Pharmacopeia

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Field LABETALOL
Cardiovascular · Cardiovascular · Level 2
ESMOLOL
Cardiovascular · Cardiovascular · Level 2
Mechanism of action

Beta blockage leads to ↓Gs activity in receptor associated organs and
associated ↓in adenylyl cyclase and intracellular Ca2+.

Alpha blockage leads to ↓ Gq activation and subsequent ↓in IP3 and intracellular Ca2+

Beta blockage leads to ↓Gs activity in receptor associated organs and
associated ↓in adenylyl cyclase and intracellular Ca2+.


Cardiovascular · Cardiovascular

Beta blockage leads to ↓ Gs activity in receptor associated organs and
associated ↓ in adenylyl cyclase and intracellular Ca2+.

Physiological effects

β: It produces
decreases in heart rate and cardiac output and myocardial oxygen consumption.

α: Peripheral vasodilation

It produces
decreases in heart rate and cardiac output and myocardial oxygen consumption

Absorption

bioavailabilty complete absorption but high first pass metabolism results in bioavailability 25%

bioavailabilty Only available as IV therefore 100%

Distribution

lipid solubility moderately lipid soluble, can enter CNS

lipid solubility is high so it crosses the BBB

Protein binding

50%

60% to albumin

Volume of distribution

3-16 L/kg

3.5 L/Kg

Metabolism

Hepatic, primarily via glucuronide conjugation

neither hepatic or renal!
by red blood cell esterases to a mostly inactive metabolite


Cardiovascular · Cardiovascular

neither hepatic or renal! by red blood cell esterases to a mostly inactive metabolite

Excretion

Urine (60% as glucuronide conjugates, <5% as unchanged drug)

urine

Half-life

6-8 hours

10 minutes

Adverse Effects Toxicity

- Withdrawal.

- Care with: Opioids, Halo, OAD, CCB

- Due to its metabolism, it should be used in caution in liver failure patients and elderly

- Care with: Opioids, Halo, OAD, CCB

- It is an irritant to veins and may lead to tissue necrosis with extravasation

Chemical Pharmaceutics

It is a racemic solution with four stereoisomers present in
equal proportions. The SR isomer is likely responsible for the alpha blocking
effects and the RR isomer for the betablockade

—
Class Group

Mixed alpha and beta blocker

Ultra-short-acting selective beta1-adrenoceptor antagonist; Vaughan Williams class II antiarrhythmic.


Cardiovascular · Cardiovascular

Beta Blocker


Cardiovascular · Cardiovascular

Antiarrhythmic –
Vaughan Williams Class II
Beta blocker

Indications Uses

- Used in the setting of an acute hypertensive crisis
- Pregnancy related hypertension

- Short term management tachycardia and hypertension in a monitored patient
- For SVT termination

- No intrinsic sympathomimetic activity or membrane stabilising properties

Introduction

an alpha 1 blocker and a non selective beta blocker.

Cardio-selective beta blocker with rapid onset and offset.


Cardiovascular · Cardiovascular

Cardio-selective beta blocker with rapid onset and off-set.

Legacy Cicm Level

Level 2

Level 2

Presentation

available as a 50-400mg tablets and as a colourless solution containing 5mg/ml.

only available as an IV formulation.
presented as a clear liquid usually at a concentration of 10mg/ml

Route And Dose

IV and oral
doses IV in 20mg pushes, oral for HTN 100-400mg BD

IV
dose In 10mg increments titrate to effect


Cardiovascular · Cardiovascular

IV
dose In 10mg increments titrate to eff¬ect