EMERGENCY DRUGS

La Ode Karnain
 PENGERTIAN
Onset : waktu yang dibutuhkan oleh obat untuk mulai bekerja
Durasi / Waktu Paruh : Periode waktu yang dibutuhkan oleh konsentrasi
atau jumlah obat di dalam tubuh untuk berkurang setengah kadar.
 PREGNANCY CATEGORIES
These have been in use since 1979 and are defined as follows:

A
Category : No risk in human studies (studies in pregnant women have not demonstrated a risk to the fetus
during the first trimester).

B
Category : No risk in animal studies (there are no adequate studies in humans, but animal studies did not
demonstrate a risk to the fetus).

C
Category : Risk cannot be ruled out. There are no satisfactory studies in pregnant
women, but animal studies demonstrated a risk to the fetus; potential benefits of
the drug may outweigh the risks.
D
Category : Evidence of risk (studies in pregnant women have demonstrated a risk to the fetus; potential
benefits of the drug may outweigh the risks).

X
Category : Contraindicated (studies in pregnant women have demonstrated a risk to the fetus, and/or
human or animal studies have shown fetal abnormalities; risks of the drug outweigh the potential benefits).
ALTEPLASE
 ALTEPLASE (t-PA) – tissue plasminogen activator
• KELAS
– Fibrinolytic
• DESKRIPSI
– Enzim yang diproduksi menggunakan teknologi DNA rekombinan
– Enzim yang berikatan dengan fibrin bound plasminogen pada area clotting
– Merubah plasminogen menjadi plasmin
– Plasmin mencerna benang-benang fibrin pada clotting
– Terjadi lysis bekuan darah
– Perfusi terjadi kembali
DIAGRAM OF FIBRINOLYTIC
• ONSET AND DURASI
– Onset: Lisis clotting terjadi dalam waktu 30 menit
– Durasi: 30-45 menit (80% bersih dalam waktu 10 menit)
• INDIKASI
– Acute evolving myocardiac infarction
– Massive pulmonary emboli
– Deep venous thrombosis
– Arterial thrombosis and embolism
– Acute stroke
• DOSIS
– Adult STEMI:
• Berikan 15 mg IV bolus,
• kemudian 0.75 mg/kg over next 30 min (tidak lebih dari 50 mg),
• Dan kemudian 0.5 mg/kg selama 60 menit (tidak lebih dari 35 mg);
• total dosis maksimum 100 mg.
• (Other doses may be prescribed by medical direction; different dosing is
indicated for stroke.) Pediatric: Safety not established
• KONTRAINDIKASI
– Perdarahan aktif
– Riwayat pembedahan dalam 2-3 mgg
– Recent cerebrovascular accident
– Terdapat perdarahan gastrointestital
– Riwayat perdarahan intrakranial
• EFEK SAMPING
– Perdarahan (GI, GU, Intracranial and tempat lain)
– Reaksi alergi
– Hypertensi
– Nyeri dada
– Dysrhythmias reperfusi
– Nyeri abdomen
• INTERAKSI OBAT
– Asam asetylsalisilat dapat meningkatkan risiko perdarahan namun
mungkin juga dapat meningkatkan efektifitas obat.
– Heparin dan antikoagulan dapat meningkatkan risiko perdarahan dan
juga meningkatkan keefektifan obat secara keseluruhan
 HOW SUPPLIED
• 50,100 mg with 50,100 ml and 2 mg (cathflo) pelarut.
• Dapat dilarutkan dengan 0.9 % sodium chloride or DW
• PERHATIAN KHUSUS
– Pregnancy safety : category C
– Periksa koagulasi darah sebelum pemberian
– Jangan aduk botol obat, guling perlahan untuk mencampur tepung obat dengan
pelarut
– Monitor tanda vital dengan ketat
– Observasi adanya perdarahan
– Jangan berikan secara IM
– Jangan lakukan pengambilan darah arteri
– Hati-hati saat pemindahan pasien untuk menghindari perdarahan atau memar
– Gunakan satu jalur infus khusus untuk pemberian fibrinolitik
ASPIRIN (ASA, BAYER, ECOTRIN, ST.JOSEPH, OTHERS)

When it comes to rates of ulceration and bleeding, there's no

difference between enteric-coated and regular aspirin. The risk
of ulcers and bleeding probably comes from aspirin's effects in
the bloodstream, rather than from where the drug dissolves
and is absorbed.
 CLASS
• KELAS
– Analgesic, anti-inflammatory, antipyretic, antiplatelet
• DESKRIPSI
– Aspirin menurunkan inflamasi (analgesic effect not limited to effects in
CNS).
– Dilatasi pembuluh darah perifer
– Mencegah agregasi platelet
– Direkomendasikan untuk semua pasien dengan ACS
• ONSET AND DURASI
– Onset 15 – 30 min
– Durasi : 4-6 hr
• INDIKASI
– Nyeri & demam ringan hingga sedang
– Mencegah agregasi platelet pada iskemia dan tromboembolisme
– Semua pasien dengan ACS
– Semua pasien dengan gejala nyeri dada iskemik
– Unstable angina
– Mencegah infark miokard atau proses reinfarksi
• KONTRAINDIKASI
– Hypersensitif terhadap salicylates
– Perdarahan gastrointestinal
– Active ulcer disease or acute asthma (relative contraindication)
– Hemorrhagic stroke
– Gangguan perdarahan
– Anak dengan flu-like symptoms
• EFEK SAMPING
– Iritasi lambung
– Gangguan pencernaan, rasa panas di lanbung
– Mual & muntah
– Reaksi alergi
• INTERAKSI OBAT
– Efek menurun bila bersamaan dengan antasida dan steroid
– Meningkatkan efeknya dengan pemberian antikoagulan, insulin,
hipoglikemik oral, bahan fibrinolitik.
• SEDIAAN
– Tablets (65, 81, 325, 500,650, 975 mg)
– Capsules (325, 500 mg)
– Controlled released tablets (800 mg)?
– Suppositories (60 mg to 1.2 g)
• DOSIS AND PEMBERIAN
– Dewasa : Mild pain and fever 325-650 mg PO q 4hr
– ACS: 160-325 mg PO non enteric coated tablet (chewing is preferable to
swallowing).
– Supositoria untuk pasien yang tidak dapat mengkonsumsi secara oral
– Pediatric : Tidak diindikasikan untuk digunakan di pre-hospital

• SPECIAL CONSIDERATION
– Pregnancy safety : category D in 3rd trimester, category C in first and
second trimester.
– Harus diberikan sesegera mungin pada pasien dengan gejala ACS
MORPHINE SULFATE
 MORPHINE
• KELAS
– Opioid analgesic
• ONSET AND DURASI
– Onset : 1-2 min setelah pemberian
– Duration: 2-7 hr
• INDIKASI
– Nyeri dada pada kondisi ACS yang tidak respons pada pemberian nitrat
– Pulmonary edema kardiogenik akut (dengan tekanan darah yg adekuat)
dengan atau tanpa nyeri yang serupa.
– Nyeri akut dan kronik yang sedang hingga berat
• DESCRIPTION
– Morfin sangat bermanfaat di perawatan emergency
– Morfin sulfat adalah opium alkaloid yang berefek analgesik
– Meningkatkan kapasitas vena perifer dan menurunkan venous return
– Menyebabkan euforia dan depresi pernafasan dan CNS
– Efek farmako sekunder : penurunan kepekaan reseptor alfa adrenerjik
(menyebabkan vasodilatasi perifer dan inhibisi baroreseptor)
– Morfin menurunkan preload dan after load, jadi, meningkatkan
demand oxygen myokard.
• CONTRAINDICATION
– Hipersensitif terhadap narkotika
– Hipovolemia
– Hipotensi
– Cedera kepala atau nyeri abdomen yang tidak terdiagnosa
– Peningkatan tekanan intra kranial
– Depresi pernafasan berat
– Pasien yang mengkonsumsi MAO inhibitor dalam 14 hari terakhir
– Penggunaan dengan kehati-hatian pada pasien dengan RV infarction
• EFEK SAMPING
– HIpotensi
– Tachyardia
– Bradycardia
– Palpitations
– Syncope
– Wajah memerah, diaforesis, pruritus
– Depresi pernafasan
– Euphoria
– Brochospasm
– Mulut kering
– Reaksi alergi
 INTERAKSI OBAT

• Depresi CNS dapat meningkatkan efek morfin (depresi

pernafasn, hipotensi, sedasi)
• Phenothiazine dapat meningkatkan efek analgesia
• MAO inhibitor dapat menyebabkan eksitasi paradoxic
• SEDIAAN
– Tablets, suppositoria, and solution
– Pada perawatan emergency: usually diberikan secara IV.
– Parenteral preparation in 10 mg in 1 ml solution ampules and
tubex syringes.
• DOSIS DAN PENBERIAN
– STEMI : 2-4 mg IV, dapat diberikan dosis tambahan of 2-8 mg IV
dalam internal 5-15 menit.
– UA/NSTEMI 1-5 mg IV hanya bila gejala tidak dapat diatasi dengan
pemberian nitrat atau bila gejala berulang (berikan dengan hati-hati)
– Nyeri: 2-4 mg IV lambat selama 1-5 menit selama 5-30 menit, hingga
efek tercapai.
– Pediatric 0.1 – 0.2 mg/kg dose IV (max dosis total 15 mg).
• PERTIMBANGAN KHUSUS
– Pregnancy safety : category B
– Narcotics rapidly cross the placenta.
– Safety in neonates has not ben established.
– Use with caution in elderly, in those with asthma and in those susceptible
to central nervous system depression.
– Morphine should be used with caution in chronic pain syndromes.
– Morphine may worsen bradycardia or heart block in inferior myocardial
infarction.
– Naloxon (0,4-2 mg IV) should be readily available.
NITROGLYCERIN
SPRAY & TABLET
AMPULE
PATCH
• KELAS
Vasodilator
• ONSET AND DURASI
– Onset : 1-3 menit
– Durasi: 30 – 60 menit
• INDIKASI
– Ischemic chest pain
– AMI (anterior wall infarction, persistent or recurrent ischemia).
– Hypertensive emergencies with ACS
• DESCRIPTION
– Nitrat dan nitrit mendilatasi arteriol dan vena di perifer (arteri
koroner pada dosis tinggi)
– Menurunkan pre-load
– Menurunkan kebutuhan oksigen miokard
– Tidak terlalu menurunkan afterload
• CONTRAINDICATIONS
– Penurunan volume darah
– Hipersensitifitas
– Hipotensi (SBP <90 mmHg di bawah baseline)
– Cedera kepala
– Bradikardi berat (HR <50 / menit)
– Takikardi berat (HR > 100 / min) tanpa adanya gagal jantung
– Infark ventrikel kanan
– Perdarahan cerebral
– Sementara menggunakan tadafil (Cialis), vardenafil (levitral) atau sildanefil
(Viagra)
– Stenosis aorta
• EFEK SAMPING
– Sakit kepala singkat
– Takikardia
– Hipotensi
– Mual dan muntah
– Syncope postural
– Diaforesis
– Kulit kemerahan
• DRUG INTERACTIONS
– Other vasodilators may have additive hypotensive effects.
– Jangan campur dengan obat lain

• HOW SUPPLIED
– Tablet: 0.15 mg, 0.3 mg, 0.4 mg, 0.6 mg
– Extended-release capsule
– Sediaan Transdermal (Patch)
– Metered spray: 0.4 mg per spray (do not shake)
– Parenteral 5 mg/ml, 10,20,40 mg/10 ml
• DOSAGE
– Adult :
• Tablet : 0.3-0.4 mg sublingually, may repeat for a total of 3 doses at 5-min
internal.
• Metered spray: 1-2 sprays (0.4 mg/dose) for 0.5 – 1 sec at 5-min internals;
max 3 sprays within 15 min.
• Infusion: Mulai dengan of 10 mcg/min; tingkatkan 10 mcg/min q 3-5 min
until desired effects is achieved. Dosis tinggi yang aman 200 mcg/

Pediatric (continuous infusion) initial dose of 0.25-0.5 mch/kg/min, titrated by 1

mcg/kg/min every 15-20 min; typical dose range 1-5 mcg/kg/min.
• SPECIAL CONSIDERATION
– Pregnancy safety : category C
– Nitroglycerin is associated with increased suspectility to hypotension in elderly.
– Nitroglycerin rusak bila terkena cahaya dan suhu panas
– Nitroglycerine harus disimpan di tempat tertutup
– Zat aktif nitroglycerine akan terasa menyengat saat diberikan sublingual
– Gunakan dengan hati-hati pada pasien dengan infark myokardial anterior dengan
kemungkinan gangguan ventrikel kanan.
– Berikan nitroglycerine IV dengan infus pump / syringe pump untuk menjamin
persisi dosis.
– Selang PVC menyerap 80% kandungan obat; non PVC tubing harus digunakan
 EPINEPHRINE
• CLASS
– Sympathomimetik
• ONSET & DURATION
ONSET
– (SubQ) 5-10 min
– IV & ETT 1-2 min

DURASI
– Duration: 5-10 min
• DESCRIPTION
– Merupakan katekolamin endogen
– Menstimulasi reseptor alfa, beta 1 dan beta 2 adrenergic sesuai dosis
– Merupakan obat pilihan utama untuk mengobati bronkokonstriksi dan
hipotensi akibat anafilaktik dan semua bentuk kardiak arrest.
– Berguna untuk penanganan penyakit airway reaktif
– Injeksi dengan cepat dapat meningkatkan tekanand arah, kontraktilitas
ventrikel dan HR
– Menyebabkan vasokonstriksi pada arteriol di kulit, mukosa dan area
splenikus
– Bersifat antoganis terhadap efek histamin
INDIKASI
• Reaksdi alergi akut (anafilaktik)
• Cardiac arrest
• Pulseless electrical activity (PEA)
• Ventricular fibrillation dan dan Pulseless VT yang tidak response
terhadap defibrilasi pertama.
• Bradikardia simptomatik
• Hipotensi berat akibat bradikardia bila pasing dan atropin gagal.
• Asma bronkial
• KONTRAINDIKASI
– Hypersensiivity (not an issue especially in emergencies-the dose
should be lowered or given slowly in non-cardiac arrest patients with
heart disease).
– Hypovolemic shock (as with other catecholamines, correct
hypovolemia before us.
– Coronary insufficiency (use with caution).
• EFEK SAMPING
– Headache
– Nausea and vomiting
– Gelisah
– Weakness
– Dysrhythmias: VT and VF
– Hyperventilation
– Prescipitation of angina pectoris.
– Tachycardia
– Tremors
– Dyspnea
 DRUG INTERACTION
• MAO inhibitors may potentiate the effect of epinephrine
• Beta-adrenergic antagonists may blunt inotropic response
• Sympathomimetics and phosphodiesterase inhibitors may
exacerbate dysrhythmia response.
• May be deactivated by alkaline solution (sodium bicarbonate,
furosemide).
• HOW SUPPLIED
– Parenteral : 1 mg/ml (1:1000, 0.1 mg/ml (1:10.000) ampule and
prefilled syringe.
– Autoinjector (EpiPen): 0.3 mg/mL (1:2000).
 DOSAGE & ADMINISTRATION
BRADYCARDIA BERAT OR HYPOTENSION
• Dewasa : 2-10 mcg/min infusion; titrate to patient response.
• Adult untuk resusitasi :
– IV / IO : 1 mg (10 mL, 1:10.000 IV/IV) push or endoctracheal tube (2-
2.5 mg diluted in 10 ml of NS).
– Ulangi setiap 3-5 min selama resusitasi (follow each IV dose with a 20
mL saline flush), tinggikan lengan 20-30 sec segera setelah dosis
diberikan.
CONTINUOUS INFUSION
• Dewasa: Add 1 mg of epinephrine (1mL of 1:1000 solution) to
500 ml of NS or DW. Initial infusion rate of 0.1 – 0.5
mcg/kg/min; titrate to response
• ANAPHYLACTIC REACTION OR BRONCHOCONTSTRICTION
– Mild: 0.3 – 0.5 mcg/kg/min; repeat in 15-20 min if needed.
– Severe: 1 ml (1:10000) slow IV over 5 min, IV infusion at rates of 1-4
mcg/min may prevent the need to repeat epinephrine injection
frequently.
• SPECIAL CONSIDERATION
– Pregnancy safety: Category C
– Do not use prefilled syringes for epinephrine infusion.
– Syncope has occurred following epinephrine administration to
asthmatic children.
– Epinephrine may increase myocardial oxygen demand.
 NOREPINEPHRINE
• CLASS
– Sympathomimetic
• ONSET & DURATION
– Onset: 1-3 minute
– Duration: 5-10 minute
• INDICATION
– Severe cardiogenic shock
– Neurogenic shock
– Inotropic support
– Hemodynamically significant hypotensiom (SBP <70 mmHg) with low
total peripheral resistence, refractory to other sympathomimetic
amines.
• CONTRAINDICATION
– Hypotensive patient with hypovolemia (relative contraindication).
• DESCRIPTION
– Is alpha- and betha1-adrenergic agonist.
– Potent vasoconstrictor
– Increase myocardial constractility
– Rarely used in prehospital
– Agent of last resort for management ischemic heart disease and
shock
• ADVERSED REACTION
– Headache
– Dysrhythmias
– Tachycardia
– Reflex bradycardia
– Angina pectoris
– Hypertension
• DRUG INTERACTIONS
– Norepinephrine can be deactivated by alkaline solutions.
– MAO inhibitors and bretylium may potentiate the effects of
catecholamines.
– Beta-adrenergic antagonists may blunt inotropic response.
– Sympathomimetics and phosphodiesterase inhibitors may exacerbate
dysrthythmia response.
• HOW SUPPLIED
1 mg/mL, 4 mL ampule
• DOSATE
– Adult
• Dilute 4 mg in 250 mL of D5W or D5NS (16 mcg/mL)
• Begin infusion at 0.1 - 0.5 mcg/kg/min (up to 30 mcg/min (up to 30
mcg/min); poison/drug-induced hypotension may require higher doses to
achieve adequate perfusion
– Pediatric
• Begin at 0.1 – 2 mcg / kg/min IV/I0; adjust infusion rate to achieve desired
change in blood pressure and systemic perfusion.
• SPECIAL CONSIDERATIONS
– Pregnancy safety: Category C
– Norepinephrine may cause fetal anoxia when used in pregnancy.
– Infuse norepinephrine through a large, stable vein to avoid
extravasation and tissue necrosis.
– Use infusion pump to ensure precise flow rate
– Do not administer in same IV line as alkaline solutions.
– May induced dysrhthmias.
 STREPTOKINASE
• KELAS
– Fibrinolytic agent
• DESCRIPTION
– Combine with plasminogen to produce activator complex that
converts free plasminogen to the proteolytic enzyme plasmin.
– Plasmin functions as enzyme that degrades fibrin threads and
fibrinogen, causing lysis of the blood clot.
– Only administered to selected patients with acute myocardial
infarction.
• ONSET & DURATION
– Onset: 10-30 min (fibrinolysis; 10-20 min; clot lysis, 60-90 min).
– Duration: 3-4 hr (prolonged bleeding times up to 24 hr)

• INDICATION
– Acute myocardial infarction
– Massive pulmonary emboli
– Arterial thrombosis and embolism
– To clear arteriovenous cannulae
– Deep venous thrombosis (rare)
• CONTRAINDICATION
– Hypersensitivity
– Active bleeding
– Recent surgery (within 2-3 weeks)
– Recent cerebrovascular accident
– Prolonged cardiopulmonary resuscitation
– Intracranial or intraspinal surgery
– Recent significant trauma (particular head trauma)
• ADVERSE REACTIONS
– Bleeding (GI, GU, Intracranial, other sites).
– Allergic reaction
– Hypotension
– Chest pain
– Reperfusion dysrhythmias
– Abdominal pain
• DRUG INTERACTION
– Acetylcalicylic acid may increase risk of bleeding.
– Heparine and other anticoagulants may increase risk of bleeding and
improve overall outcome.

• HOW SUPPLIED
– 250.000, 750.000 AND 1.500.000 unit vials.
– Reconstitute by slowly adding 5 ml of sodium chloride or D5W, directing
the stream toward the side of vial, rather than into the powder. Gently
roll-do not shake- the vial for reconstitution. Slowly dilute the entire
contents of the vial to a total of 45 ml.
• DOSAGE AND ADMINISTRATION
– Acute Myocardial Infarction
• Adult: 1.5 million units diluted to 45 ml (IV) over 1 hr (use infusion pump).
• Pediatric: safety not established.

• SPECIAL CONSIDERATION
– Pregnancy safety: category C
– Do not administer IM injection to patients receiving fibrinolytic drugs.
– Obtain blood sample for coagulation studies before administration
– Observe the patient for bleeding
– Use caution when moving patient to avoid bruising or bleeding.
– Do not draw arterial blood gas specimens in fibrinolytic therapy candidates
– Use one IV line exclusively for fibrinolytic administration
 DOPAMINE
• KELAS
– Sympathomimetic
• ONSET & DURASI
– Onset : 2-4 min
– Durasi: 10-15 min
• INDIKASI
– Hipotension signifikan tanpa adanya hypovolemia
– Symptomatic bradycardia (second-line drug after atropine)
• DESCRIPTION
– Bekerja pada reseptor alpha1 and beta1 adrenergic tergantung besarnya
– Pada dosis moderate “cardiac dose” dopamine menstimulasi beta
adrenergic receptors, meningkatkan kontraktilitas myocardial,
meningkatkan cardiac output dan tekanan darah.
– Pada dosis tinggi (“vasopressor doses”), dopamine memiliki efek alpha-
adrenergic , menimbulkan efek kontriksi perifer arteri dan vena.
– Merupakan obat second-line untuk symptomatic bradycardia (setelah
atropine). Umumnya digunakan untuk penanganan hypotension (SBP <70-
100 mmHg) dengan tanda dan gejala shock.
• KONTRAINDIKASI
– Tachydysrhythmias
– Ventricular fibrillation
– Patient dengan pheochromocytome

• EFEK SAMPING
– Dose-related tachydysrhythmias
– Hypertension
– Increased yocardial oxygen demand (e.g.ischemia).
– Headache
– Anxiety
– Nausea and vomiting
• DRUG INTERACTION
– Dopamine may be deactivated by alkaline solutions (sodium
bicarbonate and furosemide).
– MAO Inhibitors may potentiate the effects of dopamine
– Sympathomimetics and phosphodiesterase inhibitors exacerbate
dysrhythmia response.
– Beta-adrenergic antagonists may be blunt inotropic response.
– When administered with phenytoin, hypotension, bradycardia and
seizures may develop.
• HOW SUPPLIED
– 200,400,800 mg in 5 mL prefilled syringe and ampule for IV infusion
(IV piggyback).
• DOSAGE AND ADMINISTRATION
– Adult : Usual infusion rate 5-20 mcg/kg/min, titrate to response,
taper slowly.
– Pediatric: 2-20 mcg/kg/min IV/IO.
• SPECIAL CONSIDERATION
– Pregnancy safety: category C
– Infuse through large, stable vein to avoid the possibility of
extravasation injury.
– Use infusion pump to ensure precise flow rates.
– Monitor patient for signs of compromised circulation
– Correct hypovolemia before using dopamine in hypotensive patients.
– Do not mix with sodium bicarbonate.
 DOBUTAMINE
• KELAS
– Sympathomimetic
• DESCRIPTION
– Merupakan katekolamin sintetik yang menstimulasi reseptor beta 1
adrenergik dan kurang berefek pada beta 2 dan alfa adrenergik
reseptor
– Memiliki efek inotropik dengan perubahan minimal pada aktifitas
kronotropik atau tahanan vaskular perifer.
– Dobutamin berguna untuk manajemen gagal jantung kongestif bila
tidak menginginkan peningkatan heart rate
• ONSET AND DURATION
– Onset: 1-2 min, peak after 10 min
– Duration: 10-15 min
• INDICATIONS
– Pump problems (CHF, pulmonary congestion) with SBP of 70-100 mm Hg
and tidak ada tanda-tanda shock
• CONTRAINDICATION
– Tachydysrthythmias (Afib, Aflut).
– Severe hypotension with signs of shock
– Idiopathyc hyperthrophic subaortic stenosis
– Suspected or know drug-induced shock
• ADVERSED REACTION
– Anxiety
– Headache
– Nausea
– Fluctuations in blood pressure
– Dose-related tachydysrhythmias
– Hypertension
– Ventricular ectopy
• DRUG INTERACTION
– Beta-adrenergic antagonists may blunt inotropic response.
– Sympathomimetic and phosphodiesterase inhibitors may excacerbate
dysrhythmia response.
– Dobutamine is incompatible with sodium bicarbonate and
furosemide in the same IV line; it may be given in separate IV lines.
• HOW SUPPLIED
– 12.5 mg/mL. injectable
• DOSIS & PEMBERIAN
– Adult: Dosis biasa :2-20 mcg/kg/min IV, tergantung efek inotropik ;
dititrasi so heart rate does not increase by >10% baseline.
– Pediatric: 2-2- mcg/kg/min IV/IO, titrated to desired effect.
• SPECIAL CONSIDERATION
– Pregrnancy safety: category C
– Administer via an infusion pump to ensure precise flow rates.
– Blood pressure should be monitored closely, hemodynamic monitoring is
recommended for optimal use.
– Dobutamine ma be administered through a Y-site with concurrent dopamine,
lidocaine, nitropusside, and potassium chloride infusion, do not mix with sodium.
– Increase in heart rate of more than 10% may induce or exacerbate myocardial
ischemia.
– Lidocaine should be readily available.
– Correct hypovolemia before using dobutamine in hypotensive patient.
– Elderly patients may have significantly decreased responses.