Agent

Action

Immediate IV Dose

Usual Oral Maintenance Therapy

Avoid Use, or Caution with Use

Diltiazem

CCB

20mg (or 0.25 mg/kg to 0.35 mg/kg) over 2 min;

+5,10,15 mg/H infusion

120-360 mg/day

WPW, constipation,

Overt CHF

Esmolol

BB

0.5 mg/kg (500mcg/kg)  load over 1 min, then 0.05  mg/kg/min (50 mcg/min)  to 0.3 mg/kg (300 mcg/kg)  per min

IV only

Overt CHF not due to rapid ventricular rate

Metoprolol

BB

5mg every 5 min up to 15 mg total

50-200 mg/day

Bronchospastic lung disease

Overt CHF

Digoxin

Cardiac glycoside

0.5 mg +

0.25 mg in 4-6H +

0.25 mg in 4-6H

0.125-0.5 mg/day

WPW, hypertrophic cardiomyopathy (inotropic effect)