How Do You Know Dobutamine Is Effective

Continuing Education Action

The FDA canonical dobutamine for brusque-term use in patients with decreased contractility due to heart failure or cardiac surgical procedures leading to cardiac decompensation. The agent has non been shown to give positive outcomes in the hospitalized or outpatient setting for middle failure patients despite hemodynamically improving the patient's condition. Dobutamine can exist used every bit temporary intravenous inotropic back up until resolution of the astute inducing factors or the patient receives more definitive treatment, such as coronary revascularization, mechanical circulatory back up, or heart transplant. Short-term intravenous inotropic support should be given to patients in cardiogenic shock to preserve systemic claret menses and protect from finish-organ damage. This activity volition highlight the mechanism of activity, adverse consequence contour, pharmacology, monitoring, and relevant interactions of dobutamine, pertinent for members of the interprofessional team in treating patients with cardiac disorders that will reply to such therapy.

Objectives:

• Place the various indications for dobutamine.

• Outline the adverse event profile for dobutamine.

• Review the mechanism of activity of dobutamine that leads to its therapeutic furnishings.

• Summarize interprofessional squad strategies for improving care coordination and advice to advance diabetes management and meliorate outcomes by using dobutamine.

Access gratuitous multiple choice questions on this topic.

Indications

In 1975, pharmacologist Tuttle and chemist Mills, notice the compound dobutamine by modifying the structure of isoproterenol/isoprenaline. They published an commodity "Dobutamine: development of a new catecholamine to selectively increase cardiac contractility"[1]

Dobutamine is approved by the Food and Drug Administration (FDA) for short-term use in patients with decreased contractility due to heart failure or cardiac surgical procedures leading to cardiac decompensation.[ii] The agent has not demonstrated positive outcomes in the hospital or outpatient setting for heart failure patients despite hemodynamically improving the patient'southward condition.

Dobutamine can be used as temporary intravenous inotropic back up until resolution of the acute inducing factors or the patient receives more than definitive treatment, such as coronary revascularization, mechanical circulatory back up, or heart transplant. Short-term intravenous inotropic back up should be given to patients in cardiogenic shock to preserve systemic blood flow and protect from end-organ damage.

Patients can reasonably receive dobutamine in continuous intravenous form for inotropic support to bridge patients with belatedly-stage middle failure, phase D, that is refractory to guideline-directed medical therapy until patients who are candidates for and awaiting cardiac transplantation or mechanical circulatory support receive the advisable long-term treatment.[3]

Continuous intravenous inotropic dobutamine support can reasonably be given in the short term for hospitalized patients with astringent systolic dysfunction who nowadays with depression blood pressure level and a significantly decreased cardiac output to preserve systemic blood flow and protect from end-organ damage.

Continuous intravenous inotropic dobutamine support tin reasonably exist given for the long-term in palliative patients with tardily-phase middle failure, stage D, who are not candidates for mechanical circulatory back up or cardiac transplantation for symptomatic control, regardless of guideline-directed medical therapy.[iv]

Intravenous inotropic dobutamine can exist given off-label to patients to induce pharmacological stress during stress echocardiography if patients cannot perform an exercise stress exam.[v][6]

Mechanism of Activity

Dobutamine is used as a pharmacological agent and has both ionotropic and chronotropic furnishings depending on the dose. Because of its inotropic furnishings on the myocardium through bounden and activating the beta-1 receptors selectively.[7] The medication is indicated clinically for decompensated congestive middle failure considering of the sympathomimetic effects. Dobutamine's ionotropic effect increases contractility, leading to decreased finish-systolic volume and, therefore, increased stroke book. The increase in stroke volume leads to an augmentation of the cardiac output of the eye.[eight] The changes in cardiac output let for the baroreceptor-mediated response to subtract the systemic vascular resistance and crusade little to no change in the arterial blood pressure level. In addition to the well-known beta-one activity, dobutamine has been shown to have some beta-2 activity, which contributes to the reduction in the systemic vascular resistance, and alpha-ane activity, to an even lesser extent, whose vasoconstrictive furnishings are negated past the baroreceptor mediated response and beta-2 action.

Administration

Dobutamine administration is via large intravenous admission and infusion pump for inotropic back up in decompensated congestive center failure, stress echocardiogram, and stress nuclear testing. The dosage for cardiac decompensation in heart failure can begin with one-half to ane mcg/kg/min and increment upward to a maximum of twoscore mcg/kg/min. The lower doses of dobutamine can be prescribed at two.5 to 5.0 mcg/kg/min, and the higher terminate of dobutamine doses tin can be five.0 to twenty.0 mcg/kg/min.[9] The dose for the stress echocardiogram and stress nuclear test is initiated at v mcg/kg/min and can be increased in intervals of 10 mcg/kg/min every three to five minutes until reaching the target heart rate. Dobutamine comes in a solution as a racemic mixture of both positive and negative enantiomers for intravenous administration. The positive enantiomer in the solution is predominately selective for the beta sympathetic receptors, mainly beta i and 2, whereas the negative enantiomer has been shown in studies to be selective for the alpha one receptors.[ten]

Adverse Effects

Dobutamine administration tin lead to possible adverse reactions, mainly due to sympathomimetic activity. The majority of patients taking this medication take experienced a rise in the systolic claret pressure level of 10 to 20 mmHg and an increase of 5 to x beats per minute in their heart rate. There accept been reports of further increases in systolic blood pressure and centre rate. In about x% of the patients, there can be a ascent of 30 beats per infinitesimal or more in the middle rate, and in near vii.v% of patients, there can be an increase of fifty mmHg or more in the systolic blood pressure. Patients with preexisting hypertension are more than susceptible to the agin effects on systolic blood force per unit area when using dobutamine.[eleven]

Dobutamine increases the gamble of rapid ventricular response in patients with preexisting atrial fibrillation. The recommendation is that these patients utilize a regimen of digoxin before starting dobutamine to decrease the take chances of developing atrial fibrillation with a rapid ventricular response. There has been an increased hazard of developing premature ventricular beats during the administration of dobutamine. Well-nigh 5% of patients experience premature ventricular beats.[12]

Other adverse furnishings caused by this medication include hypotension rarely. While increases in systolic blood pressure level are common due to dobutamine, hypotension can occur less frequently due to the decreases in systemic vascular resistance. Recommendations include decreasing the dose or stopping the drug to reverse the hypotensive effects.

Phlebitis at the site of the intravenous administration tin can occur, but information technology an uncommon reaction. Dobutamine tin can rarely reduce the potassium concentrations to hypokalemic levels. Other rare adverse effects accept occurred in one to iii percent of the patients, including nausea, headaches, chest pain, palpitations, and shortness of jiff. Dobutamine contains sulfite, which can lead to reactions in rare patients with sulfite hypersensitivity.

Contraindications

According to the Nutrient and Drug Administration, Dobutamine utilize is contraindicated in patients with a noted history of allergic reactions to either previous dobutamine apply or any sulfite use. The medication is contraindicated in patients with astute myocardial infarction, unstable angina, left main stem disease, astringent hypertension, arrhythmias, acute myocarditis or pericarditis, hypokalemia and idiopathic hypertrophic sub-aortic stenosis.

Monitoring

Throughout the administration of this medication, there should be continuous monitoring using cardiac monitor and claret pressure checks because dobutamine is typically given to unstable patients and can lead to serious furnishings quickly that require monitoring and corrective action. The clinician can reduce the dose of dobutamine or stop the medication if the patient experiences adverse effects.

Toxicity

Dobutamine toxicity is rare, and the half-life is brusk at 2 minutes. Symptoms are generally due to sympathetic overstimulation and can include chest pain, palpitations, headaches, tremors, shortness of jiff, nausea, and vomiting. To reverse the tachycardia caused past dobutamine, metoprolol intravenous can be given.

Enhancing Healthcare Squad Outcomes

Dobutamine is a medication used in the ICU to manage low claret pressure. While the drug is safe, its use requires close monitoring as it has the potential to heighten blood pressure and cause arrhythmia. Therefore the involvement of an interprofessional healthcare team is the optimal arroyo to ensuring therapeutic effectiveness and fugitive agin effects. This squad includes clinicians, specialists, mid-level practitioners, nurses, and pharmacists. Nurses perform Iv dobutamine administration; hence these professionals should be familiar with the dosing and what parameters to monitor. Overall, the effects of dobutamine are brusque-lived. As soon as the infusion stops, the hemodynamic parameters will reverse. Collaboration and open communication between all interprofessional squad members will drive the all-time patient results with dobutamine and any other drugs or procedures. [Level five]

Review Questions

Figure

Dobutamine Pressure Volume Loop. Contributed past StatPearls

References

1.

Tuttle RR, Mills J. Dobutamine: evolution of a new catecholamine to selectively increase cardiac contractility. Circ Res. 1975 January;36(1):185-96. [PubMed: 234805]

2.

McNally EM. Tin can we exercise ameliorate than dobutamine? Circ Res. 2013 Aug 02;113(4):355-7. [PMC free commodity: PMC3869564] [PubMed: 23908327]

3.

Stevenson LW. Clinical use of inotropic therapy for middle failure: looking backward or forrard? Part I: inotropic infusions during hospitalization. Apportionment. 2003 Jul 22;108(three):367-72. [PubMed: 12876135]

4.

Martens P, Vercammen J, Ceyssens Westward, Jacobs L, Luwel Eastward, Van Aerde H, Potargent P, Renaers Thou, Dupont One thousand, Mullens West. Effects of intravenous dwelling house dobutamine in palliative cease-stage centre failure on quality of life, centre failure hospitalization, and cost expenditure. ESC Heart Fail. 2018 Aug;5(4):562-569. [PMC gratis article: PMC6073033] [PubMed: 29341466]

5.

Currie GM. Pharmacology, Part 4: Nuclear Cardiology. J Nucl Med Technol. 2019 Jun;47(ii):97-110. [PubMed: 30770476]

vi.

Lattanzi F, Picano E, Adamo E, Varga A. Dobutamine stress echocardiography: safety in diagnosing coronary artery disease. Drug Saf. 2000 April;22(4):251-62. [PubMed: 10789822]

7.

Alhayek Southward, Preuss CV. StatPearls [Net]. StatPearls Publishing; Treasure Island (FL): Aug xi, 2021. Beta 1 Receptors. [PubMed: 30422499]

8.

Kislitsina ON, Rich JD, Wilcox JE, Pham DT, Churyla A, Vorovich EB, Ghafourian K, Yancy CW. Shock - Classification and Pathophysiological Principles of Therapeutics. Curr Cardiol Rev. 2019;15(2):102-113. [PMC free article: PMC6520577] [PubMed: 30543176]

9.

Erlemeier HH, Kupper W, Bleifeld Due west. Intermittent infusion of dobutamine in the therapy of severe congestive heart failure--long-term effects and lack of tolerance. Cardiovasc Drugs Ther. 1992 Aug;6(iv):391-8. [PubMed: 1520649]

10.

Ruffolo RR. The pharmacology of dobutamine. Am J Med Sci. 1987 Oct;294(4):244-8. [PubMed: 3310640]

11.

Mertes H, Sawada SG, Ryan T, Segar DS, Kovacs R, Foltz J, Feigenbaum H. Symptoms, adverse effects, and complications associated with dobutamine stress echocardiography. Experience in 1118 patients. Circulation. 1993 Jul;88(1):15-9. [PubMed: 8319327]

12.

David S, Zaks JM. Arrhythmias associated with intermittent outpatient dobutamine infusion. Angiology. 1986 Feb;37(2):86-91. [PubMed: 3954157]

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Source: https://www.ncbi.nlm.nih.gov/books/NBK470431/

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