# The wonderful drug Lopressor



## Silverstone (Feb 27, 2009)

Yes that wonderful drug that no one at our service ever gives... Except for me, twice in a row in one night.  Our protocols say to call Medical Control for 15mg over 15 minutes for Irregular Narrow QRS Tachycardia that is stable.  In other words A-Fib for the most part.

First out of the two was an elderly gentleman that woke up shaking.  Uncontrollable shaking in his upper extremities.  No real other symptoms besides a slight dyspnea, and was tearing up.  Has a history of HTN, so his BP was a little high, his pulse was about 150 and irregular.  Otherwise pink warm and dry.  We went ahead and hooked him up to our monitor and noticed that he was in Atrial fibrillation, and he keeps going in and out of flutter.  Which I very rarely ever see.  So we got all the 12 lead, 02, IV and all that done, and I called up the hospital and got an order for 5mg of Lopressor.... I just about :censored::censored::censored::censored: my pants cause normally the anal retentive doctors say just monitor and transport.  So en route to the hospital I gave him the 5mg over 5 minutes, and his pulse dropped down into the 90's, and stayed there, he didn't convert but his BP was now normal, and his shaking stopped.  Interesting....  then he blew chunks all over our cot.  I'm going to buy stock in Zofran.

Second out of the two, elderly female at a residential facility.  C/O chest pain.  Been complaining of it off and on for the last 2-3 days.  We get on scene, she's laying supine in bed.  Her color is a little pale, but her BP is high about 160/100.  Pulse is 160 and irregular.  I look at my partner and I'm thinking.... No way....  Not this again...  We hook up the monitor and guess what.... Atrial Fibrillation.  And she has no history of heart problems.  So we get her on our cot and as we're wheeling her out to the ambulance I call up a doctor at our other hospital we have in town.  And he orders.... 5mg of lopressor.....  Says don't worry about Nitro or Morphine, just go straight to Lopressor.  I again just about :censored::censored::censored::censored: my pants.  So we again, do our 12 Lead, send it via bluetooth to the hospitals e-mail, and IV and all that happy stuff.  I gave her the 5 mg over 5 minutes.   And her pulse rate drops into the 80's.  Still showing A-Fib.  BP is now normal.  And we transport.  Her pain went from 8/10 initially to 0/10 after the lopressor.  As we were wheeling her into the ER on the cot, she converted into a beautiful Sinus Rhythm.  As I was giving the report to the receiving RN, she stopped writing and looked right at me when I told her we gave lopressor.  And then her jaw dropped when I told her the Pt converted after just 5.  She stayed in a Sinus Rhythm throughout the duration of her stay in the ER, and she was sent home after a Cardiologist consult.

I enjoy the traumas, the fun extrications, the lost cause codes, and what not.  But what I really enjoy are the medicals, where when pharmacological interventions actually work, and the Pt does a complete 180.  This lady was the sweetest person I've ever picked up in the ambulance.  She made my month.


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## Airwaygoddess (Feb 28, 2009)

Your are right about medications and they have a postive outcome, and as far as your little ol lady that is sweet!


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## Tincanfireman (Feb 28, 2009)

Way to go, dude; and hopefully the docs won't be quite so tight with the meds from now on when you can present S/S that justify them.  Well done!


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## Ridryder911 (Feb 28, 2009)

Lopressor is great drug, when given properly and needed. The only problem I have seen is reflex bradycardia and even severe bradycardia post administration about 30 minutes afterwards. 

R/r911


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## trevor1189 (Feb 28, 2009)

Ridryder911 said:


> Lopressor is great drug, when given properly and needed. The only problem I have seen is reflex bradycardia and even severe bradycardia post administration about 30 minutes afterwards.
> 
> R/r911


Have a question about this. Maybe you can help teach me something as I am not that knowledgeable on specific drugs. Lopressor decreases blood pressure so shouldn't the HR go up? I am just confused on the reflex bradycardia you mentioned. I thought that occurred as a response to high BP. So are you saying Lopressor lowers both heart rate and BP despite the bodies attempts to regulate? Love hearing or reading how this stuff works so if you could explain or point me in the right direction that would be great.


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## Silverstone (Mar 1, 2009)

It's a beta blocker so it stops norepinephrine and epinephrine from binding to beta receptors on nerves.  Beta-1 receptors are in the heart, eyes, and kidneys.  Beta-2 receptors are lungs, liver, skeletal muscles, and blood vessels.  Beta-3 receptors are basically located in fat cells.  So it dilates blood vessels, and helps lower blood pressure.  And sometimes people end up with blindness, bronchospasms, and like R/r911 said reflex bradycardia.


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## jrm818 (Mar 1, 2009)

the blockade of adernergic input to the heart is a direct effect of the drug.  There is no reflex loop involved, and thus it is not a "reflex" action per se.  It is true that B1 antagonists will lower heart rate, but that is direct interference with the sympathetic system.  If this is a true reflex, there must be something else going on.  Would be interested...

Edit: 

Small correction too.  B2 receptors are found (predominantly) in blood vessels supplying skeletal muscle.  Activation of beta receptors causes dilation of blood vessels.  The blood vessels supplying the skin and mesentary contains primarily alpha receptors.  Alpha receptors cause blood vessel contraction when activated.


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