake saben menit) kanggo perawatan blok jantung, serangan Adams-Stokes, utawa serangan jantung; nyetel dosis sakteruse adhedhasar respon pasien (umume antara 2-20 mcg / menit).
Kanggo perawatan bradikardia gejala sing ora responsif marang atropine sajrone ACLS, dosis sing disaranake yaiku 2-10 mcg / menit; nyetel tingkat infus miturut detak jantung lan respon irama.
Injeksi IVProdusen nyaranake dosis awal 0,02-0,06 mg (1-3 ml larutan sing diencerake) kanggo perawatan blok jantung, serangan Adams-Stokes, utawa serangan jantung; dosis sakteruse sawetara saka 0.01-0.2 mg (0.5-10 mL saka solusi sing diencerke).
Kanggo manajemen blok jantung lengkap sawise penutupan cacat septum ventrikel, dosis IV 0.04-0.06 mg wis digunakake. ing wong diwasa.
IMProdusen nyaranake dosis awal 0,2 mg (1 mL saka injeksi 0,2-mg/mL sing kasedhiya kanthi komersial tanpa diencerke) kanggo perawatan blok jantung, serangan Adams-Stokes, utawa serangan jantung; dosis sakteruse saka 0.02-1 mg.
Sub-QProdusen nyaranake dosis awal 0.2 mg (1 mL saka injeksi 0.2-mg/mL sing kasedhiya sacara komersial tanpa pengenceran) kanggo perawatan blok jantung, Adams- serangan Stokes, utawa serangan jantung; dosis sakteruse sawetara saka 0,15-0,2 mg. Ing tahap kejut sing luwih maju, tarif> 30 mcg / menit wis digunakake.
Injeksi IVProdusen nyaranake dosis awal 0,01-0,02 mg (0,5-1 mL saka larutan sing diencerake); dosis bisa diulang yen perlu.
Bronkospasme IVWis diwenehake ing dosis IV 0,01-0,02 mg, bola-bali yen perlu.
Diagnosis CAD lan Abnormalitas Jantung Liyane IV InfusWis wis diterbitake kanthi infus IV kanthi tingkat 1-3 mcg / menit ing diagnosis CAD utawa lesi† [off-label] utawa kanthi tingkat 4 mcg / menit minangka bantuan kanggo diagnosa etiologi regurgitasi mitral†. p>
Populasi Khusus
Gangguan Ginjal
Ora ana rekomendasi dosis khusus. Atur kanthi ati-ati.
Pasien Geriatrik
Pamilihan dosis sing ati-ati dianjurake amarga bisa nyuda fungsi ati, ginjel, lan/utawa jantung sing gegandhengan karo umur lan penyakit bebarengan lan terapi obat; miwiti terapi ing sawetara dosis sing kurang.
Pènget
Kontraindikasi
Pènget/PanandhapPènget
Efek Kardiovaskular
Ing pasien kanthi MI akut, isoproterenol bisa nambah tingkat cedera iskemik ing miokardium. Panganggone obat kasebut minangka agen awal ing perawatan kejut kardiogenik sawise MI ora dianjurake. Bisa nyebabake nekrosis fokus sel miokardium.
Paradoks, obat kasebut bisa nyebabake kejang Adams-Stokes ing sawetara pasien kanthi irama sinus normal utawa blok AV transien. Wis disaranake yen pasien kasebut bisa nandhang penyakit organik saka kelenjar AV utawa cabang-cabange.
Bukti iskemia miokard transien (yaiku, owah-owahan ECG lan elevasi fraksi [MB] jantung saka creatine kinase [ CK, creatine phosphokinase, CPK]) utawa disfungsi miokard (yaiku, temuan ECG sing ora normal) wis dilaporake kanthi nggunakake infus isoproterenol IV kanggo perawatan eksaserbasi asma sing abot ing bocah-bocah. Ing pasien asma sing nampa infus isoproterenol, ngatur oksigen bebarengan; monitor denyut jantung, BP, lan gas getih arteri (njaga tekanan oksigen arteri [PaO2]> 60 mm Hg); lan monitor ECG. Konfirmasi owah-owahan ECG sing nuduhake iskemia miokard kanthi nemtokake fraksi MB saka CK.
Gangguan irama jantung lan tingkat sing diprodhuksi dening isoproterenol bisa nyebabake palpitasi lan VT. Isoproterenol bisa nyebabake aritmia ventrikel sing bisa nyebabake fatal ing dosis sing cukup kanggo ningkatake denyut jantung ing ndhuwur 130 denyut / menit.
Administrasi isoproterenol kanggo pasien sing lagi kejut ora minangka pengganti kanggo ngganti getih, plasma, cairan, lan /utawa elektrolit.
Penipisan volume getih kudu dikoreksi kanthi lengkap sadurunge obat kasebut diwenehake.
Gunakake kanthi ati-ati ing pasien CAD, insufisiensi koroner, diabetes, hipertiroidisme, lan sensitivitas marang amina simpatomimetik.
Reaksi Sensitivitas
Sensitivitas SulfitSawetara formulasi ngandhut sulfit, sing bisa nyebabake reaksi alergi (kalebu anafilaksis lan episode asma sing ngancam nyawa utawa kurang abot) ing individu tartamtu sing rentan.
Pancegahan Umum
HipovolemiaTerapi tekanan ora minangka pengganti kanggo panggantos getih, plasma, cairan, lan/utawa elektrolit. Ngilangi volume getih sing bener sabisane sadurunge terapi isoproterenol ditindakake.
Ganti volume tambahan uga dibutuhake sajrone administrasi isoproterenol; administrasi cairan kudu cukup kanggo ngimbangi vasodilatasi isoproterenol-induced, utawa kejut bisa dadi luwih elek.
Ndeteksi lan nambani hypovolemia: Monitor tekanan vena tengah utawa tekanan isi ventrikel kiwa; Kajaba iku, ngawasi tekanan diastolik arteri vena utawa pulmonal tengah kanggo nyegah kakehan sistem kardiovaskular, ngencerake konsentrasi elektrolit serum, lan precipitating CHF.
NgawasiMonitor ECG, BP, denyut jantung, aliran urin, tekanan vena pusat, pH getih, lan konsentrasi PCO2 utawa bikarbonat getih. (Waca Hypoxia, Hypercapnia, Acidosis, Gangguan Elektrolit ing Cautions.) Ukur output jantung lan wektu sirkulasi kanggo nemtokake kondisi pasien lan respon kanggo therapy. Priksa manawa ventilasi sing cukup. Ngawasi pasien kanthi kejut kanthi ati-ati. Coba kemungkinan isoproterenol ora bisa ngasilake perfusi kapiler lan pangiriman oksigen sing luwih apik nalika nambah kabutuhan oksigen ing miokardium.
Hipoksia, Hiperkapnia, Asidosis, lan Gangguan ElektrolitKudu diidentifikasi lan dikoreksi sadurunge utawa sajrone administrasi. tamba. Bisa nyuda khasiat lan/utawa nambah insiden efek samping isoproterenol.
Negara PenyakitGunakake kanthi ati-ati ing pasien geriatrik, diabetes, pasien penyakit ginjel utawa kardiovaskular (kalebu hipertensi, CAD, insufisiensi koroner, utawa penyakit jantung degeneratif), hipertiroidisme, lan/utawa sing duwe riwayat sensitivitas marang amina simpatomimetik.
Populasi Tertentu
KandhutanKategori C.
LaktasiOra dingerteni manawa isoproterenol disebarake menyang susu manungsa. Disaranake ati-ati.
Panggunaan PediatrikKeslametan lan khasiat durung ditetepake. Wis digunakake ing bocah-bocah † kanggo kondisi tartamtu (contone, asma refrakter, bradikardia).
Infus IV 0,05-2,7 mcg / kg saben menit ing pasien pediatrik kanthi asma refrakter nyebabake kerusakan klinis, nekrosis miokard, CHF, lan pati; risiko bisa tambah dening acidosis, hypoxia, lan / utawa nggunakake bebarengan agen liyane (contone, turunan xanthine, kortikosteroid [pirsani Obat Spesifik ing Interaksi]) kamungkinan kanggo digunakake ing bocah-bocah iki. Yen digunakake ing pasien pediatrik kanthi asma refrakter, monitor tandha-tandha vital terus-terusan lan ECG kanthi kerep, lan nemtokake fraksi serum CK (CPK) khusus jantung (MB) saben dina.
Panggunaan GeriatrikPengalaman sing ora cukup ing pasien>65 taun umur kanggo nemtokake manawa pasien geriatrik nanggapi beda karo isoproterenol hidroklorida tinimbang pasien sing luwih enom. Wong sing sehat geriatrik utawa pasien hipertensi bisa uga kurang responsif marang stimulasi β-adrenergik tinimbang wong diwasa sing luwih enom. Gunakake kanthi ati-ati amarga nyuda fungsi hepatik, ginjel, lan / utawa jantung sing gegandhengan karo umur lan potensial kanggo penyakit bebarengan lan terapi obat. (Deleng Pasien Geriatrik miturut Dosis lan Administrasi.)
Gagal GinjalGunakake kanthi ati-ati.
Efek Samsaya Awon
Gemeter, sirah, pusing, gelisah, insomnia, kuatir, tegang, paningal kabur, wedi, kasenengan, takikardia, palpitasi, angina, sindrom Adam-Stokes, edema paru , hipertensi, hipotensi, aritmia ventrikel, tachyarrhythmias, kulit kemerahan, diaforesis, tremor entheng, kelemahane.
Apa obatan liyane bakal mengaruhi Isoproterenol
Obat Spesifik
Obat
Interaksi
Komentar
Anestesi, umum (contone, hidrokarbon halogenasi [halotana], siklopropana)
Potensi kanggo aritmia
Gunakake kanthi ati-ati, yen ana
Agen pamblokiran β-adrenergik
Efek jantung saka isoproterenol antagonized
Agen simpatomimetik ( contone, epinefrin)
Efek aditif lan kardiotoksisitas tambah
Aja ngaturake bebarengan; bisa diganti kanthi interval sing cocog antarane dosis
Turunan Xanthine (contone, aminophylline, theophylline)
Potensi efek kardiotoksik sing tambah utawa aditif; nekrosis miokard fatal wis dilapurake
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