Pharm
Dobutamine
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Dobutamine
Mechanism
Synthetic
Sympathomimetic
amine
Overall effect similar to
Dopamine
with
Nitroprusside
Selective for
Beta Adrenergic Receptor
s
Beta 1 Adrenergic Receptor
Increased cardiac contractility and
Heart Rate
Beta 2 Adrenergic Receptor
Mild increase in vasodilation
Does not directly affect renal or splanchnic flow
Relatively mild
Alpha 1 Adrenergic Receptor
effect
Vasocon
striction countered by more potent beta effect
Minimal effects on myocardial oxygen demand
Favorable balance between oxygen supply and demand
Preferred in
Cardiogenic Shock
over
Dopamine
Increased perfusion balances inotropic strain
Benefit lost if not titrated to avoid
Tachycardia
Does not increase infarct size
Does not elicit
Arrhythmia
Pharmacokinetics
Short half-life
Only effective by infusion
Indications
Cardiogenic Shock
(Severe
Congestive Heart Failure
)
Pulmonary congestion or
Hypotension
Right ventricular infarction
Use with fluid
Resuscitation
Often used in combination with
Dopamine
Moderate dosages of each (7.5 ug/kg/min)
Maintains critical organ perfusion
Less pulmonary congestion than with
Dopamine
alone
Not shown to alter mortality
May alter secondary organ injury outcomes
Septic Shock
May be useful in enhancing left ventricular function
Epinephrine
is preferred agent in
Septic Shock
Not usually indicated in non-
Cardiogenic Shock
Other
Catecholamine
s preferred in other shock types
Pediatric Infusion (Same as Dopamine preparation)
Preparation
Draw up "x" mg of Dobutamine
Where "x" = 6 x Weight in Kilograms
Add enough D5W or NS to Dobutamine for 100 ml total
At this dilution
Infusion rate of 1 ml/h provides 1.0 ug/kg/min
Start Dose: 5-10 ug/kg/min or 5-10 ml/hour
Titrate to clinical response (usually <20 ug/kg/min)
Adult Infusion
Preparation
Start with 2-4 ampules Dobutamine (250 mg each)
Dissolve 500-1000 mg Dobutamine in 250 ml D5W or NS
Final Concentration: 2000-4000 ug/ml
Start Dose: 0.5 to 2.0 ug/kg/min
Titrate: 2-20 ug/kg/min to clinical response
Perfusion
Urine Output
Blood Pressure
Avoid increasing
Heart Rate
10% over baseline
Adverse Effects
Tachycardia
Arrhythmia
Ectopic beats
Provokes
Myocardial Ischemia
if
Tachycardia
occurs
Headache
Nausea
Tremor
Hypokalemia
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