Metoprolol - Queensland Ambulance Service

Transcription

Metoprolol - Queensland Ambulance Service
Drug Therapy Protocols: Metoprolol
Disclaimer and copyright
©2016 Queensland Government
All rights reserved. Without limiting the reservation of copyright, no person shall reproduce, store in a
retrieval system or transmit in any form, or by any means, part or the whole of the Queensland Ambulance
Service (‘QAS’) Clinical practice manual (‘CPM’) without the priorwritten permission of the Commissioner.
The QAS accepts no responsibility for any modification, redistribution or use of the CPM or any part
thereof. The CPM is expressly intended for use by QAS paramedics whenperforming duties and delivering
ambulance services for, and on behalf of, the QAS.
Under no circumstances will the QAS, its employees or agents, be liable for any loss, injury, claim, liability
or damages of any kind resulting from the unauthorised use of, or reliance upon the CPM or its contents.
While effort has been made to contact all copyright owners this has not always been possible. The QAS
would welcome notification from any copyright holder who has been omitted or incorrectly acknowledged.
All feedback and suggestions are welcome, please forward to:
Clinical.Guidelines@ambulance.qld.gov.au
Date
October, 2015
Purpose
Scope
Author
To ensure a consistent procedural approach to Metoprolol administration.
Applies to all QAS clinical staff.
Clinical Quality & Patient Safety Unit, QAS
Review date
October, 2017
URL
https://ambulance.qld.gov.au/clinical.html
This work is licensed under the Creative Commons
This work is licensed under the Creative Commons
Attribution-NonCommercial-NoDerivatives 4.0
Attribution-NonCommercial-NoDerivatives 4.0
International License. To view a copy of this license,
International License. To view a copy of this license,
visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Metoprolol
October, 2015
Drug class
β1 selective adrenoceptor blocker
Contraindications
UNCONTROLLED WHEN PRINTED
Pharmacology
Metoprolol is a selective β1 receptor blocker used in the
treatment of cardiovascular disease. Metoprolol blocks the action of the sympathetic nervous system thereby reducing heart rate, the force of myocardial contraction and thereby reducing blood pressure and
myocardial oxygen demand.[1–4]
• KSAR or hypersensitivity to metoprolol
• Acute heart failure
• Heart rate < 60 beats
• Systolic BP < 90 mmHg
• Second OR third degree AV block
• Concomitant antiarrhythmic medication
UNCONTROLLED WHEN PRINTED
Metabolism
• Bronchospasm OR allergic disorders which may
suggest a predisposition to bronchospasm
Hepatic and excreted by the kidneys.[1] Precautions
Indications
• History of heart failure
UNCONTROLLED WHEN PRINTED
• ACS (unresponsive to sublingual nitrates and narcotic analgesia)
• Heart rate control (in the setting of ACS)
• First degree AV block
• Diabetes Mellitus (patient receiving insulin or oral hypoglycaemics)
Side effects
• Hypotension
UNCONTROLLED WHEN PRINTED
• Bradycardia
• Palpitations
• Dizziness
Figure 4.32
• Headache
QUEENSLAND AMBULANCE SERVICE
804
Metoprolol
October, 2015
Adult dosages
Presentation
UNCONTROLLED WHEN PRINTED
• ACS (unresponsive to sublingual nitrates and • Ampoule, 5 mg/5 mL metoprolol
narcotic analgesia)
Onset (IV)
Duration (IV)
Half-life
1 – 2 minutes
5 – 8 hours
3 – 7 hours
E CCP
• Heart rate control (in the setting of ACS)
IV
RSQ Clinical Coordinator consultation and approval required in all situations.
1 – 2 mg
Repeated every 5 minutes.
Total maximum dose 10 mg.
UNCONTROLLED WHEN PRINTED
Schedule
• S4 (Restricted drugs).
Paediatric dosages
Routes of administration
Intravenous injection (IV)
(RSQ taskings only)
E CCP
UNCONTROLLED WHEN PRINTED
Note: QAS officers are NOT authorised to administer
metoprolol to paediatric patients.
Special notes
UNCONTROLLED WHEN PRINTED
• Metoprolol 5 mg/5 mL ampoules are not currently available via QAS warehouse – for procurement information please refer to the QAS Drug Management Code of Practice.
QUEENSLAND AMBULANCE SERVICE
805

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