Short term management of heart failure
Dobutamine has a positive inotropic effect (increases cardiac output) with very
little effect on heart rate. Stimulates Beta1 receptors in the heart.
• Monitor hemodynamics: hypertension, ↑HR, PVCs
• Skin reactions may occur with hypersensitivity
• Beta blockers may negate therapeutic effects of dobutamine
• Monitor cardiac output
• Monitor peripheral pulses before, during, and after therapy
• DO NOT confuse dobutamine with dopamine
Hey guys, let’s talk about Dobutamine also known as Dobutrex. This is an IV medication. As you can see here, this is a picture I actually took at my job. So the therapeutic class of Dobutamine is an isotropic agent, which is how it works in the body. That’s the therapeutic class. While the pharmacologic class is the chemical effect of the drug, which in this case is a beta-adrenergic agonist. So Dobutamine works because it has a positive inotropic effect, which means it increases cardiac output with little effect on the heart rate. And it stimulates beta-1 receptors in the heart. Dobutamine is indicated for the short-term management of heart failure.
So a few side effects that we see with dobutamine are tachycardia and hypertension. And remember cardiac output is increased, which can also cause palpitations and sometimes a headache. So let’s take a look at a few nursing considerations for dobutamine. Before, during, and after therapy, be sure to assess the patient’s peripheral pulse. Skin reactions can occur in patients who have a hypersensitivity to Dobutamine. Beta-blockers may negate the therapeutic effects of Dobutamine because beta-blockers block the beta-1 receptors that Dobutamine is trying to stimulate. So make sure you are aware of that. Monitor your patient’s hemodynamics, including hypertension, increased heart rate, PVCs, and cardiac output. Teach the patient that Dobutamine and Dopamine are different medications and not to confuse the two. At high doses, due to beta-2 stimulation, Dobutmaine can cause hypotension instead of the hypertension that we would normally expect. And this should be monitored when doses increase. In going along with this in patients on long-term dobutamine, for more than 72 hours, there can be a down-regulation of the beta receptors leading to tolerance. These effects can turn into a dangerous cyclical effect, meaning the patient is becoming tolerant so they are hypotensive, which causes the provider to increase the dose, which keeps perpetuating the issue. So make sure you remember this fact, the next time you have a patient who has been on Dobutamine for 72 hours or more. That’s it for Dobutamine or Dobutrex. Now go out and be your best self today. And as always happy nursing.