Conjugated estrogens and Isoproterenol Hydrochloride

• Generic Name: conjugated estrogens
• Dosage Forms: n.a.
• Other Brand Names: Enjuvia, Premarin, Premarin Intravenous, Cenestin

Estrogen is a female sex hormone produced by the ovaries. Estrogen is necessary for many processes in the body.

Conjugated estrogens are a mixture of estrogen hormones used to treat menopause symptoms such as hot flashes and vaginal changes, and to prevent osteoporosis (bone loss) in menopausal women. Conjugated estrogens are also used to replace estrogen in women with ovarian failure or other conditions that cause a lack of natural estrogen in the body.

Conjugated estrogens are sometimes used as part of cancer treatment in both women and men.

Conjugated estrogens may also be used for purposes not listed in this medication guide.

• Generic Name: isoproterenol
• Dosage Forms: n.a.
• Other Brand Names: Isuprel

Used for treatment of heart block and Adams-Stokes attacks. Also has been used for treatment of ventricular arrhythmias secondary to AV nodal block and carotid sinus hypersensitivity. However, evidence supporting benefit in patients with cardiac arrhythmias generally lacking; safer and more effective alternatives such as cardiac pacing and other drug therapies are available.

Has been used in the treatment of cardiac arrest until defibrillation or emergency pacemaker therapy could be employed. However, experts state that isoproterenol is not a drug of choice in ACLS and should only be considered in this setting for treatment of symptomatic bradycardia unresponsive to atropine or as a temporary measure until pacemaker therapy can be instituted. Should not be used for resuscitation in patients with cardiac arrest or hypotension because of potential deleterious effects (e.g., exacerbation of ischemia, arrhythmias, peripheral vasodilation).

Must not be administered to patients with acetylcholinesterase-induced bradycardias; however, may be beneficial at high doses in refractory bradycardia caused by β-adrenergic blocking agents.

Used as adjunctive therapy to produce cardiac stimulation and vasodilation in the treatment of shock.

The value of isoproterenol therapy in shock has been questioned because the drug increases oxygen demand in the myocardium and other tissues to levels that may not be met by increased blood flow. Efficacy in reducing mortality in refractory shock not demonstrated.

Vasopressors such as norepinephrine and epinephrine generally considered drugs of choice for effective hemodynamic management of shock.

Isoproterenol generally not recommended for cardiogenic shock; increases in myocardial oxygen consumption and cardiac workload usually outweigh benefits, and arrhythmias can occur more readily.

Should not be used in patients with drug-induced distributive shock; may worsen hypotension by further decreasing systemic vascular resistance.

IV isoproterenol may be useful in bronchospasm occurring during anesthesia but must be administered with extreme caution, if at all, in patients receiving cyclopropane or halogenated hydrocarbon general anesthetics.

Has been used as a bronchodilator in the symptomatic treatment of bronchial asthma and reversible bronchospasm that may occur in association with chronic bronchitis, pulmonary emphysema, bronchiectasis, and other chronic obstructive pulmonary disorders. However, oral, sublingual, and oral inhalation preparations of the drug no longer are commercially available in the US.

Has been used by IV infusion to reverse decreases in cardiac output and circulating pulmonary blood volume and to reverse increases in pulmonary arterial pressure and pulmonary vascular resistance occurring during pulmonary embolism.

Has been used as an aid in the diagnosis of CAD. Also has been used in the diagnosis of CAD by increasing myocardial oxygen consumption and intensifying symptoms of ischemia.

Has been used as an aid in diagnosing the etiology of mitral regurgitation.