DEXMEDETOMIDINE

ACTION

Alpha2-adrenergic agonist sedative.

INDICATIONS AND USAGE

Precedex is a relatively selective alpha2-adrenergic agonist indicated for:

  • Sedation of initially intubated and mechanically ventilated patients
  • Sedation of non-intubated patients prior to and/or during surgical and other procedures.


DOSAGE

Dilute the 200 mcg/2 mL (100 mcg/mL) vial contents in 0.9% sodium chloride solution to achieve required concentration (4 mcg/mL) prior to administration.

Neat 200 mcg/50mL and 400 mcg/100 mL

General Sedation

Load 1 mcg/kg over 10 minutes, followed by a maintenance infusion of 0.2 to 1mcg/kg/hour.



WARNINGS AND PRECAUTIONS:

Bradycardia and Sinus Arrest: Have occurred in young healthy volunteers with high vagal tone or with different routes of administration, e.g., rapid intravenous or bolus administration.

Hypotension and Bradycardia: May necessitate medical intervention. May be more pronounced in patients with hypovolemia, diabetes mellitus, or chronic hypertension, and in the elderly.

Use with caution in patients with advanced heart block or severe ventricular dysfunction.

Co-administration with Other Vasodilators or Negative Chronotropic Agents: Use with caution due to additive pharmacodynamic effects.

Transient Hypertension: Observed primarily during the loading dose. Consider reduction in loading infusion rate.

Arousability: Patients can become aroused/alert with stimulation; this alone should not be considered as lack of efficacy.

Prolonged exposure to dexmedetomidine beyond 24 hours may be associated with tolerance and tachyphylaxis and a dose-related increase in adverse events

DOBUTAMINE

ACTION

  • Synthetic catecholamine with strong β1 and weak β2 effects
  • Consists of racemic mixture of two isomers: L-isomer (α-agonist) and D-isomer (β1 and β2 agonist).
  • The α1 and β2 effects largely cancel each other out, resulting in an agent which is near to a pure intotrope in its actions, increasing contractility, cardiac output, stroke volume and (at higher doses) heart rate.

INDICATIONS AND USAGE

  • Used to increase cardiac output in the short-term treatment of patients with cardiac decompensation caused by depressed contractility from organic heart disease, cardiac surgical procedures, cardiac arrest or acute myocardial infarction.
  • Dobutamine can also be used in septic shock, in combination with volume replacement.

COMES AS

  • IV
    • 20ml vial contains 250mg of dobutamine
    • Add 250mg of dobutamine (20ml) to 80ml of compatible IV fluid (i.e. 250mg in 100ml)

DOSAGE

  • IV
    • 2.5-20 mcg/kg/min

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Warnings

  • CVS
  • Tachycardia and marked increase in systolic blood pressure indicate overdosage.
  • Nausea and vomiting, headache, angina, palpitations are common
  • Peripheral administration can cause peripheral vasoconstriction and necrosis. If peripheral administration is required a more dilute solution should be used- 250mg dobutamine in 500mL sodium chloride 0.9% (500micrograms/mL).