THE COLLEGE OF MAASIN

Nisi Dominus Frustra

PATIENT’S NAME: Fernando Lopez____________ AGE: 74_____________________ CIVIL STATUS: Married___________________________

DIAGNOSIS: __Acute Decompensated Heart Failure____________________________________________________________

Generic Name: dobutamine Dobutamine is a Dobutamine is Dobutamine must not Side effects: (by system) (at least 10 nursing
Brand Name: synthetic indicated for be used in the case of: increased heart rate and interventions)
catecholamine patients who increased blood pressure,
Therapeutic Class: Inotropes that acts on require a positive - known hypersensitivity ventricular ectopic activity, - Monitor BP
Pharmacological Class: alpha-1, beta-1 inotropic support to dobutamine or to any nervousness, - Monitor heart rate
Adrenergics-beta1 agonists and beta-2 in the treatment of the excipients, headache, - Alert: Because drug
Actual Dose, Timing and Route: adrenergic of cardiac nausea, increases AV node
Dosage in adults: receptors. In the decompensation - mechanical obstruction vomiting, conduction, patients with
According to experience, the majority of heart, the due to depressed of ventricular filling palpitations, atrial fibrillation may develop
patients respond to doses of 2.5-10 µg stimulation of contractility. and/or of outflow, such low platelet counts a rapid ventricular rate.
these receptors as pericardial (thrombocytopenia), or - Continuously monitor ECG,
dobutamine/kg/min. In individual cases,
produces a In cardiogenic tamponade, constrictive swelling at the injection BP, pulmonary artery wedge
doses up to 40 µg dobutamine/kg/min
relatively strong, shock pericarditis, site. pressure, cardiac output.
have been administered. additive inotropic hypertrophic obstructive - Monitor electrolyte levels.
characterised by
Dosage in paediatric patients: effect and a cardiomyopathy, severe Drug may lower potassium
heart failure with
relatively weak aortic stenosis, Adverse effects: (by level.
severe system)
For all paediatric age groups (neonates chronotropic -Look alike-sound like alike:
hypotension and in
to 18 years) an initial dose of 5 effect. - hypovolaemic don’t confuse dobutamine to
case of septic Dobutamine increases the
micrograms/kg/minute, adjusted conditions. dopamine.
shock Dobutamine risk of rapid ventricular
according to clinical response to 2– 20 - Tell patient to report
may be useful if response in patients with
micrograms/kg/minute is Dobutamine stress adverse reaction promptly,
recommended. Occasionally, a dose as added to echocardiography preexisting atrial fibrillation. especially labored breathing
low as 0.5-1.0 micrograms/kg/minute dopamine in case The recommendation is that and drug-induced headache.
will produce a response. of disturbed Dobutamine must not these patients use a regimen -Instruct patient to report
ventricular be used for detection of of digoxin before starting discomfort at I.V. insertion
Route: IV function, raised myocardial ischaemia dobutamine, to decrease the site.
filling pressure of and of viable risk of developing atrial -Monitor urinary output
the ventricles and myocardium in case of: fibrillation with a rapid cautiously.
raised systemic ventricular response. There
- recent myocardial
resistance. has been an increased risk of
infarction (within the last
30 days), developing premature
Dobutamine may ventricular beats during the
also be used for - unstable angina administration of
detection of pectoris, dobutamine. About 5% of
myocardial patients experience
ischaemia and of - stenosis of the main premature ventricular beats.
viable myocardium left coronary artery,
within the scope of Other adverse effects caused
an - haemodynamically by this medication include
echocardiographic significant outflow hypotension rarely. While
examination obstruction of the left increases in systolic blood
(dobutamine stress ventricle including pressure is a common effect
echocardiography), hypertrophic obstructive due to dobutamine,
if patients cannot cardiomyopathy, hypotension can occur, less
undergo a period frequently, due to the
- haemodynamically
of exercise or if the decreases in the systemic
significant cardiac
exercise yields no valvular defect, vascular resistance.
information of Recommendations include
value. - severe heart failure decreasing the dose or
(NYHA III or IV), stopping the drug to reverse
Dobutamine is the hypotensive effects.
indicated in all - predisposition for or
paediatric age documented medical
groups (from history of clinically
neonates to 18 significant or chronic
years of age) as arrhythmia, particularly
inotropic support recurrent persistent
in low cardiac ventricular tachycardia,
output
hypoperfusion - significant disturbance
states resulting in conduction,
from
- acute pericarditis,
decompensated
myocarditis or
heart failure,
endocarditis,
following cardiac
surgery, - aortic dissection,
cardiomyopathies
and in cardiogenic - aortic aneurysm,
or septic shock.”
- poor sonographic
imaging conditions,

- inadequately treated /
controlled arterial
hypertension,

- obstruction of
ventricular filling
(constrictive pericarditis,
pericardial tamponade),

- hypovolaemia,

- previous experience of
hypersensitivity to
dobutamine.

Note:

If administering
atropine, the respective
contraindications have
to be observed.