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Diambil dari :

http://www.jurnalmedika.com/edisi-tahun2012/edisi-no-12-vol-xxxvii-2012/501kegiatan/1099-dobutamin-untuk-stabilisasidan-koreksi-kontraksi-jantung-.
Dobutamin untuk Stabilisasi dan Koreksi
Kontraksi Jantung
Syok dalam Kamus Kedokteran Dorland adalah gangguan keseimbangan fisik atau mental
yang timbul mendadak. Atau dapat juga diartikan sebagai gangguan metabolik dan hemodinamik berat yang ditandai dengan kegagalan sistem sirkulasi untuk mempertahankan perfusi organ vital yang adekuat. Keadaan ini disebabkan oleh volume darah yang tidak adekuat
(syok hipovolemik); fungsi jantung tidak adekuat (syok kardiogenik), atau tonus vasomotor
tidak adekuat (syok neurogenik dan syok septik). Perubahan gaya hidup masyarakat dan
semakin maraknya makanan yang tidak sehat saat ini menjadikan kasus syok kardiogenik
semakin meningkat. Di Amerika, angka kejadian syok termasuk syok kardiogenik di unitunit emergensi meningkat dari 17% pada 1998 menjadi 22% pada 2002. Padahal, dampak
terjadinya syok kardiogenik ini dapat menyebabkan serangan jantung (cardiac arrest) atau
kerusakan organ. Hal ini dapat mengakibatkan kematian dengan cepat bila tidak segera
dilakukan tindakan medis karena gejalanya bisa memburuk dengan cepat. Oleh karena itu,
stabilisasi koreksi bagi penderita syok kardiogenik sangat diperlukan agar tidak sampai
terjadi kematian mendadak.
Syok kardiogenik terjadi apabila terdapat kegagalan primer jantung dalam memompa, seperti
pada infark miokard atau kardiomiopati berat. Syok ini ditandai oleh gangguan fungsi
ventrikel, yang mengakibatkan gangguan berat pada perfusi jaringan. Masalah yang terjadi
disini adalah kurangnya kemampuan jantung untuk berkontraksi. Atau kondisi curah jantung
yang menjadi berkurang atau berhenti sama sekali untuk memenuhi kebutuhan metabolisme.
Sehingga kondisi jaringan tubuh menjadi kekurangan oksigen (hypoxia). Hal inilah nantinya
yang mengakibatkan munculnya serangan jantung.
Gejala syok kardiogenik dapat dikenali melalui tanda-tanda seperti pernapasan menjadi cepat,
sesak napas pada saat istirahat, detak jantung tiba-tiba cepat (takikardia), kebingungan,
kehilangan kesadaran atau pingsan, denyut nadi lemah, berkeringat, kulit pucat, dan tangan
atau kaki dingin. Alat-alat canggih untuk memastikan lebih jauh pasien menderita penyakit

ini biasanya menggunakan electrocardiogram (ECG), sonogram, scan jantung, kateterisasi


jantung, atau roentgen dada.
Pengobatan syok kardiogenik berfokus pada perbaikan kerusakan pada otot jantung dan
organ lain yang disebabkan oleh kekurangan oksigen. Oleh karena itu, diperlukan obat-obat
inotropik positif untuk mengatasi gangguan dinamika aliran darah di dalam tubuh akibat syok
dengan meningkatkan kontraksi otot jantung agar oksigen dapat disalurkan ke jaringan tubuh
dengan lancar. Melalui kesempatan acara Weekend Course on Cardiology (WECOC) yang
diselenggarakan oleh para pakar jantung pada akhir Oktober lalu, PT Pharos dengan bangga
memperkenalkan obat inotropik positif yaitu dobutamin. Produk yang diberi nama
Cardiotone ini mengandung 50 mg/ml dobutamin. Obat ini lebih menonjol dalam hal meningkatkan kontraktilitas otot jantung dari pada meningkatkan frekuensi denyut jantung.
Secara kimia, dobutamin mirip dengan dopamin, tetapi mempunyai gugus aromatik sebagai
pengganti gugus amino. Dobutamin merupakan sediaan agonis beta-adrenergik yang bersifat
inotropik, signifikan memperbaiki fungsi jantung, mengoptimalkan cardiac output, serta
meningkatkan konsumsi oksigen pada miokard. Target obat ini adalah mencapai saturasi
oksigen di vena sebesar 70%.
Cara pemakaian obat ini yaitu dengan mengencerkannya ke dalam konsentrat infus dengan
larutan NaCl 0,9% atau larutan glukosa 5%. Penyimpanan dobutamin pada suhu ruangan di
bawah 25oC dan terlindung cahaya. Apabila disimpan pada suhu kamar, larutan infus dapat
digunakan selama 12 jam dan apabila disimpan di refrigerator, larutan infus dapat digunakan
selama 24 jam. Dosis yang diberikan disesuaikan dengan kondisi penderita sesuai dengan
kecepatan jantung, ritme, tekanan darah dan diuresis.
Dengan demikian, dapat disimpulkan bahwa langkah yang dilakukan untuk menanggulangi
syok adalah dengan mengenali gejalanya terlebih dahulu karena tidak ada tes laboratorium
yang dapat mendeteksi terjadinya syok dengan segera. Diagnosis dibuat berdasarkan
pemahaman klinik berupa tidak adekuatnya perfusi organ. Langkah selanjutnya yaitu dengan
memberikan terapi secara tepat. Misalnya, dalam manajemen terapi pada beberapa sindrom
kardiovaskuler yang berkaitan dengan syok dapat digunakan dobutamin seperti yang terdapat
dalam Cardiotone. (Risky)

Diambil dari: cardiologyupdateunand.com/tag/dobutamine/

Dobutamine Stress Echocardiography


12/12/2011

Dobutamine Stress Echocardiography

Indri Putri Festari, Bobby Arfhan Anwar

Dobutamin merupakan suatu stimulator beta reseptor terutama beta 1 di jantung, ia


mempunyai efek sebagai intropik, kronotropik dan dromotropik positif. Efek intropik dan
kronotropik dari dobutamin menginduksi iskemia miokard pada jantung yang memiliki
stenosis signifikan pada arteri koronernya. Waktu paruh dobutamin adalah 2 menit.
Kebanyakan protokol dobutamin stress ekokardiografi menggunakan dosis awal 5
mikrogram/kg/menit dan dinaikkan hingga 40-50 mikrogram/kg/menit dan pemberian
atropine 0,25 sampai 1 mg di akhir test atau beta bloker, seperti esmolol. Stress
ekokardiografi ini bermanfaat untuk menilai iskemia miokard yang diinduksi stress dan
mendeteksi viabilitas miokardial.

Oksigen dan metabolit disuplai ke miokardium melalui arteri koroner. Aliran darah koroner
yang berkurang menyebabkan iskemia miokard akibat deprivasi metabolit. Dalam keadaan
istirahat, aliran koroner dapat tercukupi sesuai kebutuhan basal, kecuali jika terjadi stenosis.
Dalam keadaan normal, saat terjadi stress, maka aliran koroner akan meningkat sesuai dengan
kebutuhan oksigennya. Lebih dari 70% stenosis korner berhubungan dengan berkurangnya
kemampuan aliran maksimal koroner, yang kemudian memicu terjadinya kaskade iskemia.
Kaskade iskemia dimulai dengan heterogenisitas perfusi, perubahan metabolism, selanjutnya
terjadi gangguan diastolik, disinergi sistolik, perubahan EKG dan munculnya angina pectoris.
Daerah miokard yang mengalami asinergi tidak segera mengalami kerusakan ireversibel atau
sikatriks. Oklusi arteri koroner menyebabkan disfungsi miokard, reperfusi yang bertahap
akan mengembalikan fungsi miokard ketahap yang lebih baik dalam kurun waktu tertentu.
Fenomena ini disebut stunned miokardium. Jika aliran darah koroner diperbaiki, maka
miokardium yang mengalami iskemia kronik akan memiliki kemampuan untuk memperbaiki
kontraksinya, ini disebut hibernating myocardium. Stunning dan hibernating miokard
memiliki kemampuan inotropik, yang dapat distimulasi oleh dobutamin, hal ini ditunjukkan
oleh gerakan dinding yang lebih baik pada ekokardiogram.
Stess test ekokardiografi dihentikan jika sudah ditemukan endpoint, yaitu ditemukannya
gerakan dinding jantung yang abnormal lebih dari 1 segmen, meningkatnya volume akhir
sistolik, atau tercapainya denyut jantung maksimal yaitu ( 220-umur)*85%. Selama test,
fungsi ventrikel kiri baik regional maupun global dimonitor dengan ekokardiografi, frekuensi
nadi dan irama dinilai dengan EKG kontinu dan setiap 3 menit dilakukan pengukuran tekanan
darah dan EKG 12-lead.
Stress test ini dilakukan untuk menilai iskemia miokard, bukan untuk membuktikan efek obat
antiiskemik. Untuk menilai stress ekokardiografi ini, dinilai 16 segmen ventrikel
menggunakan sistem skor. Skor 1 adalah normokinesia, 2 adalah hipokinesia, 3 yaitu
akinesia, dan 4 diskinesia.. Abnormalitas gerakan ventrikel ditegakkan jika ditemukan
peningkatan skor >1 pada >1 segmen sebagai marker iskemia. Dan dikatan perbaikan jika
kenaikan skor >1 pada >1 segmen dengan dobutamin dosis rendah, sebagai biomarker
viability miokardium pada abnormalitas yang ditemukan pada saat istirahat

Dobutamin stress echo lebih efisien mendeteksi stenosis arteri koroner daripada exercise
ECG dan sebanding dengan skintigrafi perfusi miokard. Dibandingakan dengan angiografi
koroner, sensitivitas, spesivisitas, dan akuasi stress echo 72-86%, 77-95%, dan 76-89%.
Semakin rendah dosis Dobutamin yang diberikan, semakin rendah tingkat akurasi
diagnostiknya. Sensitivitas lebih baik pada stenosis multi-vesel dibandingkan single-vessel
dan lebih tinggi pada 70% stenosis dibandingkan 50% stenosis. Sensitivitas maksimum
ditemukan pada daerah iskemik yang diperdarahi oleh arteri koroner anterior desending.
Stress echo juga mampu menilai viabilitas miokard dengan sensitivitas dan spesifisitas 80 %
dan 90%.
Penggunaan strees echo setelah intervensi koroner masih terbatas. Setelah angioplasty
coroner yang berhasil, perbaikan gerakan dinding ventrikel dapat dinilai, dan stress echo
dapat digunakan pada keadaan restenosis setelah PCI, meskipun tidak dapat membedakan
restenosis atau lesi di pembuluh koroner baru.
Pre-operative stress echo merupakan alat diagnostik, terutama pada pasien yang tidak dapat
melakukan exercise test, pasien yang memiliki abnormalitas pada dinding ventrikelnya
memiliki resiko kardiovaskular peri-operative yang lebih tinggi.
Dobutamin stress echo memiliki beberapa komplikasi yang serius.

Diambil dari: http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=402f24d2-5e674dd6-99c6-84bb7c1c29e7


DOBUTAMINE- dobutamine hydrochloride injection
Bedford Laboratories
---------DOBUTamine Injection USP

Rx ONLY
DESCRIPTION

Dobutamine Injection USP is ()-4-[2-[[3-(p-Hydroxyphenyl)-1-methylpropyl]amino]ethyl]pyrocatechol hydrochloride. It is a synthetic catecholamine.

Molecular Formula: C18H23NO3HCl


Molecular Weight: 337.84
The clinical formulation is supplied in a sterile form for intravenous use only. Each mL
contains: dobutamine hydrochloride, equivalent to 12.5 mg (41.5 mol) dobutamine; sodium
bisulfite 0.28 mg (added during manufacture), and water for injection, q.s. Hydrochloric acid
and/or sodium hydroxide may have been added during manufacture to adjust the pH (2.5 to
5.5).
CLINICAL PHARMACOLOGY

Dobutamine is a direct-acting inotropic agent whose primary activity results from stimulation
of the receptors of the heart while producing comparatively mild chronotropic,
hypertensive, arrhythmogenic, and vasodilative effects. It does not cause the release of
endogenous norepinephrine, as does dopamine. In animal studies, dobutamine produces less
increase in heart rate and less decrease in peripheral vascular resistance for a given inotropic
effect than does isoproterenol.
In patients with depressed cardiac function, both dobutamine and isoproterenol increase the
cardiac output to a similar degree. In the case of dobutamine, this increase is usually not
accompanied by marked increases in heart rate (although tachycardia is occasionally
observed), and the cardiac stroke volume is usually increased. In contrast, isoproterenol

increases the cardiac index primarily by increasing the heart rate while stroke volume
changes little or declines.
Facilitation of atrioventricular conduction has been observed in human electrophysiologic
studies and in patients with atrial fibrillation.
Systemic vascular resistance is usually decreased with administration of dobutamine.
Occasionally, minimum vasoconstriction has been observed.
Most clinical experience with dobutamine is short-termnot more than several hours in
duration. In the limited number of patients who were studied for 24, 48, and 72 hours, a
persistent increase in cardiac output occurred in some, whereas output returned toward
baseline values in others.
The onset of action of dobutamine is within 1 to 2 minutes; however, as much as 10 minutes
may be required to obtain the peak effect of a particular infusion rate.
The plasma half-life of dobutamine in humans is 2 minutes. The principal routes of
metabolism are methylation of the catechol and conjugation. In human urine, the major
excretion products are the conjugates of dobutamine and 3-O-methyl dobutamine. The 3-Omethyl derivative of dobutamine is inactive.
Alteration of synaptic concentrations of catecholamines with either reserpine or tricyclic
antidepressants does not alter the actions of dobutamine in animals, which indicates that the
actions of dobutamine are not dependent on presynaptic mechanisms.
The effective infusion rate of dobutamine varies widely from patient to patient, and titration
is always necessary (see DOSAGE AND ADMINISTRATION). At least in pediatric patients,
dobutamine-induced increases in cardiac output and systemic pressure are generally seen, in
any given patient, at lower infusion rates than those that cause substantial tachycardia (see
PRECAUTIONS, Pediatric Use).
INDICATIONS AND USAGE

Dobutamine is indicated when parenteral therapy is necessary for inotropic support in the
short-term treatment of adults with cardiac decompensation due to depressed contractility
resulting either from organic heart disease or from cardiac surgical procedures. Experience
with intravenous dobutamine in controlled trials does not extend beyond 48 hours of repeated
boluses and/or continuous infusions.
Whether given orally, continuously intravenously, or intermittently intravenously, neither
dobutamine nor any other cyclic-AMP-dependent inotrope has been shown in controlled
trials to be safe or effective in the long-term treatment of congestive heart failure. In
controlled trials of chronic oral therapy with various such agents, symptoms were not
consistently alleviated, and the cyclic-AMP-dependent inotropes were consistently associated

with increased risk of hospitalization and death. Patients with NYHA Class IV symptoms
appeared to be at particular risk.
CONTRAINDICATIONS

Dobutamine is contraindicated in patients with idiopathic hypertrophic subaortic stenosis and


in patients who have shown previous manifestations of hypersensitivity to dobutamine.
WARNINGS
1.
Increase in Heart Rate or Blood Pressure
Dobutamine may cause a marked increase in heart rate or blood pressure,
especially systolic pressure. Approximately 10% of adult patients in clinical
studies have had rate increases of 30 beats/minute or more, and about
7.5% have had a 50 mm Hg or greater increase in systolic pressure.
Usually, reduction of dosage promptly reverses these effects. Because
dobutamine facilitates atrioventricular conduction, patients with atrial
fibrillation are at risk of developing rapid ventricular response. In patients
who have atrial fibrillation with rapid ventricular response, a digitalis
preparation should be used prior to institution of therapy with dobutamine.
Patients with preexisting hypertension appear to face an increased risk of
developing an exaggerated pressor response.
2.
Ectopic Activity
Dobutamine may precipitate or exacerbate ventricular ectopic activity, but
it rarely has caused ventricular tachycardia.
3.
Hypersensitivity
Reactions suggestive of hypersensitivity associated with administration of
dobutamine including skin rash, fever, eosinophilia, and bronchospasm,
have been reported occasionally.
4.
Dobutamine contains sodium bisulfite, a sulfite that may cause allergictype reactions, including anaphylactic symptoms and life-threatening or
less severe asthmatic episodes, in certain susceptible people. The overall
prevalence of sulfite sensitivity in the general population is unknown and
probably low. Sulfite sensitivity is seen more frequently in asthmatic than
in nonasthmatic people.
PRECAUTIONS

General
1.
During the administration of dobutamine, as with any adrenergic agent,
ECG and blood pressure should be continuously monitored. In addition,
pulmonary wedge pressure and cardiac output should be monitored
whenever possible to aid in the safe and effective infusion of dobutamine.
2.
Hypovolemia should be corrected with suitable volume expanders before
treatment with dobutamine is instituted.
3.
No improvement may be observed in the presence of marked mechanical
obstruction, such as severe valvular aortic stenosis.

Usage Following Acute Myocardial Infarction


Clinical experience with dobutamine following myocardial infarction has been insufficient to
establish the safety of the drug for this use. There is concern that any agent that increases
contractile force and heart rate may increase the size of an infarction by intensifying
ischemia, but it is not known whether dobutamine does so.

Laboratory Tests
Dobutamine, like other 2-agonists, can produce a mild reduction in serum potassium
concentration, rarely to hypokalemic levels. Accordingly, consideration should be given to
monitoring serum potassium.

Drug Interactions
Animal studies indicate that dobutamine may be ineffective if the patient has recently
received a -blocking drug. In such a case, the peripheral vascular resistance may increase.
Preliminary studies indicate that the concomitant use of dobutamine and nitroprusside results
in a higher cardiac output and, usually, a lower pulmonary wedge pressure than when either
drug is used alone.
There was no evidence of drug interactions in clinical studies in which dobutamine was
administered concurrently with other drugs, including digitalis preparations, furosemide,
spironolactone, lidocaine, glyceryl trinitrate, isosorbide dinitrate, morphine, atropine, heparin,
protamine, potassium chloride, folic acid, and acetaminophen.

Carcinogenesis, Mutagenesis, Impairment of Fertility


Studies to evaluate the carcinogenic or mutagenic potential of dobutamine, or its potential to
affect fertility, have not been conducted.

Pregnancy
Teratogenic EffectsPregnancy Category B

Reproduction studies performed in rats at doses up to the normal human dose (10 mcg/kg/min
for 24 h, total daily dose of 14.4 mg/kg), and in rabbits at doses up to twice the normal human
dose, have revealed no evidence of harm to the fetus due to dobutamine. There are, however,
no adequate and well-controlled studies in pregnant women. Because animal reproduction
studies are not always predictive of human response, this drug should be used during
pregnancy only if clearly needed.

Labor and Delivery


The effect of dobutamine on labor and delivery is unknown.

Nursing Mothers
It is not known whether this drug is excreted in human milk. Because many drugs are
excreted in human milk, caution should be exercised when dobutamine is administered to a
nursing woman. If a mother requires dobutamine treatment, breastfeeding should be
discontinued for the duration of the treatment.

Pediatric Use
Dobutamine has been shown to increase cardiac output and systemic pressure in pediatric
patients of every age group. In premature neonates, however, dobutamine is less effective
than dopamine in raising systemic blood pressure without causing undue tachycardia, and
dobutamine has not been shown to provide any added benefit when given to such infants
already receiving optimal infusions of dopamine.

Geriatric Use
Of the 1893 patients in clinical studies who were treated with dobutamine, 930 (49.1%) were
65 and older. No overall differences in safety or effectiveness were observed between these
and younger subjects. Other reported clinical experience has not identified differences in
responses between the elderly and younger patients, but greater sensitivity of some older
individuals cannot be ruled out.
In general, dose selection for an elderly patient should be cautious, usually starting at the low
end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or
cardiac function, and of concomitant disease or drug therapy.
ADVERSE REACTIONS

Increased Heart Rate, Blood Pressure, and Ventricular


Ectopic Activity
A 10- to 20-mm increase in systolic blood pressure and an increase in heart rate of 5 to 15
beats/minute have been noted in most patients (see WARNINGS regarding exaggerated
chronotropic and pressor effects). Approximately 5% of patients have had increased
premature ventricular beats during infusions. These effects are dose related.

Hypotension
Precipitous decreases in blood pressure have occasionally been described in association with
dobutamine therapy. Decreasing the dose or discontinuing the infusion typically results in
rapid return of blood pressure to baseline values. In rare cases, however, intervention may be
required and reversibility may not be immediate.

Reactions at Sites of Intravenous Infusion


Phlebitis has occasionally been reported. Local inflammatory changes have been described
following inadvertent infiltration. Isolated cases of cutaneous necrosis (destruction of skin
tissue) have been reported.

Miscellaneous Uncommon Effects


The following adverse effects have been reported in 1% to 3% of patients: nausea, headache,
anginal pain, nonspecific chest pain, palpitations, and shortness of breath.
Isolated cases of thrombocytopenia have been reported.
Administration of dobutamine, like other catecholamines, can produce a mild reduction in
serum potassium concentration, rarely to hypokalemic levels (see PRECAUTIONS).
OVERDOSAGE

Overdoses of dobutamine have been reported rarely. The following is provided to serve as a
guide if such an overdose is encountered.

Signs and Symptoms


Toxicity from dobutamine is usually due to excessive cardiac -receptor stimulation. The
duration of action of dobutamine is generally short (T1/2= 2 minutes) because it is rapidly
metabolized by catechol-0-methyltranferase. The symptoms of toxicity may include anorexia,
nausea, vomiting, tremor, anxiety, palpitations, headache, shortness of breath, and anginal and
nonspecific chest pain. The positive inotropic and chronotropic effects of dobutamine on the
myocardium may cause hypertension, tachyarrhythmias, myocardial ischemia, and
ventricular fibrillation. Hypotension may result from vasodilation.

Treatment
To obtain up-to-date information about the treatment of overdose, a good resource is your
certified Regional Poison Control Center. Telephone numbers of certified poison control
centers are listed in the Physicians Desk Reference (PDR). In managing overdosage,
consider the possibility of multiple drug overdoses, interaction among drugs, and unusual
drug kinetics in your patient.
The initial actions to be taken in a dobutamine overdose are discontinuing administration,
establishing an airway, and ensuring oxygenation and ventilation. Resuscitative measures
should be initiated promptly. Severe ventricular tachyarrhythmias may be successfully treated

with propranolol or lidocaine. Hypertension usually responds to a reduction in dose or


discontinuation of therapy.
Protect the patients airway and support ventilation and perfusion. If needed, meticulously
monitor and maintain, within acceptable limits, the patients vital signs, blood gases, serum
electrolytes, etc.
If the product is ingested, unpredictable absorption may occur from the mouth and the
gastrointestinal tract. Absorption of drugs from the gastrointestinal tract may be decreased by
giving activated charcoal, which, in many cases, is more effective than emesis or lavage;
consider charcoal instead of or in addition to gastric emptying. Repeated doses of charcoal
over time may hasten elimination of some drugs that have been absorbed. Safeguard the
patients airway when employing gastric emptying or charcoal.
Forced diuresis, peritoneal dialysis, hemodialysis, or charcoal hemoperfusion have not been
established as beneficial for an overdose of dobutamine.
DOSAGE AND ADMINISTRATION

Note
Do not add dobutamine to 5% Sodium Bicarbonate Injection or to any other strongly alkaline
solution. Because of potential physical incompatibilities, it is recommended that dobutamine
not be mixed with other drugs in the same solution. Dobutamine should not be used in
conjunction with other agents or diluents containing both sodium bisulfite and ethanol.

Preparation and Stability


At the time of administration, dobutamine must be further diluted in an IV container to at
least a 50 mL solution using one of the following intravenous solutions as a diluent: 5%
Dextrose Injection, 5% Dextrose and 0.45% Sodium Chloride Injection, 5% Dextrose and
0.9% Sodium Chloride Injection, 10% Dextrose Injection, Isolyte M with 5% Dextrose
Injection, Lactated Ringers Injection, 5% Dextrose in Lactated Ringers Injection,
Normosol-M in D5-W, 20% Osmitrol in Water for Injection, 0.9% Sodium Chloride
Injection, or Sodium Lactate Injection. Intravenous solutions should be used within 24 hours.

Recommended Dosage
Infusion of dobutamine should be started at a low rate (0.5 to 1 mcg/kg/min) and titrated at
intervals of a few minutes, guided by the patients response, including systemic blood
pressure, urine flow, frequency of ectopic activity, heart rate and (whenever possible)
measurements of cardiac output, central venous pressure, and/or pulmonary capillary wedge
pressure. In reported trials, the optimal infusion rates have varied from patient to patient,
usually 2 to 20 mcg/kg/min but sometimes slightly outside of this range. On rare occasions,
infusion rates up to 40 mcg/kg/min have been required to obtain the desired effect. Rates of
infusion (mL/h) for dobutamine concentrations of 500 mcg/mL, 1000 mcg/mL, and 2000
mcg/mL necessary to attain various delivery rates of dobutamine (mcg/kg/min) for patients of
different weights are given in Table 1.

Table 1 Dobutamine Injection USP Infusion Rate (mL/h) for 500 mcg/mL
concentration

Drug Delivery Rate

Patient Body Weight (kg)

(mcg/kg/min)

10 20 30 40

50

60

70

80

90

100

110

0.5

0.3

0.6 1.2 1.8 2.4

3.6

4.2

4.8

5.4

6.6

0.6

1.2 2.4 3.6 4.8

7.2

8.4

9.6 10.8

12

13.2

2.5

1.5

12

15

18

21

24

27

30

33

12 18 24

30

36

42

48

54

60

66

7.5

4.5

18 27 36

45

54

63

72

81

90

99

10

12 24 36 48

60

72

84

96

108 120 132

12.5

7.5

15 30 45 60

75

90

105 120 135 150 165

15

18 36 54 72

90

108 126 144 162 180 198

17.5
20

10.5 21 42 63 84 105 126 147 168 189 210 231


12

24 48 72 96 120 144 168 192 216 240 264

Dobutamine Injection USP Infusion Rate (mL/h) for 1000 mcg/mL concentration

Drug Delivery Rate


(mcg/kg/min)
0.5
1
2.5
5
7.5
10
12.5
15
17.5
20

Patient Body Weight (kg)


5

10

20

30

40

50

100

110

0.1 0.3 0.6 0.9 1.2 1.5 1.8 2.1 2.4 2.7

3.3

0.3 0.6 1.2 1.8 2.4

6.6

10.5 12 13.5 15

16.5

60

4.5

7.5

1.5

12

15

18

2.2 4.5
3

9
12

80

90

3.6 4.2 4.8 5.4

0.7 1.5
3

70

21

24

27

30

13.5 18 22.5 27 31.5 36 40.5 45


18

24

30

36

42

48

54

60

3.7 7.5

15 22.5 30 37.5 45 52.5 60 67.5 75

4.5

18

27

36

45

54

63

72

81

90

33
49.5
66
82.5
99

5.2 10.5 21 31.5 42 52.5 63 73.5 84 94.5 105 115.5


6

12

24

36

48

60

72

84

96 108 120

132

Dobutamine Injection USP Infusion Rate (mL/h) for 2000 mcg/mL concentration

Drug Delivery Rate


(mcg/kg/min)

Patient Body Weight (kg)


5

10

20

30

40

50

60

70

80

90

100

110

0.5

0.07 0.1 0.3

0.4 0.6 0.7

0.9

1.2 1.3

1.5

1.6

0.1 0.3 0.6

0.9 1.2 1.5

1.8

2.1

2.4 2.7

3.3

2.5

0.4 0.7 1.5

7.5

15

16.5

0.7 1.5

4.5

4.5

7.5

10.5 12 13.5

7.5

1.1 2.2 4.5

11

13.5

16

18

20

22.5

25

10

1.5

12

15

18

21

24

27

30

33

11

15

19

22.5

26

30

34

37.5

41

45

49.5

12.5

1.9 3.7

15

2.2 4.5

17.5

13.5 18 22.5

27

31.5 36 40.5

2.6 5.2 10.5 15.7 21 26.2 31.5 36.7 42 47.2 52.5 57.7

20

12

18

24

30

36

42

48

54

60

66

Concentrations of up to 5,000 mcg/mL have been administered to humans (250 mg/50 mL).
The final volume administered should be determined by the fluid requirements of the patient.
Parenteral drug products should be inspected visually for particulate matter and discoloration
prior to administration, whenever solution and container permit.
HOW SUPPLIED

Dobutamine Injection USP, 20 mL single dose vial contains dobutamine hydrochloride,


equivalent to 250 mg dobutamine per 20 mL; ten vials per carton. NDC 55390-560-90.
Store at controlled room temperature, 15 to 30C (59 to 86F) [see USP].
Manufactured by: Ben Venue Laboratories, Inc.,
Bedford, Ohio 44146
Manufactured for: Bedford Laboratories,
Bedford, OH 44146
June 2007
VIAL LABEL

Vial Label

DBP05

Diambil dari: publichealthnote.blogspot.com/2012/02/dopamin.html


Public Health
Publichealthnote menyediakan informasi seputar penyakit dan obat sebagai
referensi bagi tenaga kesehatan dan sebagai wawasan tambahan bagi
masyarakat umum. Tidak disarankan untuk mengkonsumsi obat-obatan tanpa
petunjuk dokter.
Terima kasih atas kunjungan Anda. Semoga blog ini bisa bermanfaat bagi
masyarakat dan dapat menjadi amal jariyah bagi penulis.

Saturday, February 25, 2012


Dopamin

Sediaan:
Injeksi (Ampul) 10 mg/ml, 20 mg/ml, 40 mg/ml

Cara Kerja Obat:

Dopamine adalah agen vasopressor dan inotropic. Dopamine bekerja dengan cara
meningkatkan kekuatan memompa pada jantung dan suplai darah ke ginjal dan digunakan
untuk meningkatkan fungsi jantung ketika jantung tak mampu memompa cukup darah.

Indikasi:
Memperbaiki keseimbangan hemodinamik pada kondisi sindroma syok terhadap infark
miokardial, trauma, syok sepsis, operasi terbuka gagal jantung, gagal ginjal dan serangan
jantung kronis.

Kontraindikasi:
Hipersensitif terhadap sulfit (sediaan yang mengandung natrium bisulfit), takiaritmia,
phaeochromocytoma, fibrilasi ventrikular.

Dosis:
Infus I.V (pemberiannya memerlukan pompa infus) :
-

Bayi : 1-20 mcg/kg/menit, infus kontinyu , titrasi sampai respon yang diharapkan

Anak-anak : 1-20 mcg/kg/menit, maksimum 50 mcg/kg/menit, titrasi sampai respon yang


diharapkan.

Dewasa : 1-5 mcg/kg/menit sampai 20 mcg/kg/menit, titrasi sampai respon yang


diharapkan. Infus boleh ditingkatkan 4 mcg/kg/menit pada interval 10-30 menit sampai
respon optimal tercapai.

Jika dosis > 20-30 mcg/kg/menit diperlukan, dapat menggunakan presor kerja langsung
(seperti epinefrin dan norepinefrin).

Peringatan dan Perhatian:


-

Hipovolemia harus diperbaiki sebelum pengobatan dilakukan.

Hindari pada pasien dengan pheochromocytoma atau hipertiroidisme dan kemunculan


tachyarrhythmias atau fibrilasi ventrikular.

Gunakan dengan hati-hati dan dalam dosis rendah pada pasien dengan syok secondary
terhadap MI, pasien dengan riwayat peripheral vascular disease (PVD) berisiko
meningkatkan kemungkinan terkena ischemia akut.

Efek Samping:

Sering : denyut ektopik, takikardia, sakit karena angina, palpitasi, hipotensi, vasokonstriksi,
sakit kepala, mual, muntah, dispnea.

Jarang : bradikardia, aritmia ventrikular (dosis tinggi), gangrene, hipertensi, ansietas,


piloereksi, peningkatan serum glukosa, nekrosis jaringan (karena ekstravasasi dopamin),
peningkatan tekanan intraokular, dilatasi pupil, azotemia, polyuria.
Tifoid inet
Diambil dari : http://www.abclab.co.id/?p=345

Step ladder who pain: http://www.who.int/cancer/palliative/painladder/en/


WHO's cancer pain ladder for adults
WHO has developed a three-step "ladder" for cancer pain relief in
adults.

If pain occurs, there should be prompt oral administration of drugs in the following order:
nonopioids (aspirin and paracetamol); then, as necessary, mild opioids (codeine); then strong
opioids such as morphine, until the patient is free of pain. To calm fears and anxiety,
additional drugs adjuvants should be used.
To maintain freedom from pain, drugs should be given by the clock, that is every 3-6 hours,
rather than on demand This three-step approach of administering the right drug in the right
dose at the right time is inexpensive and 80-90% effective. Surgical intervention on
appropriate nerves may provide further pain relief if drugs are not wholly effective. In the
case of cancer pain in children, WHO recommends a two step ladder.
For further information see WHO Guidelines on the pharmacological treatment of persisting
pain in children with medical illnesses at:

WHO Analgesic Ladder

Diambil dari: http://www.paincommunitycentre.org/article/who-analgesic-ladder-0


This article discusses the WHO analgesic ladder for those who are unfamiliar with it and its
use in practice.

Learning outcomes:

to understand the basis of the WHO analgesic ladder

to understand the concept of multimodal analgesia

WHO Analgesic Ladder


An analgesic is a member of the group of drugs which are used to relieve pain, also known
as painkillers. The word analgesic derives from Greek an ("without") and algos ("pain").
The analgesic ladder was designed by the World Health Organisation (WHO) [1] to assist the
healthcare prescriber in the prescription of analgesic drugs by suggesting a logical strategy
for managing pain in a multitude of pain situations.

The ladder advocates a stepped approach to the use of painkillers from these analgesic
groups:

Simple analgesics i.e. paracetamol and non-steroidal anti-inflammatory


drugs (NSAIDs)

Weak opioids i.e. tramadol, codeine

Strong opioids i.e. morphine, fentanyl, oxycodone, pethidine

Adjuvants - adjuvant analgesics are drugs which were not originally for
pain but rather for other conditions but have been found to be effective in
difficult to manage pain, particularly neuropathic pain. They are a diverse
group of drugs that includes antidepressants, anticonvulsants (antiseizure
drugs), and others.

At every step of the analgesic ladder non-opioid analgesics form the basis of the pain
management. Paracetamol and NSAID (if not contraindicated) should always therefore be
prescribed with opioid analgesia (weak or strong). This is known as multi-modal analgesia
and is the concept that pain is best managed, not by a single drug or therapy, but by
combinations, which maximise efficacy whilst keeping side-effects low. Evidence has
demonstrated that when this happens pain relief is better, smaller amounts of pain killers are
needed and less side effects occur.

Figure 1: WHO Analgesic Ladder


The WHO advocates that these analgesics should be given by the clock, that is every 3-6
hours, rather than on demand. This stepped approach of administering the right drug in the
right dose at the right time is inexpensive and generally effective in managing acute pain.
The advantages of the analgesic ladder include:

Simplicity, as only a few analgesic groups are used

Flexibility to a large variety of pain situations and also to prescribers


globally. By referring to drug classes, rather than specific drugs, the ladder
maintains a level of flexibility that allows clinicians to work within their set
regulations and limitations.

Safety, in that safest drugs are used first in their lowest effective dose

Emphasis on multimodal analgesia.

Its disadvantages include:

It may be too simplistic for management of certain types of pain,


especially neuropathic pain or for those who are opioid dependant.

It suggests that analgesics should be administrated orally, which may


occasionally not be appropriate, for example, when patients are 'nil by
mouth'.

References
1. Organisation W. Analgesic Ladder. World Health Organization; 1986.

World Health Organization Ladder


Diambil dari:
http://www.va.gov/PAINMANAGEMENT/World_Health_Organization_Ladder.asp

The WHO ladder portrays a progression in the doses and


types of analgesic drugs for effective pain management. The
best choice of modality often changes as the patients
condition and the characteristics of the pain change.
The first step in this approach is the use of acetaminophen,
aspirin, or another Non-steroidal Anti-inflammatory Drug
(NSAID) for mild to moderate pain. Adjuvant drugs to
enhance analgesic efficacy, treat concurrent symptoms that
exacerbate pain, and provide independent analgesic activity
for specific types of pain may be used at any step.
When pain persists or increases, an opioid such as codeine
or hydrocodone should be added (not substituted) to the
NSAID. Opioids at this step are often administered in fixed
dose combinations with acetaminophen or aspirin because
this combination provides additive analgesia. Fixed
combination products may be limited by the content of
acetaminophen or NSAID, which may produce dose-related
toxicity. When higher doses of opioid are necessary, the
third step is used. At this step separate dosage forms of the
opioid and non-opioid analgesic should be used to avoid
exceeding maximally recommended doses of acetaminophen
or NSAID.
Pain that is persistent or is of moderate to severe intensity
from the outset should be treated by increasing the dosage
or with more potent opioids. Drugs such as codeine or
hydrocodone are replaced with more potent opioids (usually
morphine, hydromorphone, methadone, fentanyl, or
levarphanol).
Medications for persistent cancer-related pain should be
administered on an around-the-clock schedule, with
additional "as needed" doses, because regularly scheduled
dosing maintains a constant level of drug in the body and
helps to prevent a recurrence of pain. Patients who have
moderate to severe pain when first seen by the clinician
should be started at the second or third step of the ladder.

Reference: U.S. Department of Health and Human Services,


Agency for Health Care Policy and Research Clinical Practice
Guidelines, Number 9, March 1994.

Syringe pump
http://materi-sehat.blogspot.com/2011/03/rumus-perhitungan-cairan-dengansyring.html