Cardiac technology

1. DRUG PROFILE
PRESENTED BY:
SYEDA ZAHRA AZIZ
DOBUTAMINE

3. DOBUTAMINE
(Myocardiac stimulant)

4. INTRODUCTION;
Name of drug;
 Dobutamine (generic name)
 Dobutrex (trade name)
Class of drug;
Sympathomimetic (beta-1 agonist)
Vasopressor

5. STRUCTURE OF DOBUTAMINE;
( SYNTHETIC CATECHOLAMINE)

6. PHARMACEUTICAL FORM;
STERILE INJECTION

7. QUALITATIVE AND QUANTITAVE COMPOSITION;

8. PHARMACODYNAMIC PROPRTIES
 MECHANISM OF ACTION;
 Directly stimulates beta adrenergic receptor.
 Stimulation of Adenyl cyclase activity.
 Doesn‘t cause release of nor epinephrine.
 Cardiac Stimulation.

9.  Positive inotropic effect on
myocardium.
 Increase in cardiac output.
 Decrease in peripheral resistence.
 Increased myocardial Oxygen
consumption.
 Increase in urine flow.
 Doesn‘t affect Dopaminergic
receptor.

10. PHARMACOKINETIC PARAMETERS;
 Absorption;
 Following IV administration
 Onset of action is 2 min
 Peak plasma conc. of drug is 10 min after initiation of
an IV infusion.
 Distribution;
 Metabolism; ( in liver)
 Methylaion and Conjugation
 Elimination;
 Plasma half-life is 2 min
 Excretion mainly through urine.

11. INDICATIONS;
 Inotropic support
 Cardiac failure
 Open heart surgery
 Positve end expiratory
pressure
 Alternative to exercise
in Cardiac stress
testing.

12. CARDIAC STRESS TESTING;
 It is a test used in
medicine and
cardiology to
measure Heart‘s
ability to respond to
the external stress in
a controlled clinical
environment.

13. CONTRAINDICATIONS;
 Hypersensitivity to dobutamine.
 Pheochromocytoma
 Must not be used in myocardial ischemia, in
case of ;
 Recent myocardial infarction,
 Unstable angina pectoris,
 Stenosis of main left coronary artery,
 Heart failure

14. ECHOCARDIOGRAPHY;
In this technique, heart disease is detected by
using sound waves and this will generate image
of heart.

15. OVERDOSAGE;
Symptoms;
 Anorexia
 Nausea, vomiting, tremor
 Headache, chest pain
 Excessive Hypertention
 Tachycardia

16. MANAGMENT OF TOXICITY;
 The initial action to be taken;
 Discontinuing administration of drug.
 Ensuring oxygenation and ventilation.
 If product is ingested , then absorption of
drug from GIT may be decreased by giving
activated charcoal. It is better than emesis
and gastric lavage.

17. ADVERSE DRUG REACTION;
 Immune system disorders;
 Hypersensitivity reactions including;
 rash
 fever
 Anaphylactic reactions and severe life-
threatening asthmatic episodes may be due
to sulphite sensitivity.

18.  Metabolism and nutrition
disorder;
 Hypokalemia
 Central Nervous System;
Headache
Tremor
Restlessness
Feeling of anxiety

19.  Cardiovascular system;
 Increase in heart beat by >30 beats/min.
 Vasoconstriction
 Anginal pain
 Tachycardia
 Renal;
 Urinary urgency
 Respiratory;
 Shortness of breath
 GIT;
 nausea

20. POSOLOGY AND ROUTE;
 Route;
 For IV use only
 Because of its shorter half life it is administered
as continuous IV infusion.
 Dilutions
 Dosage of adult and the elderly;
 2.5-10 mcg/kg/min
 0.5mcg/kg/min
 Rarely upto 40mcg/kg/min may be
required.

21.  Rate of administration and duration of
therapy should be adjusted according to patient
response, as determined by measurement of;
 Heart rate
 Blood pressure
 Urine flow
 Children;
 Safety and efficacy of dobutamine therapy in
children have not been established.

22. INTERACTIONS;
 Halogenated anesthesia;
 Desflurane;
 Onset : rapid
 Severity: major
 Documentation: possible
 Effect; death due to cardiac ischemia
 Mechanism; unknown
 Managment; this has not proven because of its
severity,the possiblity of this drug be considered

23. H 2- Anta gonist (cimitidine);
 Significance; 4
 Onset; rapid
 Severity; moderate
 Documentation; possible
 Effects; increased hypertention
 Mechanism; unknown
 Managment; monitor blood
pressure and adjust dobutamine
dose.

24.  Rauwolfia alkaloid ( Reserpine);
 Significance; 2
 Onset; rapid
 Severity; moderate
 Documentation; suspected
 Effect; it potentiate pressor response of
dobutamine and results in incresed hypertention
 Mechanism; it depletes stores of catecholamines,
increasing receptor sensitivity to dobutamine.

25.  Pregnancy and lactation;
 Category; B
 Reproduction studies in rats and rabbits
have revealed no evidence of impaired
fertility, harm to the foetus, or teratogenic
effects due to dobutamine. As there are no
adequate and well-controlled studies in
pregnant women, and as animal
reproduction studies are not always
predictive of human response, dobutamine
should not be used during pregnancy unless
the potential benefits out weigh the
potential risks to the foetus.

26.  Lab test interferences;
 None well documented

27.  Precautions ;
 Use with extreme caution after myocardial
ischemia
 Dose is decreased if there is undue increase
in heart rate, systolic blood pressue or
arrythmia is precipitated.
 Mild hypokalemia may occur.
 Sulphite sensitivity;
 Use with caution in sulphite – sensitive
patients because it causes allergy.

28. PATIENT CARE CONSIDERATION;
 Administration and storage;
Administration only by IV infusion.
 Carton text shall contain the following statements:
 “Dilute to at least 50 ml volume before intravenous
infusion”
 if not required immediately, the diluted solution
may be stored for up to 24 hours in a refrigerator.”
 Keep out of the reach of children
 “If only part used, discard the remaining
solution”
 “Protect from light”
 “Do not store above 25°C”

29. ASSESSMENT AND INTERVENTION;
 Obtain pt. History
 Monitor vital signs , ECG,
cardiac output, urinary
output etc
 Monitor potassium level
 Monitor placement of IV
catheter to reduce risk of
extravasation.
 If pt. has diabetes then
monitor blood glucose level
and then report to physician.

30. PATIENT AND FAMILY EDUCATION;
 Instruct patient to report
these symptoms to physician
and Pharmacist ;
 Pain or discomfort at IV site
 Any anginal pain

31. COUNCELLING WITH PATIENT ;

32. PATIENT SHOULD CONSULT HIS PHYSICIAN
AND PHARMACIST FOR SAFE USE OF
MEDICATION;

33.  I believe that;
PREVENTION IS BETTER THAN CURE

34. Keep ur mind, heart,body
and soul healthy;

35. Make ur life style healthier;

40. Any
Question ?

41. Thanks
again
all of
you 