Pushing 50mg of IV Lopressor? Tell me no !

About 1 1/2 years ago I worked in a Radiology department where a cardiology group was starting up a CTA program, I have to tell you as an ER nurse the amount of Lopressor in their protocol concerned me too, however, the cardiologists and 2 nurses who worked with their protocol at another hospital came and we did scans on 25 volunteers to get us more comfortable with the protocol. We gave up to 50mg of IV Lopressor and I did a lot of research and talking with the pharmacists etc. We had very specific criteria for the meds and we gave 5 mg over 2 minutes with VS done q3minutes during the giving of meds and q5 minutes after meds completed up to 30 minutes. We kept our outpatients until they returned to baseline/30-60minutes post test. Outpatients had to come with a driver and were also made NPO for the possibility of nausea/vomiting related to the large bolus of contrast. Inpatients who were NOT on a monitored floor (didnt happen often) we also kept for the same time like the outpatients.
I once gave 70mg of Lopressor with the Cardiologist standing in the room but the patient never responded to the medications. We also had standing orders for treatment of bronchospasms/bradycardia etc. We actually found that the patients receiving oral Lopressor the night before and the morning of had better outcome with less medications. Those patients also had to have a driver for the exam.

I work in a cardiologist owned clinic with a 64 slice ct scanner. Our current protocol is to give 5mg to 40mg of metoprolol IV to get the HR less than 70 or 65 for certain protocols. If asthmatic, we can give up to 25mg of IV cardizem, if still no effect 20mg of metoprolol in addition to the cardizem. This is a protocol dictated by our cardiologist. It also concerns me but he and others tell me that it is common practice, I just can't seem to find those protocols in writing. I am so happy to find this site.
Unfortunately we only have 1 nurse scheduled and pt's are scheduled every 30min, so needless to say when things don't happen quickly or we need to watch them longer we can get behind. Our pt's do not always have a driver and it is not mandatory at this time. This is a fairly new dept and we are learning. I appreciate any help or expertise you all can give us.

thanks for your quick reply, we have been practicing for about 9 months too, it still freaks me out, but our patients do well. The contrast seems to bump their pressure and pulse back up before they leave, my concern is max effect is about 40min and we are only keeping about 10-15min after, sometimes 30min. And the half life is 4hrs, so how are they at home or driving? I have not heard back from anyone that they have had trouble. Our pt population of course is elderly with most of them on betablockers already and lots of other meds. They also have some heart disease.

I have another question about patient history and paper work is there another thread for that we are trying to get organized, but with only 1 nurse per day (we job share) we are responsible for all the pt's history, meds and looking for lab results. Calling for allergy to contrast and mucomyst before the scan. So we are pretty busy even if only 6 scans a day, and if we do 9 it is crazy.

If you are in need of a history sheet/documentation tool let me know I can fax you one of ours. We have one that has now been revised. As far as written protocols I think that is MD dependent in your facility.

I attended a Coronary CTA Seminar in August. They routinely push 50mg lopressor and even go as high as 100 mg of Lopressor for coronary CTA's and then monitor the patient for only 30 minutes prior to sending them home. I explained to them that I was very concerned about the doses, they looked at me as if I had just fallen off the turnip truck. (This was a outpatient clinic that was affiliated with a cardiologist office, yet they performed this exam often when there was not even a cardiologist on site).

Besides my concern regarding the amount that was being administered for obvious patient safety reasons, I suggested that that they had a little more freedom to manage these patients than we did as we are a hospital based Radiology department and therefore subject to regulatory agencies such as JCAHO, TDH, CMS etc.

My personal experience if 25-35 mg of Lopressor does not obtain the targeted heart rate of 55-60, then you are better off canceling and approaching heart rate control a little differently. Our refering cardiologist have had great luck with premedicating with 50mg PO Lopressor BID for 2-3 days prior, then we administer IV lopressor as needed the day of. These patients seem to respond much easier to the IV with the premedicaion on board.

Hope this helps.

I once pushed Lopressor 5mg 23 times, I told the attending I was not comfortable & the Cardiologist was at the bedside teling me that was a proper order, I involved Pharmacy & Nurse educator. No one found any literature to support that it is unsafe so long as the pts lungs are clear, no CHF, & not brady. The MTP didn't even touch the. BP pt. I still think of it cause I don't know if that waas even right.
The pt. did live BTW he was on a nitro drip maxed out at 200mcg per min., & with MTP every 5min ATyed like at 200/100 with hr 90ish