I hope someone here can give me some info on this. I am working in a 22 bed ICU(mixed census of coronary/surgical/med- little of everything). This past week I was assigned to a pt who had suffered a SAH and was placed on a Lopressor Drip for b/p control. The drip had been started at 1300 and when I came on at 1900 her b/p was still elevated at 170s/100s. During the shift report the off going RN had told me that she had been titrating the drip and it was going at 0.7mcg/kg/min. After report I went in to assess the pt and found indeed that the drip was going at that rate but was loaded into the IV pump and labeled Levophed not Lopressor. The patient was in no distress. I must admit I was not familiar with using lopressor in a drip form usually we give it as a bolus push for b/p not cont infusion. when I reviewed the order the md had written it simply said Lopressor Drip to keep sbp less than 140. So i called the pharmacy and asked them if they had any reference info on giving lopressor this way so that i would be titrating it correctly and was told that the PHARM was unable to find any references for this use and had simply mixed the drip and sent it to the ICU.
Next I went to my own reference books and my charge nurse and we both had never heard of using Lopressor this way and could find no references in the books or on the computer.
well by this time my next b/p was still elevated and the pt's heartrate was now about 46 after having been in the high 50s all day (even before the drip was started). So i turned off the medication and paged the attending md. When he returned the call I explained to him that 1.the medication was having no effect on the b/p but had lowered her heartrate 2.i needed some clarification on how he wanted the drip given; mcg/kg/min mg/hr etc. After a pause he said "Wellhow do you all normallly give it?" I told him that we didn't and that pharm and the icu staff could find no guidelines or references for this use. Then came the question all ICU nurses love to hear "Well want to you want to Use?" I suggested nipride since labetolol had already failed. So that's what I ended up hanging andhad b/p control within the next 1hr.
So after my long vent my question is Has anyone been using Lopressor as an infusion not as a bolus? If so I would love to hear your facilities guidelines or any references you know of.
Actually, I'd expect a NEURO doc to THROW A FIT over a Lopressor gtt. Nitro or Nipride are much better choices, I've even known a few NEURO guys that wouldn't allow Labetolol, which is much more of a Cardio-selective B-blocker than Lopressor. The big risk is BRADYCARDIA. If the patient suddenly becomes Bradycardic, is it because of the B-Blocker or and increased ICP??? Therein lies the problem as I see it. Hydralazine may also be a good choice, however you have to keep in mind the long half-life of it, thus why I'd say NTG or Nipride would seem better choice.
Actually, I'd expect a NEURO doc to THROW A FIT over a Lopressor gtt. Nitro or Nipride are much better choices, I've even known a few NEURO guys that wouldn't allow Labetolol, which is much more of a Cardio-selective B-blocker than Lopressor. The big risk is BRADYCARDIA. If the patient suddenly becomes Bradycardic, is it because of the B-Blocker or and increased ICP??? Therein lies the problem as I see it. Hydralazine may also be a good choice, however you have to keep in mind the long half-life of it, thus why I'd say NTG or Nipride would seem better choice.
We routinely have orders for PRN labetalol, metoprolol, hydralazine, and enalipril PRN as well as orders for cardene or nipride gtts to keep SBP less than 150.
We routinely have orders for PRN labetalol, metoprolol, hydralazine, and enalipril PRN as well as orders for cardene or nipride gtts to keep SBP less than 150.
Lopressor for a NEURO patient though??? Kind of iffy. I like Cardene, forgot to mention that in the post, as I think it's a great drug, better than NTG, without the bad side effect of the Nipride. But look at your S/S of increased ICP, and seeing increased vagal tone and bradycardia is why I'd not like to be using Lopressor on a Neuro pt., especially one who may already have some abnormality in his/her neuro assessment.
Surprisingly, yes! It's on our standing orders for neuro admits. I typically prefer to start a cardene gtt and call it a shift.
We use PO cardene as part of our vasospasm protocol for strokes/coils etc, but I have not used it IV. Personally, I don't like using Calcium channel blockers as first line drugs to control hypertension, but that just might be my comfort level.
We use PO cardene as part of our vasospasm protocol for strokes/coils etc, but I have not used it IV. Personally, I don't like using Calcium channel blockers as first line drugs to control hypertension, but that just might be my comfort level.
Compared to IV verapamil or diltiazem, Cardene has relatively little to no effect on contractility and AV node supression. On the other hand it tends to be much better at arterial dilation than other CCBs. It's easy on and easy off too and typically involves minimal titration.
Specializes in SICU, EMS, Home Health, School Nursing.
I remember one of my patients who was having HR issues on a lopressor drip. We ran it mg/hr... I can't remember what our exact policy is for it though. It is very very rare to have it as a drip at my hospital. We generally use nipride or cardene (#1 choice) for our neuro patients and they use nitro for cardiac
is it common for you guys to use nipride for heads? some of our neurosurgeons try to stay clear of it citing a risk of increased icp.
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the fact that the patient actually tolerated the lopressor gtt (per you, her hr dropped from the mid50 to mid40) i would actually think that this is a person who in not bb niaeve and probably needs some blockade. i would probably have grabbed some nitro, but with the idea that esmolol or labetlol would probably be needed once the lopressor wore off. i would probably (assuming you a ngt and there are no other issue) be looking to start some po hypertensives asap, - then a drug like hydralzine can used for "breakthrough" hypertension.
also, in terms of the metrop gtt, that's a huge drug error and i hope you filled an incident report. these are the types of errors that kill people. please watch out for your patients and make sure this series of errors can't happen again.
heart rate in the 50's before the lopressor gtt was hung?? that alone is a contraindication for a beta blocker of any kind. very poor judgement on the day nurse's part.
we use cardene for heads in our neuro unit. GREAT drug.
Specializes in Cardiothoracic Transplant Telemetry.
Is it common for you guys to use nipride for heads? Some of our neurosurgeons try to stay clear of it citing a risk of increased ICP.
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The fact that the patient actually tolerated the lopressor gtt (per you, her HR dropped from the mid50 to mid40) I would actually think that this is a person who in not BB niaeve and probably needs some blockade. I would probably have grabbed some nitro, but with the idea that esmolol or labetlol would probably be needed once the lopressor wore off. I would probably (assuming you a NGT and there are no other issue) be looking to start some PO hypertensives asap, - then a drug like hydralzine can used for "breakthrough" hypertension.
Also, in terms of the metrop gtt, that's a huge drug error and I hope you filled an incident report. These are the types of errors that kill people. Please watch out for your patients and make sure this series of errors can't happen again.
My thought as well was that a nitro gtt would be a good choice. My worry for the OP would be the long lasting nature of so much beta blocker over the course of the previous shift. I hate it when doc's keep trying increasing dosages of the same meds with poor results. As you said, this patient was probably under significant beta blockade already, so even if metoprolol would be a good choice for infusion,(and it wasn't) it wouldn't be effective for this patient.
Wow, that's crazy! No wonder the BP was high if it was Levophed! We usually use nicardipine for our neuro patients. If that isn't enough, we also give them IVP labetalol and hydralizine. We also do a lot of sedation and neuromuscular blockade if necessary.
SEOBowhntr
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Actually, I'd expect a NEURO doc to THROW A FIT over a Lopressor gtt. Nitro or Nipride are much better choices, I've even known a few NEURO guys that wouldn't allow Labetolol, which is much more of a Cardio-selective B-blocker than Lopressor. The big risk is BRADYCARDIA. If the patient suddenly becomes Bradycardic, is it because of the B-Blocker or and increased ICP??? Therein lies the problem as I see it. Hydralazine may also be a good choice, however you have to keep in mind the long half-life of it, thus why I'd say NTG or Nipride would seem better choice.