에스몰롤

베타-1 아드레날린 수용체 차단제 (초단기 작용)

에스몰롤은 초단기 작용을 하는 심장 선택성 **베타-1 아드레날린 수용체 길항제**입니다. 수의학에서는 주로 심방세동, 심방조동, 동성 빈맥과 같은 상심실성 빈맥(SVT)의 급성 및 단기 관리를 위한 정맥 주입용으로 사용됩니다. 또한 환자를 장기 작용 경구용 베타 차단제로 전환하기 전에 베타 차단제 요법이 효과적이고 내약성이 있는지 확인하기 위한 **진단용 시험 약물**로도 매우 유용합니다. 이는 특히 비대성 심근병증(HCM)이 있는 고양이에서 베타 차단이 동적 좌심실 유출로 폐쇄를 감소시키는지 평가하는 데 유용합니다. > **임상 요점:** 에스몰롤은 적혈구 에스테라아제에 의해 빠르게 대사되기 때문에 주입을 중단한 후 10~20분 이내에 효과가 사라지며, 중증 환자의 시험적 치료에 있어 매우 안전합니다.

작용 기전: Esmolol competitively blocks **beta-1 adrenergic receptors** in the myocardium with minimal to no effect on beta-2 receptors at clinical doses. * **Negative Chronotropy:** Decreases heart rate by slowing sinoatrial (SA) node firing and increasing sinus cycle length. * **Negative Dromotropy:** Slows conduction velocity through the atrioventricular (AV) node and prolongs sinus node recovery time. * **Negative Inotropy:** Decreases myocardial contractility, which reduces myocardial oxygen demand. Unlike propranolol, esmolol lacks intrinsic sympathomimetic activity (ISA) and does not possess membrane-stabilizing (quinidine-like) or bronchoconstrictive effects.

동물 종별 용량

Cats

HCM (to determine if beta-blockers will reduce dynamic left-ventricular outflow tract obstruction) · An initial loading dose of 0.25-0.5 mg/kg (250-500 micrograms/kg) administered IV as slow bolus over 1-2 minutes, then followed by a constant rate infusion of 10-200 micrograms/kg/minute. · IV · CRI
Critical Arrhythmias · Loading dose of 200-500 micrograms/kg IV over 1 minute; followed by a constant rate IV infusion of 25-200 micrograms/kg/minute · IV · CRI

Dogs

Ultra-short acting beta blockade (ventricular arrhythmias) - Normal cardiac function · An initial loading dose of 0.25-0.5 mg/kg (250-500 micrograms/kg) administered IV as slow bolus over 1-2 minutes, then followed by a constant rate infusion of 10-200 micrograms/kg/minute; or Start CRI at 10-200 micrograms/kg/minute without the bolus loading dose. · IV · CRI · If no loading dose, maximal effect should occur in 10-20 minutes.
Ultra-short acting beta blockade - Severe dilated cardiomyopathy or severe mitral regurgitation · Start CRI at 10-20 micrograms/kg/min and titrate upward every 10 minutes to an effective endpoint. · IV · CRI · Do not give loading dose.
SVTs · 0.05-0.1 mg/kg (50-100 micrograms/kg) IV bolus over 2 minutes; repeat every 5 minutes to a maximum of 0.5 mg/kg (500 micrograms/kg). · IV · q5m
Arrhythmia conversion · Give in incremental IV bolus doses of 0.05-0.1 mg/kg every 5 minutes up to a maximum dose of 0.5 mg/kg. · IV · q5m · Because esmolol's effects are short-lived, if arrhythmia conversion does not occur, other negative inotropes (e.g., diltiazem, or verapamil) can be safely used 30 minutes after esmolol.

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

금기

Overt cardiac failure
2nd or 3rd degree AV block
Sinus bradycardia
Cardiogenic shock
Second or third-degree AV block
Uncompensated congestive heart failure
Hypotension

이상반응

Hypotension
Bradycardia
Heart block
Exacerbation of congestive heart failure
Bronchospasm (at high doses where beta-1 selectivity is lost)

약물 상호작용

Digoxin · Esmolol may increase serum digoxin levels up to 20%, but these drugs have been used together safely and effectively. · moderate
Monoamine Oxidase Inhibitors (MAOIs) · Concurrent use is not recommended due to potential risk of hypertension.
Morphine · May increase steady-state esmolol serum concentrations up to 50%; titrate esmolol dosage carefully.
Reserpine · May see additive effects (hypotension, bradycardia) if used with esmolol.
Vasoconstrictors/Inotropes (e.g., dopamine, epinephrine, norepinephrine) · If systemic vascular resistance is high, there is an increased risk for blocked cardiac contractility; esmolol is not recommended to control SVTs in patients receiving these drugs.
Verapamil · In humans, particularly with severe cardiomyopathy, cardiac arrest has occurred (rarely). · major
Calcium channel blockers (e.g., Diltiazem, Verapamil) · Additive negative inotropic and chronotropic effects; risk of severe bradycardia and hypotension · major
Alpha-2 agonists (e.g., Dexmedetomidine) · Increased risk of severe bradycardia · major
Sympathomimetics (e.g., Epinephrine) · Mutual antagonism · moderate
Diltiazem · Additive negative inotropic and chronotropic effects, increasing risk of severe bradycardia and hypotension. · major

모니터링

Blood Pressure
ECG
Heart Rate
Continuous Electrocardiogram (ECG)
Direct or indirect blood pressure
Heart rate and rhythm
Clinical signs of heart failure

과용량

The IV LD50 in dogs is approximately 32 mg/kg. * **2 mg/kg/min for 1 hour:** No adverse effects. * **3 mg/kg/min for 1 hour:** Produced ataxia and salivation. * **4 mg/kg/min for 1 hour:** Caused muscular rigidity, tremors, seizures, ptosis, vomiting, hyperpnea, vocalizations, and prostration. **Management:** These effects all resolved within 90 minutes of the end of infusion. Because of the short duration of action of the drug, discontinuation or dosage reduction may be all that is required; otherwise, symptomatic and supportive treatment may be initiated.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.