2. Brand Name - Dobutrex

3. Stock Dosage - 12.5 mg/mL injection

4. Classification - AUTONOMIC NERVOUS SYSTEM AGENT; BETA-ADRENERGIC AGONIST; CATECHOLAMINE

5. Mechanism of Action
Produces inotropic effect by acting on beta receptors and primarily on myocardial alpha-adrenergic receptors. Increases cardiac output and decreases pulmonary wedge pressure and total systemic vascular resistance with comparatively little or no effect on BP. Also increases conduction through AV node. Has lower potential for precipitating arrhythmias than dopamine.

6. Indication/s

Inotropic support in short-term treatment of adults with cardiac decompensation due to depressed myocardial contractility (cardiogenic shock) resulting from either organic heart disease or from cardiac surgery.

7. Contraindications

History of hypersensitivity to other sympathomimetic amines, ventricular tachycardia, idiopathic hypertrophic subaortic stenosis. Safe use during pregnancy (category C), lactation, children, or following acute MI is not established.

8. Side Effects and Adverse Effects

All: Generally dose related. CNS: Headache, tremors, paresthesias, mild leg cramps, nervousness, fatigue (with overdosage). CV: Increased heart rate and BP, premature ventricular beats, palpitation, anginal pain. GI: Nausea, vomiting. Other: Nonspecific chest pain, shortness of breath.

9. Nursing Responsibilities

Monitor therapeutic effectiveness. At any given dosage level, the drug takes 10–20 min to produce peak effects.

Monitor ECG and BP continuously during administration.

Note: Marked increases in blood pressure (systolic pressure is the most likely to be affected) and heart rate, or the appearance of arrhythmias or other adverse cardiac effects are usually reversed promptly by reduction in dosage.

Observe patients with preexisting hypertension closely for exaggerated pressor response.

Note: Tolerance has been observed with continuous or prolonged infusions; adverse reactions are no different than those seen with shorter infusions.

Monitor I&O ratio and pattern. Urine output and sodium excretion generally increase because of improved cardiac output and renal perfusion.

2. Brand Name - Protamine Sulfate

3. Stock Dosage - 10 mg/mL injection

4. Classification - ANTIDOTE

5. Mechanism of Action

Purified mixture of simple, low-molecular-weight proteins obtained from sperm or testes of suitable fish species. Anticoagulant effect when used alone.

6. Indication/s

Antidote for heparin calcium or heparin sodium overdose (after heparin has been discontinued).

7. Contraindications

Hemorrhage not induced by heparin overdose; pregnancy (category C).

8. Side Effects and Adverse Effects

CV: Abrupt drop in BP (with rapid IV infusion), bradycardia. Body as a Whole: Urticaria, angioedema, pulmonary edema, anaphylaxis, dyspnea, lassitude; transient flushing and feeling of warmth. GI: Nausea, vomiting. Hematologic: Protamine overdose or "heparin rebound" (hyperheparinemia).

9. Nursing Responsibilities

Do not use protamine if only minor bleeding occurs during heparin therapy because withdrawal of heparin will usually correct minor bleeding within a few hours.

Monitor BP and pulse q15–30min, or more often if indicated. Continue for at least 2–3 h after each dose, or longer as dictated by patient's condition. Be prepared to treat patient for shock as well as hemorrhage.

Observe patients undergoing extracorporeal dialysis or patients who have had cardiac surgery carefully for bleeding (heparin rebound). Even with apparent adequate neutralization of heparin by protamine, bleeding may occur 30 min to 18 h after surgery. Monitor vital signs closely. Additional protamine may be required in these patients.