Dobutrex
Dobutrex
[do´bu-treks]DOBUTamine
(doe-byoo-ta-meen) dobutamine,Dobutrex
(trade name)Classification
Therapeutic: inotropicsPharmacologic: adrenergics
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (inotropic effects)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| IV | 1–2 min | 10 min | brief (min) |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- headache
Respiratory
- shortness of breath
Cardiovascular
- hypertension (most frequent)
- increased heart rate (most frequent)
- premature ventricular contractions (most frequent)
- angina pectoris
- arrhythmias
- hypotension
- palpitations
Gastrointestinal
- nausea
- vomiting
Local
- phlebitis
Miscellaneous
- hypersensitivity reactions including skin rash, fever, bronchospasm or eosinophilia
- nonanginal chest pain
Interactions
Drug-Drug interaction
Use with nitroprusside ; may have a synergistic effect on ↑ cardiac output.Beta blockers may negate the effect of dobutamine.↑ risk of arrhythmias or hypertension with some anesthetics (cyclopropane, halothane ), MAO inhibitors, oxytocics, or tricyclic antidepressants.Route/Dosage
Availability
Nursing implications
Nursing assessment
- Monitor BP, heart rate, ECG, pulmonary capillary wedge pressure (PCWP), cardiac output, CVP, and urinary output continuously during the administration. Report significant changes in vital signs or arrhythmias. Consult physician for parameters for pulse, BP, or ECG changes for adjusting dose or discontinuing medication.
- Palpate peripheral pulses and assess appearance of extremities routinely throughout dobutamine administration. Notify physician if quality of pulse deteriorates or if extremities become cold or mottled.
- Lab Test Considerations: Monitor potassium concentrations during therapy; may cause hypokalemia.
- Monitor electrolytes, BUN, creatinine, and prothrombin time weekly during prolonged therapy.
If overdose occurs, reduction or discontinuation of therapy is the only treatment necessary because of the short duration of dobutamine.
Potential Nursing Diagnoses
Decreased cardiac output (Indications)Ineffective tissue perfusion (Indications)
Implementation
- high alert: IV vasoactive medications are potentially dangerous. Have second practitioner independently check original order, dosage calculations, and infusion pump settings. Do not confuse dobutamine with dopamine. If available as floor stock, store in separate areas.
- Correct hypovolemia with volume expanders before initiating dobutamine therapy.
- Administer into a large vein and assess administration site frequently. Extravasation may cause pain and inflammation.
Intravenous Administration
- pH: 2.5–5.5.
- Continuous Infusion: Diluent: Vials must be diluted before use. Dilute 250–1000 mg in 250–500 mL of D5W, 0.9% NaCl, 0.45% NaCl, D5/0.45% NaCl, D5/0.9% NaCl, or LR. Admixed infusions stable for 48 hr at room temperature and 7 days if refrigerated. Premixed infusions are already diluted and ready to use.Concentration: 0.25–5 mg/mL.
- Rate: Based on patient's weight (see Route/Dosage section). Administer via infusion pump to ensure precise amount delivered. Titrate to patient response (heart rate, presence of ectopic activity, BP, urine output, CVP, PCWP, cardiac index). Dose should be titrated so heart rate does not increase by >10% of baseline.
- Y-Site Compatibility: amifostine, amikacin, amiodarone, anidulafungin, argatroban, atracurium, atropine, aztreonam, bivalirudin, bumetanide, calcium chloride, calcium gluconate, caspofungin, cimetidine, ciprofloxacin, cisatracurium, cyclosporine, cladribine, dexmeditomidine, diazepam, digoxin, diltiazem, diphenhydramine, docetaxel, dopamine, doxorubicin liposome, doxycycline, enalaprilat, epinephrine, eptifibatide, erythromycin, esmolol, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, gemcitabine, gentamicin, granisetron, haloperidol, hydromorphone, insulin, isoproterenol, labetalol, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, meperidine, methylprednisolone sodium succinate, metoclopramide, metoprolol, milrinone, morphine, nafcillin, nicardipine, nitroglycerin, norepinephrine, ondansetron, oxaliplatin, palonosetron, pancuronium, phenylephrine, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, ranitidine, remifentanil, streptokinase, tacrolimus, theophylline, thiotepa, tigecycline, tirofiban, tobramycin, tolazoline, vancomycin, vasopressin, vecuronium, verapamil, voriconazole, zidovudine
- Y-Site Incompatibility: acyclovir, alteplase, aminophylline, amphotericin B cholesteryl sulfate, ampicillin, ampicillin/sulbactam, amphotericin B, cefazolin, cefoxitin, ceftriaxone, cefuroxime, chloramphenicol, ertapenem, foscarnet, ganciclovir, hydrocortisone sodium succinate, indomethacin, ketorolac, lansoprazole, micafungin, pantoprazole, pemetrexed, penicillin G potassium, phenytoin, phytonadione, piperacillin/tazobactam, sodium bicarbonate, thiopental, ticarcillin/clavulanate, trimethoprim/sulfamethoxazole, warfarin
Patient/Family Teaching
- Explain to patient the rationale for instituting this medication and the need for frequent monitoring.
- Advise patient to inform nurse immediately if chest pain; dyspnea; or numbness, tingling, or burning of extremities occurs.
- Instruct patient to notify nurse immediately of pain or discomfort at the site of administration.
- Home Care Issues: Instruct caregiver on proper care of IV equipment.
- Instruct caregiver to report signs of worsening HF (shortness of breath, orthopnea, decreased exercise tolerance), abdominal pain, and nausea or vomiting to health care professional promptly.
Evaluation/Desired Outcomes
- Increase in cardiac output.
- Improved hemodynamic parameters.
- Increased urine output.