eye-soe-proe-TER-e-nole

• Management of bronchospasm during anesthesia.
• Treatment of asthma or COPD.
• Management of bradycardia (IV only).

• Results in the accumulation of cyclic adenosine monophosphate (cAMP) at beta-adrenergic receptors.
• Produces bronchodilation.
• Inhibits the release of mediators of immediate hypersensitivity reactions from mast cells.
• Has additional significant beta (cardiac)-adrenergic action, which results in positive inotropic and chronotropic effects.

• Bronchodilation.
• Increased heart rate.

Absorption: Well absorbed following IM or subcut administration, IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Metabolism occurs in the lung, liver, and other tissues; 50% excreted unchanged by the kidneys after IV administration.

Half-life: 2.5–5 min.

Contraindicated in:

• Hypersensitivity to adrenergic amines or bisulfites.

Use Cautiously in:

• Cardiovascular disease (including hypertension and coronary artery disease)
• Hyperthyroidism
• Diabetes
• Glaucoma
• Geri: Geriatric patients are more susceptible to adverse reactions; may require dosage reduction
• Pregnancy (near term)and lactation;.
• Pedi: Safety not established in children; pediatric use has been associated with serious adverse reactions.

CNS: nervousness, restlessness, tremor, headache, insomnia.

CV: ARRHYTHMIAS, angina, hypertension, tachycardia.

GI: nausea, vomiting, xerostomia.

Endo: hyperglycemia.

Misc: pink/red discoloration of saliva.

Drug-Drug:

• Concurrent use with other adrenergic agents (sympathomimetics) will have additive adrenergic side effects.
• Use with MAO inhibitors may lead to hypertensive crisis.
• May increasetheophylline elimination.
• Beta blockers may negate therapeutic effect.

• IV (Adults): Heart block, Adams-Stokes attacks and cardiac arrest — 0.02–0.06 mg may be followed by additional doses of 0.01–0.02 mg or 5 mcg/min infusion; bronchospasm during anesthesia — 0.01–0.02 mg, repeated as needed).
• IV (Neonates , Infants, and Children): 0.05–2 mcg/kg/min via continuous infusion.
• IM (Adults): Heart block, Adams-Stokes attacks and cardiac arrest — 0.2 mg; subsequent range 0.02–1 mg.
• SC (Adults): Heart block, Adams-Stokes attacks and cardiac arrest — 0.2 mg; subsequent range 0.15 mg–0.2 mg.
• Intracardiac (Adults): Heart block, Adams-Stokes attacks and cardiac arrest — 0.02 mg.

• High Alert:IV vasoactive medications are inherently dangerous. Prior to administration, have second practitioner independently check original order, dose calculations, concentration, route of administration, and infusion pump settings.

IV Administration:

• IV Push: May administer 20 mcg (1 mL) solution undiluted. Do not use if solution is pinkish to brownish or contains a precipitate.
• Rate: Administer 0.5–1 mL (10–20 mcg) over 1 min.
• Continuous Infusion:
  Diluent: Prepare by adding 4 mg (20 mL of 0.2 mg/mL solution) of isoproterenol to 500 mL of D5W, D10W, 0.9% NaCl, 0.45% NaCl, dextrose/saline combinations, dextrose/Ringer’s or lactated Ringer’s combinations, Ringer’s or LR. Concentration: 8 mcg/mL.
• Rate: Administer at a rate of 2–10 mcg/min (15–75 mL/hr), adjusting according to patient response and parameters for heart rate and hemodynamic values. Administer via infusion pump to delivery of precise amounts of medication. Infusion must be gradually tapered over a 24– to 48– hr period to prevent rebound bronchospasm.
• Y-Site Compatibility:
  • acyclovir
  • alfentanil
  • amikacin
  • amiodarone
  • amphotericin B liposome
  • anidulafungin
  • ascorbic acid
  • atracurium
  • atropine
  • aztreonam
  • benztropine
  • bivalirudin
  • bleomycin
  • bumetanide
  • buprenorphine
  • butorphanol
  • calcium chloride
  • calcium gluconate
  • carboplatin
  • caspofungin
  • cefazolin
  • cafonocid
  • cefotaxime
  • cefotetan
  • cefoxitin
  • ceftazidime
  • ceftriaxone
  • cefuroxime
  • chloramphenicol
  • chlorpromazine
  • cimetidine
  • cisatracurium
  • cisplatin
  • clindamycin
  • cyanocobalamin
  • cyclophosphamide
  • cyclosporine
  • cytarabine
  • dactinomycin
  • daptomycin
  • dexamethasone
  • dexmedetomidine
  • digoxin
  • diltiazem
  • diphenhydramine
  • dobutamine
  • docetaxel
  • dopamine
  • doxacurium
  • doxorubicin
  • doxycycline
  • enalaprilat
  • ephedrine
  • epinephrine
  • epirubicin
  • epoetin alfa
  • eptifibatide
  • ertapenem
  • erythromycin
  • esmolol
  • etoposide
  • etoposide phosphate
  • famotidine
  • fenoldopam
  • fentanyl
  • fluconazole
  • fludarabine
  • fluorouracil
  • gemcitabine
  • gentamicin
  • glycopyrrolate
  • granisetron
  • heparin
  • hetastarch
  • hydrocortisone
  • hydromorphone
  • idarubicin
  • ifosfamide
  • imipenem/cilastatin
  • ketorolac
  • labetalol
  • levofloxacin
  • lidocaine
  • linezolid
  • lorazepam
  • magnesium sulfate
  • mannitol
  • mechlorethamine
  • meperidine
  • metaraminol
  • methotrexate
  • methoxamine
  • methyldopate
  • methylprednisolone
  • metoclopramide
  • metoprolol
  • metronidazole
  • midazolam
  • milrinone
  • mitoxantrone
  • morphine
  • multivitamins
  • nafcillin
  • nalbuphine
  • naloxone
  • nitroglycerin
  • nitroprusside
  • norepinephrine
  • octreotide
  • ondansetron
  • oxacillin
  • oxaliplatin
  • oxytocin
  • paclitaxel
  • palonosetron
  • pancuronium
  • pantoprazole
  • papaverine
  • pemetrexed
  • penicillin G
  • pentamidine
  • pentazocine
  • phentolamine
  • phenylephrine
  • phytonadione
  • piperacillin/tazobactam
  • potassium chloride
  • procainamide
  • prochlorperazine
  • promethazine
  • propofol
  • propranolol
  • protamine
  • pyridoxime
  • quinupristin/dalfopristin
  • ranitidine
  • remifentanil
  • rocuronium
  • sodium acetate
  • streptokinase
  • succinylcholine
  • sufentanil
  • tacrolimus
  • teniposide
  • theophylline
  • thiamine
  • thiotepa
  • tigecycline
  • tirofiban
  • tobramycin
  • tolazoline
  • trimetaphan
  • vancomycin
  • vasopressin
  • vecuronium
  • verapamil
  • vincristine
  • vinorelbine
  • vitamin B complex with C
  • voriconazole
• Y-Site Incompatibility:
  • aminophylline
  • amphotericin B colloidal
  • azathioprine
  • dantrolene
  • diazepam
  • diazoxide
  • ganciclovir
  • indomethacin
  • insulin
  • pentobarbital
  • phenobarbital
  • phenytoin
  • sodium bicarbonate
  • trimethoprim/sulfamethoxazole
.

Isuprel, Medihaler-Iso

Therapeutic Classification: antiarrhythmics, bronchodilators

Pharmacologic Classification: adrenergics

(Generic available)

• Injection: 20 mcg (0.02 mg)/mL; 200 mcg (0.2 mg)/mL;

(bronchodilation)

• Bronchodilator: Assess lung sounds, respiratory pattern, pulse, and BP before administration and during peak of medication. Note amount, color, and character of sputum produced.
• Monitor pulmonary function tests before initiating therapy and periodically during therapy to determine effectiveness.
• Pedi: Continuous assessment of vital signs, frequent electrocardiography, and daily measurements of cardiac enzymes, including CPK-MB, are required if IV isoproterenol therapy is administered to pediatric patients. May cause myocardial necrosis, HF, and death. Risks of cardiac toxicity may be increased by acidosis, hypoxemia, coadministration of corticosteroids, coadministration of theophylline, or aminophylline.

• May cause transient ↓ in serum potassium concentrations with nebulization or at higher than recommended doses.

• Symptoms of overdose include persistent agitation, chest pain or discomfort, decreased BP, dizziness, hyperglycemia, hypokalemia, seizures, tachyarrhythmias, persistent trembling, and vomiting.
  • Treatment includes discontinuing beta-adrenergic agonists and symptomatic, supportive therapy. Cardioselective beta blockers are used cautiously, as they may induce bronchospasm.

• Ineffective airway clearance (Indications).
• Ineffective tissue perfusion (Indications).

• Advise patient to consult health care professional before taking any OTC medications or alcoholic beverages concurrently with this therapy. Caution patient also to avoid smoking and other respiratory irritants.
• Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain.

• Prevention or relief of bronchospasm.
  • Increase in ease of breathing.
• Increase in cardiac rate and output when used intravenously.

NDC Code^*

• 0187- Bausch Health US LLC
  • 0187-4330- Isuprel
    • 0187-4330-01- 25 AMPULE in 1 CARTON (0187-4330-01) > 1 mL in 1 AMPULE

• 0187- Bausch Health US LLC
  • 0187-4330- Isuprel
    • 0187-4330-05- 10 AMPULE in 1 CARTON (0187-4330-05) > 5 mL in 1 AMPULE

• 0548- Amphastar Pharmaceuticals, Inc.
  • 0548-9501- ISOPROTERENOL HYDROCHLORIDE
    • 0548-9501-00- 10 VIAL in 1 CARTON (0548-9501-00) > 1 mL in 1 VIAL

• 0548- Amphastar Pharmaceuticals, Inc.
  • 0548-9502- ISOPROTERENOL HYDROCHLORIDE
    • 0548-9502-00- 10 VIAL in 1 CARTON (0548-9502-00) > 5 mL in 1 VIAL

• 14789- Nexus Pharmaceuticals Inc
  • 14789-011- Isoproterenol Hydrochloride
    • 14789-011-01- 10 VIAL, SINGLE-DOSE in 1 CARTON (14789-011-01) > 1 mL in 1 VIAL, SINGLE-DOSE

• 14789- Nexus Pharmaceuticals Inc
  • 14789-015- Isoproterenol Hydrochloride
    • 14789-015-05- 10 VIAL, SINGLE-DOSE in 1 CARTON (14789-015-05) > 5 mL in 1 VIAL, SINGLE-DOSE

• 69097- Cipla USA Inc.
  • 69097-521- ISOPROTERENOL
    • 69097-521-31- 25 AMPULE in 1 CARTON (69097-521-31) > 1 mL in 1 AMPULE

• 69097- Cipla USA Inc.
  • 69097-522- ISOPROTERENOL
    • 69097-522-35- 10 AMPULE in 1 CARTON (69097-522-35) > 5 mL in 1 AMPULE

• 70121- Amneal Biosciences LLC
  • 70121-1604- Isoproterenol Hydrochloride
    • 70121-1604-7- 10 VIAL in 1 CARTON (70121-1604-7) > 1 mL in 1 VIAL (70121-1604-1)

• 70121- Amneal Biosciences LLC
  • 70121-1605- Isoproterenol Hydrochloride
    • 70121-1605-7- 10 VIAL in 1 CARTON (70121-1605-7) > 5 mL in 1 VIAL (70121-1605-1)