Podcasts about Dobutamine

Patients and their families feel more empowered and regain normalcy by participating in their own care. In this episode, Dr. Kavita Bhavan, Chief Innovation Officer at Parkland Health and an infectious disease specialist, shares how empowering patients to self-administer IV antibiotics at home has improved health care access and equity. She highlights the success of involving patients and their families in their care, addressing health disparities, and engaging the community. Dr. Bhavan discusses initiatives like using Dobutamine at home for end-stage heart failure patients, holding financial literacy fairs for kids, and improving flu vaccination rates through community health assessments. She also emphasizes the importance of trusting patients, addressing social determinants of health, and moving away from paternalistic health care models. Tune in and learn how innovative approaches to health care delivery are significantly impacting patient empowerment and health equity! Learn more about your ad choices. Visit megaphone.fm/adchoices

Take Home Points: Know clinical (cold extremities, oliguria, confusion, dizziness, narrow pulse pressure) and laboratory markers (metabolic acidosis, elevated creatinine, lactic acidosis) of hypoperfusion. An elevated lactate is a danger sign and requires explanation. Norepinephrine is a great first line vasopressor in Cardiogenic shock. Dobutamine is useful for inotropic support in Cardiogenic shock. Use POCUS ... Read more The post REBEL Core Cast 115.0 – Cardiogenic Shock appeared first on REBEL EM - Emergency Medicine Blog.

Commentary by Drs. Sadeer Al-Kindi, Anju Bhardwaj and Juan Russo

Visit: https://nursing.com/140meds to request your free copy of "140 Must Know Meds" Generic Name Dobutamine Trade Name Dobutrex Indication Short term management of heart failure Action Dobutamine has a positive inotropic effect (increases cardiac output) with very little effect on heart rate. Stimulates Beta1 receptors in the heart. Therapeutic Class Inotropic Pharmacologic Class Beta-adrenergic agonist Nursing Considerations • Monitor hemodynamics: hypertension, ↑HR, PVCs • Skin reactions may occur with hypersensitivity • Beta blockers may negate therapeutic effects of dobutamine • Monitor cardiac output • Monitor peripheral pulses before, during, and after therapy • DO NOT confuse dobutamine with dopamine

Contributor: Travis Barlock MD Educational Pearls: Three categories of pressors: inopressors, pure vasoconstrictors, and inodilators Inopressors:  Epinephrine - nonselective beta- and alpha-adrenergic agonism, leading to increased cardiac contractility, chronotropy (increased heart rate), and peripheral vasoconstriction. Dose 0.1mcg/kg/min. Levophed (norepinephrine) - more vasoconstriction peripherally than inotropy; useful in most cases of shock. Dose 0.1mcg/kg/min. Peripheral vasoconstrictors: Phenylephrine - pure alpha agonist; useful in atrial fibrillation because it avoids cardiac beta receptor activation and also in post-intubation hypotension to counteract the RSI medications. Start at 1mcg/kg/min and increase as needed. Vasopressin - No effect on cardiac contractility. Fixed dose of 0.4 units/min. Inodilators are useful in cardiogenic shock but often not started in the ED since patients mostly have undifferentiated shock Dobutamine - start at 2.5mcg/kg/min. Milrinone - 0.125mcg/kg/min. References 1. Ellender TJ, Skinner JC. The Use of Vasopressors and Inotropes in the Emergency Medical Treatment of Shock. Emerg Med Clin North Am. 2008;26(3):759-786. doi:https://doi.org/10.1016/j.emc.2008.04.001 2. Hollenberg SM. Vasoactive drugs in circulatory shock. Am J Respir Crit Care Med. 2011;183(7):847-855. doi:10.1164/rccm.201006-0972CI 3. Lampard JG, Lang E. Vasopressors for hypotensive shock. Ann Emerg Med. 2013;61(3):351-352. doi:10.1016/j.annemergmed.2012.08.028 Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII  

Welcome all to IS PHARMACOLOGY DIFFICULT Podcast! I am Dr Radhika Vijay. This is again a coming of time episode in February. Its fortnightly occurrence reveals a little hectic start of the month. Well, in today's episode I will be majorly talking about Beta 2 receptor agonist drugs which are short acting. To begin the discussions, I talk about Dobutamine, the rest of the List is long and covers agents like Metaproterenol, Albuterol, Terbutaline, Pirbuterol, Levalbuterol, Fenoterol, Isoetharine, and Procaterol. I will be covering the features, structural aspects, metabolism, duration of action, effects, uses and adverse effects of these drugs and the highlight points for which they are known for. Last three mentioned drugs are in fact withdrawn, unavailable or have some issues in regard of their efficacy. With this detailed account of Short acting beta 2 receptor agonists, I will be wrapping up this episode and will be returning back with the account of Long acting beta 2 receptor agonists. For all the updates and latest episodes of my podcast, please visit www.ispharmacologydifficult.com where you can also sign up for a free monthly newsletter of mine. It actually contains lot of updates about the medical sciences, drug information and my podcast updates also. You can follow me on different social media handles like twitter, insta, facebook and linkedin. They all are with same name "IS PHARMACOLOGY DIFFICULT". If you are listening for the first time, do follow me here, whatever platform you are consuming this episode, stay tuned, do rate and review on ITunes, Apple podcasts, stay safe, stay happy, stay enlightened, Thank you!! You can access various links via- https://linktr.ee/ispharmacologydifficult Please leave Review on Apple podcasts! Connect on Twitter & Instagram! My books on Amazon & Goodreads!

Welcome all to IS PHARMACOLOGY DIFFICULT Podcast! I am Dr Radhika Vijay.This is again a coming of time episode in February. Its fortnightly occurrence reveals a little hectic start of the month.Well, in today's episode I will be majorly talking about Beta 2 receptor agonist drugs which are short acting. To begin the discussions, I talk about Dobutamine, the rest of the List is long and covers agents like Metaproterenol, Albuterol, Terbutaline, Pirbuterol, Levalbuterol, Fenoterol, Isoetharine, and Procaterol.I will be covering the features, structural aspects, metabolism, duration of action, effects, uses and adverse effects of these drugs and the highlight points for which they are known for. Last three mentioned drugs are in fact withdrawn, unavailable or have some issues in regard of their efficacy.With this detailed account of Short acting beta 2 receptor agonists, I will be wrapping up this episode and will be returning back with the account of Long acting beta 2 receptor agonists.For all the updates and latest episodes of my podcast, please visit www.ispharmacologydifficult.com where you can also sign up for a free monthly newsletter of mine. It actually contains lot of updates about the medical sciences, drug information and my podcast updates also.You can follow me on different social media handles like twitter, insta, facebook and linkedin. They all are with same name "IS PHARMACOLOGY DIFFICULT". If you are listening for the first time, do follow me here, whatever platform you are consuming this episode, stay tuned, do rate and review on ITunes, Apple podcasts, stay safe, stay happy, stay enlightened, Thank you!!You can access various links via- https://linktr.ee/ispharmacologydifficultPlease leave Review on Apple podcasts!Connect on Twitter & Instagram!My books on Amazon & Goodreads!

This week, Rob and Zach will be talking about Drugs for Treating Heart Failure - Let's master this topic together, Ninja Nerds!We will be discussing the following topics within this episode on Drugs for Heart Failure!Defining Congestive Heart Failure (CHF)Pathophysiology of CHFDrug Categories used to Treat Heart Failure:Beta BlockersACE InhibitorsAngiotensin II Receptor Blockers (ARBs)Neprilysin Inhibitors + ARB (Known as ARNi)Hydralazine + Isosorbide DinitrateDiureticsIvabradinePositive Inotropes (Digoxin, Dobutamine, Milrinone, Dopamine)NYHA Heart Failure ClassificationAcute Heart FailureCausesPathophysiologyComplicationsTreatmentTo follow along with Notes & Illustrations for our podcasts please become a member on our website! https://www.ninjanerd.org/podcast/drugs-for-heart-failureFollow us on:YouTube: https://www.youtube.com/ninjanerdscienceInstagram: https://www.instagram.com/ninjanerdlecturesFacebook: https://www.facebook.com/NinjaNerdLecturesTwitter: https://twitter.com/ninjanerdsciDiscord: https://discord.com/invite/3srTG4dngWTikTok: https://www.tiktok.com/@ninjanerdlecturesSupport the show

Martin Ingi Sigurðsson, prófessor og sérfræðingur í svæfinga- og gjörgæslulækningum fer yfir æðavirk lyf. Hvað eru æðavirk lyf, hvernig virka þau og hvernig beitum við þeim? Þessi þáttur er unnin í samstarfi við Læknadeild Háskóla Íslands og nýtist við kennnslu læknanema í lyfjafræði á 3. ári og svæfinga- og gjörgæslulækningum á 6. ári. Magnús Karl Magnússon, prófessor í lyfjafræði og sérfræðingur í blóðlækningum heldur utan um verkefnið og er jafnframt gestaspyrill í þættinum.

Should we use milrinone or dobutamine in patients in cardiogenic shock? NEJM published data providing us with the answer. Show Notes: https://eddyjoemd.com/milrinone-dobutamine/ TrueLearn Link: https://truelearn.referralrock.com/l/EDDYJOEMD25/ Discount code: EDDYJOEMD25 Citation: Mathew R, Di Santo P, Jung RG, Marbach JA, Hutson J, Simard T, Ramirez FD, Harnett DT, Merdad A, Almufleh A, Weng W, Abdel-Razek O, Fernando SM, Kyeremanteng K, Bernick J, Wells GA, Chan V, Froeschl M, Labinaz M, Le May MR, Russo JJ, Hibbert B. Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock. N Engl J Med. 2021 Aug 5;385(6):516-525. doi: 10.1056/NEJMoa2026845. PMID: 34347952. --- Support this podcast: https://anchor.fm/eddyjoemd/support

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/DobutamineDobutrexNursingConsiderations    Generic Name Dobutamine Trade Name Dobutrex Indication Short term management of heart failure Action Dobutamine has a positive inotropic effect (increases cardiac output) with very little effect on heart rate. Stimulates Beta1 receptors in the heart. Therapeutic Class Inotropic Pharmacologic Class Beta-adrenergic agonist Nursing Considerations • Monitor hemodynamics: hypertension, ↑HR, PVCs • Skin reactions may occur with hypersensitivity • Beta blockers may negate therapeutic effects of dobutamine • Monitor cardiac output • Monitor peripheral pulses before, during, and after therapy • DO NOT confuse dobutamine with dopamine

Trade: DobutrexClass: Adrenergic agent, InotropicMOA: Increases myocardial contractility and stroke volume with minor chronotropic effects, resulting in increased cardiac outputIndication: CHF, Cardiogenic shockContraindications: Drug induced shock, Systolic pressure greater then 100, use caution in HTN, recent MI, Arrhythmias, hypovolemia Side effects: Tachycardia, PVC's, HTN, Hypotension, palpitations, arrhythmiasDosing:Adult: 2-20 mcg/kg/min IV/IOPedi: SAA

Milrinone vs. Dobutamine: DOREMI trial

COVID-19, vaccine-induced myocarditis, Watchman complications, SGLT2 inhibitors, and cardiogenic shock are the topics John Mandrola, MD, discusses in this week's podcast. https://www.medscape.com/twic 1 - COVID-19 - 18 Months Later, the COVID-19 Memories Won't Go Away https://www.medscape.com/viewarticle/956335 2 - Vaccine-Myocarditis - Myocarditis in Adolescents After COVID-19 Vaccine Typically Mild https://www.medscape.com/viewarticle/956359 - Association of Myocarditis With BNT162b2 Messenger RNA COVID-19 Vaccine in a Case Series of Children https://jamanetwork.com/journals/jamacardiology/fullarticle/2783052 3 - Watchman - 'Striking' Difference in Adverse Events in Women With Watchman LAAO https://www.medscape.com/viewarticle/956593 - Sex Differences in Procedural Outcomes Among Patients Undergoing Left Atrial Appendage Occlusion https://jamanetwork.com/journals/jamacardiology/fullarticle/2782726 4 - SGLT2 Inhibitors - EU Approves Dapagliflozin for Kidney Disease, Regardless of Diabetes https://www.medscape.com/viewarticle/956345 - Dapagliflozin in Patients with Chronic Kidney Disease https://www.nejm.org/doi/full/10.1056/NEJMoa2024816 5 - Cardiogenic Shock - No Win for Milrinone Over Dobutamine in Cardiogenic Shock https://www.medscape.com/viewarticle/956222 - Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock https://www.nejm.org/doi/full/10.1056/NEJMoa2026845 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Show notes at pharmacyjoe.com/episode634. In this episode, I'll discuss milrinone vs dobutamine for cardiogenic shock. The post 634: Which is better for cardiogenic shock - milrinone or dobutamine? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode634. In this episode, I ll discuss milrinone vs dobutamine for cardiogenic shock. The post 634: Which is better for cardiogenic shock milrinone or dobutamine? appeared first on Pharmacy Joe.

  Contributor:  Nick Tsipis, MD Educational Pearls: Epinephrine: alpha-1, alpha-2, beta-1, and beta 2 agonist - used in cardiac arrest with positive effects on ROSC in prehospital and peri-hopsital setting Norepinephrine: alpha-1 and beta-1 agonist - used in septic shock to increase cardiac output and peripheral vasoconstriction Phenylephrine: alpha-1 adrenergic agonist - used in spinal/neurogenic shock as well as medication-induced peri-procedural hypotension (propofol for RSI) as it only helps with vasoconstriction Dopamine: alpha-1, alpha-2, beta-1, beta 2, and dopamine agonist - used for sepsis in the past, but not recommended due to dysrhythmias Vasopressin: V1 agonist (vasoconstricts) -  used when maxed out of norepinephrine for septic shock Milrenone: phosphodiesterase inhibitor - used in heart failure to drop preload and afterload Dobutamine: beta-2 (with minimal beta-1) adrenergic agonist - used in heart failure and cardiogenic shock to reduce afterload References Shields SH, Holland RM. Pharmacology of Vasopressors and Inotropes. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7e. McGraw-Hill; Accessed February 14, 2021. Episode 31 - Vasopressors. FOAMcast: An Emergency Medicine Podcast. 25 July 2015. https://foamcast.org/tag/vasopressors/ Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

CardioNerd Amit Goyal is joined by Dr. Erika Hutt (Cleveland Clinic general cardiology fellow), Dr. Aldo Schenone (Brigham and Women’s advanced cardiovascular imaging fellow), and Dr. Wael Jaber (Cleveland Clinic cardiovascular imaging staff and co-founder of Cardiac Imaging Agora) to discuss nuclear and complimentary multimodality cardiovascular imaging for the evaluation of myocardial viability. Show notes were created by Dr. Hussain Khalid (University of Florida general cardiology fellow and CardioNerds Academy fellow in House Thomas). To learn more about multimodality cardiovascular imaging, check out Cardiac Imaging Agora!  Collect free to CME/MOC credit just for listening to the episode!  CardioNerds Multimodality Cardiovascular Imaging PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Show Notes & Take Home Pearls In response to ischemia the myocardium can dynamically change along a spectrum from myocardial stunning to myocardial hibernation to myocardial necrosis. The goals of viability testing are to identify patients who may benefit from revascularization as hibernating or stunned myocardium are potentially reversible causes of LV dysfunction. There are numerous imaging modalities available for the evaluation of myocardial viability. The broad range of ways in which myocardial viability is assessed speaks to the complexity of the disease spectrum and the difficulty in creating a unifying definition of viability to assess in clinical trials.   Five Take Home Pearls 1. In response to an acute episode of ischemia with subsequent reperfusion, the myocardium can be exposed to a large flux of oxygen free radicals or calcium overload that affects the cellular membrane and contractile apparatus. This phenotypically results in decreased contractility of the affected region of myocardium that can persist for weeks, labeled myocardial stunning  2. Repeated episodes of myocardial stunning or chronic low myocardial blood flow can lead to cellular changes such as resorption of the contractile apparatus in order to decrease oxygen demand and allow the myocardial cells to survive. Phenotypically, this might appear as regions of hypokinesis or akinesis at rest with a fixed perfusion defect on myocardial perfusion imaging. This is typically considered hibernating myocardium.   3. The goal of myocardial viability testing is to be able to differentiate between stunned, hibernating and necrosed myocardium. In patients with known epicardial coronary disease, this differentiation allows us to identify who may benefit from revascularization with improved LV systolic function and overall survival.   4. There are several imaging modalities that can be used in the assessment of myocardial viability. The most sensitive modalities are FDG-PET and CMR. The addition of Dobutamine or first pass perfusion with Gadolinium additionally increases the specificity of CMR. These modalities are more expensive and not as widely available.   5. The dynamic nature of the myocardial hibernation and the lack of a unifying definition/phenotypic expression of myocardial hibernation and viability have made it difficult for clinical trials to show that re-establishing myocardial blood flow to hibernating myocardium is beneficial. As Dr. Jaber stated in the episode in his spin on the classic opening phrase from Leo Tolstoy’s masterpiece, Anna Karenina, “All normal hearts are normal in the same way, and all abnormal hearts are abnormal in different ways.”  6. The PARR-2 trial was one of the few randomized, controlled trials of patients with LV systolic dysfunction and coronary artery disease who were randomized to either FDG-PET guided management or standard care with respect to whether to pursue revascularization. Overall,

In this 5 minute bit we discuss Phenylephrine, Angiotensin II, Dobutamine and Milrinone. Please see attached evidence related to our topic:*Just to clarify, dobutamine and milrinone can both be used for right ventricular systolic failure but there is some evidence that milrinone may provide better pulmonary vascular afterload reduction than dobutamine. NO MILRINONE IN RENAL FAILURE. MILRINONE IS LONG ACTING. *Just to clarify, Angiotensin II data was not solely tested against placebo. The actual randomized trial had both groups on high dose norepinephrine and one group had placebo as a second agent and the other group had angiotensin II as a second agent. The point of the trial was to demonstrate Angiotensin II efficacy in a patient that was failing high dose norepinephrine alone (or equivalent dose of another vasopressor). So the trial was not really Angiotensin II against just placebo as both groups were also on high dose catecholamine.https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0534-9https://www.nejm.org/doi/full/10.1056/NEJMoa1704154https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764562/https://www.ncbi.nlm.nih.gov/books/NBK470431/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691094/https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/Treatment-of-right-heart-failure-is-there-a-solution-to-the-problem

लखनऊ स्मार्ट न्यूज़ के इस एपिसोड में सुनिए: पी एम स्वनिधी योजना के तहत मिलेगा क़र्ज़। किसे होगा लाभ? लखनऊ यूनिवर्सिटी ने पोस्ट ग्रैजुएशन के लिए निकाली 11 विषयों की लिस्ट। डोबुटामिन इंजेक्शन पर लगी रोक।

Vasoactives in Septic Shock with Special Guest: Alex Flannery, PharmD, BCCCP, BCPS3:35 – Why is Alex interested in sepsis?...5:49 – How do you teach sepsis with the recent changes?...8:35 – When to start vasopressors in a hypotensive patient?...11:58 – What do you consider high-dose norepinephrine?...13:40 – How do you add vasopressin and corticosteroids for patients in refractory septic shock?...15:15 – Do you use fludricortisone in combination with hydrocortisone?...16:49 – Utility of cortisol levels or ACTH stimulation testing...18:27 – Cost:benefit analysis of vasopressin...19:21 – Role of epinephrine in septic shock...21:15 – Dobutamine or Epinephrine?...22:57 – HAT cocktail...24:55 – Thiamine supplementation in sepsis and septic shock...28:35 – Use of Angiotensin II and its place in therapy...32:30 – Approach to using methylene blue...34:05 – Modify hemodynamic goals to assist with vasopressor weaning...36:07 – Managing adverse effects due to vasopressors...39:27 – Order of operations in weaning vasopressors and corticosteroids...44:35 – The use of midodrine to wean off IV vasopressors...49:25 – Take-away points for vasoactives and their use in septic shock...51:11– Future areas for research PharmacyToDose.Com@PharmacyToDose on Twitter/InstragramPharmacyToDose@Gmail.com

Albuterol, Dobutamine, Dopamine, Epinephrine, Formoterol, Isoproterenol, Levalbuterol, Midodrine, Mirabegron, Norepinephrine, Oxymetazoline, Phenylephrine, Pirbuterol*, Pseudoephedrine, Salmeterol, Terbutaline *Note that I've discovered that Pirbuterol is not currently available in the US, will be changing this episode as soon as possible. This is a volunteer effort put together by medical students to bring you quality audio lectures on the topic of medicine. Our focus is specifically on material that may be covered in the USMLE® and throughout medical school. The first subject that we are covering is pharmacology. Right now, we're a very small team, and we're just getting started, so we may not be able to release episodes on a regular schedule, but we do hope to do so in the near future. We'd love to hear from you! Whether you found an error, believe that some changes should be made to the podcast, or you just think we're doing a great job, please email us your feedback at mededpodcast@gmail.com. Thanks for listening! Music (See link below for more information): "May the Chords Be with You" by Computer Music All-stars is licensed under a CC BY 4.0 License "Where Was I?" by Lee Rosevere is licensed under a CC BY 4.0 License "Night Owl" by Broke For Free is licensed under a CC BY 3.0 License *Disclaimer* - The MedEd Podcast is intended for educational purposes only and it is not intended to replace proper medical consultation from a trained and licensed professional. The improper diagnosis and treatment of disease can lead to injury and death. Contact a qualified healthcare provider about your health concerns. While we will strive to bring the most correct and up-to-date material, the information presented may not always be accurate and is ultimately your responsibility to verify. The MedEd Podcast has no affiliation with The United States Medical Licensing Examination® (USMLE®), or any other affiliations for that matter, and the information presented here is not guaranteed to be representative of information presented on any examination or within the context of medical practice. Any opinions expressed in this podcast belong solely to the creators of said podcast. They do not purport to reflect the opinions of The University of Nevada Reno School of Medicine or the opinions of any other institution with which the creators may be associated. Any opinions expressed in this podcast belong solely to the creators of said podcast. They do not purport to reflect the opinions of The University of Nevada Reno School of Medicine or the opinions of any other institution with which the creators may be associated. Click here for the transcript of this episode, or you can use this URL if the link isn't working: https://docs.google.com/document/d/167q62LArhZoHstW_YCGpF5_lokjXSIIEuuipYSwwQo8/edit?usp=sharing

In this episode, I ll discuss the effect of beta-blocker therapy on dobutamine. Show notes at pharmacyjoe.com/episode403. The post 403: What is the effect of beta-blocker therapy on dobutamine? appeared first on Pharmacy Joe.

In this podcast Ty Harrison, a Physician Assistant with the Minneapolis Heart Institute at Ridgeview Heart Center, addresses which type of stress test for chest pain is correct - why and for whom. Ty will also discuss the issue of assigning the wrong test, and that it is largely multi factorial, secondary to associated risk factors.  Objectives:    Upon completion of this podcast, participants should be able to: Describe how various stress tests are employed. Select which provocative test(s) should be ordered for specific cohorts of patients. Recite the contraindications for stress testing. Identify when a CT coronary angiogram or CMR should be considered, and on which patient subtype(s). CME credit is only offered to Ridgeview Providers for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: "Don't Stress the Test" (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition.”   FACULTY DISCLOSURE ANNOUNCEMENT  It is our intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: Before you send a patient over for a stress test, get a baseline EKG. Does the patient have a LBBB?  If so, then is the EKG really not interpretable? If the patient has a history of previous MI, or old Q waves via EKG a stress echo is not the appropriate test; as the patient will likely have wall motion abnormalities. The basics of adenosine testing is there are adenosine receptors on the vascular smooth muscle of cardiac vessels which causes healthy arteries to dilate and those vessels that are unhealthy will not dilate creating a perfusion mismatch. The nuclear portion of the stress test is where the radioisotope is given with the adenosine, which is taken up by healthy myocardium. If area has diminished perfusion, this will create a mismatch.  Dead tissue will not take up isotope - indicative of a previous infarct. The stress portion of the nuclear test will be to assess for a perfusion mismatch to evaluate for signs of ischemia. You want to compare rest vs. stress images. Lexiscan is an A2A agonist. Advantages do not require pharmacy, single injection, short acting. Lexiscan is the stress portion of the nuclear testing. By the way, the radionuclear isotope is about 10 mSv or equivalent to about 200 chest x-rays. Optimal patient for a Lexiscan is someone who cannot exercise, once again LBBB, paced, those who can walk on a treadmill. Specificity and sensitivity: 90% for Lexiscan, if selected correctly. Cons to Lexiscan are: cost, hospital based, radiation exposure, pregnancy. Pearl: things that buy you an angio on treadmill stress testing are EKG changes, redevelopment of chest sxs, image changes. 2 of those 3 criteria moves us to angio. CHAPTER 2 SUMMARY: The 2-main echos we are concerned with are stress echo, and Dobutamine or chemical echo. Unfortunately, the stress echo is not as sensitive as a nuclear test. The pros of a stress echo:  cost, no radiation. The echo process: patient will initially have a baseline-resting echo to look at the EF, and for wall motion abnormalities. Important to point out that this is not a valvular study. Although if Aortic Stenosis is visualized, this generally is a contraindication to stress echo. Sensitivity and specificity:  around 85%, not bad. For the stress portion of the test, you are shooting for about 85% of the patient maximum predicted heart rate. Unfortunately, if obese - a nuclear study is a 2-day test due to large amount of radiation required for the studies. An additional contraindication for stress echo would be morbid obesity, COPD, previous cardiac insult with wall motion abnormalities, LBBB, reduced EF. Dobutamine Echos have limited utility. They take a long time to perform. It makes people feel crummy. Physicians usually have to be present. Once caveat would be for the chronically wheezing asthmatic with bronchospasms or history of status asthmatics. Dobutamine is a B1 and B2 agonist, which will help with asthmatic sxs.  Dobutamine has inotropic properties and less chronotropic activity, which can occasionally require atropine to increase HR. Dobutamine has limited utility. Treadmill stress testing is used to "rule out" disease.  Stress echos are generally considered the appropriate test for women. Caffeine is an adenosine analog and can affect Lexiscan results.  Beta-blockers are typically held for about 36-hours. CHAPTER 3 SUMMARY: A treadmill stress test Bruce protocol is performed in 3-minute increments. Starts at a 10% grade, with a pace 1.8 miles per hour. Goal standard is about 10-minutes. Bruce protocol goes to 21- minutes. Predictive value of a significant coronary event if the patient meets the goals of a Bruce protocol is extremely low. Buzz words that make you stop the treadmill test are pretty self-explanatory, include: reproduced chest pain sxs, drop in BP, arrhythmias, EKG changes. The negative predictive value of a neg CT coronary angiogram - in upper 90% range. Elevated calcium scores can limit the efficacy of the CT coronary angio making it difficult to accurately interpret the test. Stress test is for revealing sxs. Stress tests are not for modifying outcomes.  If the patient can do 4 METS, usually you can clear them for surgery. Stress test should be a rule-out test. CTA FFR is Fractional Flow Reserve - is an assessment of flow across a coronary lesion. In addition, it tends to take the reader out of the equation.

Show notes at pharmacyjoe.com/episode389. In this episode, I ll discuss whether to use phentolamine to treat dobutamine extravasation. The post 389: Phentolamine to treat dobutamine extravasation appeared first on Pharmacy Joe.

Join Drs. Trigonis and Murray from the EMGuideWire team as they discuss use and selection of Vasopressors in the ED. 

I've known Tiffany for quite a long time now and she truly is like a sister to me.  I was so excited to have her on the show, but I've never once worked with her.  Despite this, she is such a wonderful person that if I ever was to be sick, injured, or my family needed care I would be so fortunate if she was the nurse.  She has been caring for people her entire life, even when not her responsibility.  I hope you feel as inspired as I am after listening to her.   As we discussed here is a wonderful Florence Nightingale quote:   The most important practical lesson that can be given to nurses is to teach them what to observe, how to observe, what symptoms indicate improvement, what the reverse, which are of importance, which are of none, which are the evidence of neglect, and of what kind of neglect.   Thank you Tiffany!       Registered Nurses* Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members.   2017 Median Pay: $70,000 per year ($33/hour)   Educational Degree: Initially Associate's Degree or Bachelor's Degree   Number of US jobs in 2016: 2,955,200   10 Year Job Outlook: 15% growth, much faster then avg.   *Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Registered Nurses, on the Internet at https://www.bls.gov/ooh/healthcare/registered-nurses.htm (visited November 16, 2018).   Terms Covered in Episode American Nurses Association   Palliative Medicine - An interdisciplinary approach to specialized medical and nursing care for people with life-limiting illnesses. It focuses on providing relief from the symptoms, pain, physical stress, and mental stress at any stage of illness.   Geriatrics Medicine - A specialty that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults.   Pediatrics Medicine - A branch of medicine that involves the medical care of infants, children, and adolescents.   NP (Nurse Practitioner) - A nurse practitioner is trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose illness and disease, prescribe medication and formulate treatment plans. They may work in a solo practice independently or they may work within part of a hospital system.  They graduate from a Master's or Doctorate level medical program.   Travel RN - Nurse who travels for limited contracts working in all variety of places and roles.  On average 8 to 13 week contracts.   Autonomy - Being able to work independently.   CNA (Certified Nursing Assistant) - Takes care of patients under the supervision of Licensed Practicing Nurses and Registered Nurses in a facility.   Personal Home Care - Providing medical care in a home setting.  Either in a group facility, as a visitor to an individual home, or as a live in caregiver providing 24/7 support.   Pharmacy Tech - A health care provider who performs pharmacy-related functions working under the direct supervision of a licensed pharmacist.   Corpsman - An enlisted member of a military medical unit.   Prerequisites - Classes required to set an educational foundation prior to enrolling in more focal studies.   Bachelor's Degree - On average four to five year University Program to pursue a degree in a specific field.   LPN (Licensed Practicing Nurse, aka Licensed Vocational Nurse) - Provides nursing centered patient care as part of a medical team.  Requires less years of education with less responsibilities on average compared to a Registered Nurse.   ASN/ADN - Associate’s Degree in Nursing   BSN - Bachelor of Science in Nursing, More schooling then Associate's.   ER Techs - Staff who in all aspects of patient care under the supervision of the Practitioners and Nursing staff.  Many have a paramedic/firefighting background.   Antimicrobial - An agent that kills microorganisms or stops their growth.   Oncology - Oncology is a branch of medicine that deals with the prevention, diagnosis, and treatment of cancer.   ICU (Intensive Care Unit, Critical Care Unit, or Intensive Therapy/Treatment Unit) - Part of the hospital with the sickest patients requiring the most intervention from both staff and equipment.  May consist of intubated, sedated, and ventilated patients.   CCU (Cardiac Care Unit) - Part of the hospital that focuses on postoperative cardiac surgical patients and those who have suffered from cardiac events or other variety of cardiac related disease processes.   ER (Emergency Room, Emergency Department, Emergency Ward, Accident & Emergency Dept) - Department that must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention that arrive unplanned by walk-in, private vehicle, or ambulance.   CABG (Coronary Artery Bypass Graft Surgery) - "Bypass" surgery is a surgical procedure to restore normal blood flow to an obstructed coronary artery.   MI (Miocardial Infarction) - "Heart Attack" refers to a blocked coronary artery that has caused, or is moments away from causing, irreversible cardiac (heart) tissue damage.   Epinephrine - Endogenous hormone that is given to patient's to treat a number of conditions including anaphylaxis, cardiac resuscitation, and bleeding.  Inhaled epinephrine is used to help treat symptoms of croup.  Is used in the ICU and cardiac unit to help maintain a high enough blood pressure.   Dobutamine - Inotrope class of cardiac medication used in the treatment of adults with weakened cardiac function due to poor effort of cardiac contractions (pumping of the heart) that may result from cardiac disease or cardiac surgery.  Helps the heart to beat stronger and more efficiently.   Dopamine - Medication used as a stimulant for low blood pressure, cardiac arrest, or slow heart rate.   Vasopressors - Class of Antihypotensive medications that are used to raise blood pressure by contracting blood vessels.   Insulin - Hormone naturally produced by the body to help process carbohydrates that is given via injection to diabetics who are unable to either produce, or are no longer as sensitive to, their insulin.   Massive Transfusion Protocol - Protocol that a hospital system has when need of large quantities of blood and blood products are needed to be transfused for a patient with significant blood loss that may still be ongoing.   Florence Nightingale - Founder of Modern Nursing   Certified Breastfeeding Specialist - Specialized healthcare provider who work with mom and their baby to assist in feeding and help those experiencing breastfeeding problems, such as latching issues, painful nursing, or low milk production.   Prenatal Care - Care being provided to those pregnant or planning to become pregnant.   Acute Care - The opposite of long term care.  Providing care for expected temporary illness or injury.   Foley Catheter - A tube that is inserted through the urethra to the bladder to empty urine.  May be left in place and a bag attached to it.   Skills Lab - Focused area to learn new medical techniques or further practice known skills.   Colostomy - A surgical procedure that brings one end of the large intestine out through an opening (stoma) made in the abdominal wall. Poop and liquid moving through the intestine empties via the stoma into a bag attached to the abdomen.   Oregon State Board of Nursing   Latching - The application and placement of the child's mouth to the nipple/breast to form an appropriate connection for feeding.   Colostrum - The nutrient rich first form of milk produced immediately following delivery of the newborn and contains antibodies to protect the newborn against disease.   Breast Pumping - Using a machine to mild the breasts for milk to be used at a later date or if there is issues with the infant latching on to the nipple for adequate feedings.   Torticollis - A rare, and often temporary, condition in which the neck muscles contract, causing the head to twist to one side.   Teddy Bear Constipation - Your teddy bear is "overstuffed."   Each and every episode of Maybe Medical is for educational purposes only, not to be taken as medical advice.  The opinions of those involved are of their own and not representative of their employer.

Dr Paul Wang:   Welcome to the monthly podcast, On The Beat for Circulation: Arrhythmia and Electrophysiology. I'm Dr Paul Wang, editor-in-chief, with some of the key highlights from this month's issue.                                 In our first paper, Ruairidh Martin and associates used ultra-high-density mapping to access the ventricular tachycardia circuit dependent upon re-entry, with scar regions in 36 tachycardias in 31 patients. The author has found that 11 of the ventricular tachycardia circuits and isthmuses were single-loop, and 25 were double-loop. Three had two entrances, five had two exits, and fifteen had dead-end activation. Isthmuses were defined by barriers which included anatomical obstacles, lines of block, and slow conduction in 27 out of 36 isthmuses. The barrier to conduction in isthmus appeared to be partially functional in 75% of circuits. Isthmus voltage is often higher in ventricular tachycardia than in sinus or paced rhythms. The authors found that conduction velocity in the VT isthmus slowed at the isthmus entrances and exits when compared with mid-isthmus. The mean conduction velocity was 0.08 meters per second in entrance zones, 0.29 meters per second in isthmus regions, p < 0.0001, and 0.11 meters per second in exit regions. P = 0.002.                                 In our next paper Daniel Duprez and associates found that plasma collagen biomarkers, particularly at elevated levels, were associated with excess risk of atrial fibrillation. In a stratified sample of the Multi-Ethnic Study of Atherosclerosis (MESA), initially age 45 to 84 years, the authors examined in 3,071 participants plasma Procollagen Type III N-Terminal Propeptide, also known as P3NP, which reflects collagen synthesis in degradation in Collagen Type I Carboxy-Terminal Telopeptide, also known as ICTP, which reflects collagen degradation at baseline. The authors aimed to determine if the levels of these biomarkers were associated with incident atrial fibrillation in participants initially free of overt cardiovascular disease. Incident atrial fibrillation in ten-year follow-up was based on a hospital ICD code for atrial fibrillation or atrial flutter, in or outpatient Medicare claims, or ECG ten years after baseline. The authors found that baseline levels of these markers were positively related, both p < 0.0001 to incident atrial fibrillation in a model adjusting for age, race, ethnicity, and sex. These findings were attenuated but remain statistically significant after further adjustment for systolic blood pressure, height, body mass index, smoking, and renal function.                                 In our next paper, Ahmet Adiyaman and associates conducted a randomized controlled trial comparing the safety and efficacy of minimally invasive thoracoscopic pulmonary vein isolation with left atrial appendage ligation versus percutaneous catheter ablation pulmonary vein isolation. In 52 patients with symptomatic paroxysmal or early persistent atrial fibrillation, paroxysmal atrial fibrillation was present in 74% of patients. The authors found that percutaneous pulmonary vein isolation with a 56% single procedure arrhythmia-free survival at two years was not inferior to minimally invasive thoracoscopic pulmonary vein isolation with left atrial appendage ligation, which had a 29% arrhythmia freedom, p = 0.059. Procedure-related major adverse events occurred in 21% of patients undergoing minimally invasive thoracoscopic pulmonary vein isolation, compared to none undergoing percutaneous catheter ablation with p = 0.029.                                 In the next paper, Richard Ang and associates examined whether the glucagon-like peptide-1 receptor agonist exendin 4 has an effect on ventricular action potential duration in susceptibility to ventricular arrhythmia in the rat heart in vivo and ex vivo. Ventricular monophasic action potentials recorded in anesthetized rats in vivo in isolated profused rat hearts in sinus rhythm and/or ventricular pacing. In vivo systemic administration of exendin 4 increased heart rate and this effect was abolished by beta adrenoceptor blockade. Despite causing sympathetic activation, exendin 4 increased axon potential duration at 90% repolarization, APD90, during ventricular pacing by 7% and reversed the effect of beta adrenoceptor agonist Dobutamine on APD90. In isolated profused hearts, 3 nanomolar exendin 4 increased APD90 by 14% with no effect on heart rate. Exendin 4 also reduced ventricular arrhythmia inducibility in conditions of beta adrenoceptor stimulation with Isoproterenol. Exendin 4 effects on action potential duration in ventricular arrhythmia susceptibility were prevented in conditions of muscarinic receptor blockade or inhibition of nitric oxide synthase. The authors concluded that glucagon-like peptide-1 receptor activation effectively reverses the effects of beta adrenoceptor stimulation on cardiac ventricular excitability and reduces ventricular arrhythmic potential. The effect of glucagon-like peptide-1 receptor activation on the ventricular myocardium is indirect, mediated by acetylcholine and nitric oxide, and, therefore, might be explained by stimulation of cardiac parasympathetic neurons.                                 In our next paper, Michael Barkagan and associates examined the role of modulating baseline impedance on ablation lesion dimension. Radiofrequency ablation was performed using an irrigated catheter at a fixed power setting of 30 watts 20 seconds and a multi-step impedance load from 100 to 210Ω ex vivo in 20 swine hearts and in vivo in the right atrium and in thigh preparations. Ablation was performed using similar power settings at three baseline impedances: low, 90 to 130Ω; intermediate, 131 to 180Ω; and high, 181 to 224Ω. The relationship between baseline impedance, current, and lesion dimensions were examined. Baseline impedance had a strong negative correlation with current squared for all of these experimental models with R either -0.93 or -0.94. Lesion dimensions at similar power setting were directly related to current squared with R = 0.853 for width and R = 0.814 for depth. In thigh muscle lesion depth was greatest at low impedance, 8.2 millimeters, compared to 6.5 millimeters and intermediate impedance and 4.2 millimeters at high impedance, p < 0.0001. In right atrial lines, low baseline impedance resulted in wider lines, 7.2 millimeters, relative to intermediate 5.8 millimeters and high impedance, 4.7 millimeters, p < 0.0001.                                 In the next study, Virginie Dubes and David Benoist and associates examined the origin of ventricular arrhythmias in animal model of repair of tetralogy of Fallot. They studied six piglets undergoing tetralogy of Fallot repair-like surgery compared to five sham-operated piglets. Twenty-three weeks post-surgery, the authors found that right ventricular dysfunction was present, while left ventricular function was preserved in tetralogy of Fallot pigs. Optical mapping showed longer action potential duration on the tetralogy of Fallot left ventricular epicardial and endocardium. Epicardial conduction velocity was significantly reduced in the longitudinal direction but not the transverse direction in tetralogy of Fallot ventricles compared to sham. Elevated collagen content was found in left ventricular basal and apical sections from the tetralogy of Fallot pigs. The tetralogy of Fallot left ventricles had a lower threshold for arrhythmia induction using incremental pacing protocols.                                 In our next study, Meera Varshneya and associates sought to understand the individual roles of slow and rapid delayed rectifier potassium currents, IKS and IKR, and quantify how effectively each stabilize the actions potential, protecting cells against arrhythmias across multiple species. The authors compared ten mathematical models describing ventricular myocytes from human, rabbit, canine, and guinea pig. They examined variability within heterogeneous cell population, tested the susceptibility of cells to a pro-rhythmic behavior, and studied how IKS and IKR responded to changes in the action potential. They found, one, models of higher baseline IKS exhibited less cell-to-cell variability in action potential duration; two, models with higher baseline IKS were less susceptible to early afterdepolarizations induced by depolarizing perturbations; three, as action potential durations lengthened, IKS increases more profoundly than IKR, thereby providing negative feedback that resists excessive action potential duration prolongation; and four, the increase in IKS that occurs during β-Adrenergic stimulation is critical for protecting cardiac myocytes from early afterdepolarizations under these conditions. The authors concluded that slow, delayed rectifier current is uniformly protected across a variety of cell types, suggesting that IKS enhancement could be potentially anti-arrhythmic.                                 In our final paper, Piotr Podziemski and Stef Zeemering and associates performed a direct one-to-one comparison between phase and activation time mapping in high-density epicardial direct contact mapping files of human atrial fibrillation. The authors examined 38 unipolar electrum files of ten seconds duration recorded in 20 patients with atrial fibrillation using a 16 x 16 electrode array placed on the epicardial surface of the left atrial posterior wall or right atrial free wall. Using sinusoidal recomposition and Hilbert Transform, 138 phase singularities were detected, with 104 out of 138 phase singularities detected within on electro distance, 1.5 millimeters, from a line of conduction block between non-rotating wave fronts determined by activation mapping. Only 18 rotating wave fronts were detected out of 8,219 detected waves based on wave mapping. Fourteen out of these 18 cases were detected as phase singularities in phase mapping. Phase analysis of filter electrograms produced by simulated wave fronts separated by conduction block also identified phase singularities on the line of conduction block. The authors found that phase singularities identified by phase analysis of filter epicardial electrograms colocalized with conduction block lines identified by activation mapping. The authors concluded that detection of phase singularity using phase analysis has a low specificity for identifying rotating wave fronts using activation mapping of human atrial fibrillation.                 That's it for this month. We hope that you'll find the journal to be the go-to place for everyone interested in the field. See you next time.

In non-cardiac ICU patients, the two major causes of acute myocardial dysfunction are sepsis-related cardiac depression (SRCD) and stress-related cardiomyopathy, the most common cause being the former. The main mechanisms responsible for SRCD include release of cardiac-depressant substances such as pro-inflammatory cytokines, hyporesponsiveness of beta-adrenergic receptors, decreased sensitivity of the myofilament to Ca++, and excessive production of perioxynitrite. Echocardiography is the best method to diagnose SRCD. If a cut-off value of 45% left ventricular ejection fraction is used to define SRCD, the occurrence of SRCD is 60% in septic shock patients (40% on the day of admission and in 20% the two following days). Recent advances in ultrasonography such as speckle-tracking (measuring the longitudinal systolic strain) may allow detecting cardiac abnormalities that are not detected by conventional echocardiography. Even when the SRCD is diagnosed, an important issue is to decide to treat it since left ventricular dilatation is an adaptive mechanism associated with a good outcome. The Surviving Sepsis Campaign suggests using dobutamine in patients who show evidence of persistent hypoperfusion despite adequate fluid loading and the use of vasopressor agents. In our opinion, it is more logical to give an inotrope when the shock state persists in the presence of: 1) proven SRCD with echocardiography and, 2) either low (mixed or central) venous blood oxygen saturation or increased veno-arterial carbon dioxide pressure gradient. Dobutamine is still recommended as the first-choice inotropic agent. Levosimendan is considered an alternative as it can restore the sensitivity of the cardiomyocyte myofilament to Ca++. Early administration of norepinephrine can not only increase blood pressure through an alpha1-adrenergic effect but also improve cardiac contractility through a beta1-adrenergic effect and/or an increase in the diastolic arterial pressure (i.e. the perfusion pressure of the left ventricle). 

The post Dobutamine (Dobutrex) Nursing Pharmacology Considerations appeared first on NURSING.com.

Commentary by Dr. Valentin Fuster

Let’s face it: Dopamine and Dobutamine can be a bit confusing!  This podcast covers these two medications and helps to dispel the confusion around these two meds.  One is an inotrope while the other is an alpha agonist.  So if… The post Dopamine vs Dobutamine appeared first on NURSING.com.

Let’s face it: Dopamine and Dobutamine can be a bit confusing!  This podcast covers these two medications and helps to dispel the confusion around these two meds.  One is an inotrope while the other is an alpha agonist.  So if… The post Dopamine vs Dobutamine appeared first on NURSING.com.

For the 30 years, clinical understanding of haemodynamic resuscitation has been based on physiological paradigms that focus on convective oxygen delivery. Most of these emphasise the role of cardiac output, haemoglobin and recommend interventions using synthetic agents such as dobutamine, synthetic colloids and blood transfusions. Markedly influenced by industry, these interventions and strategies hijacked critical thinking creating a belief in the utiliity of attaining short-term physiological surrogates for resuscitation that have little relevance in improving patient-centred outcomes. This 'physiological fallacy' has been demonstrated in high-quality RCTs of fluids, goal-directed therapy and catecholamines, that paradoxically inform the interpretation of new insights in the physiological basis of health and disease.

In this episode of The FlightBridgeED Podcast, we continue our conversation about hemodynamic pharmacology started in our previous podcast titled Pure Vasopressors. Today’s conversation focuses on left ventricular dysfunction and how inodilators such as dobutamine, and milrinone are used.

In this episode of The FlightBridgeED Podcast, we continue our conversation about hemodynamic pharmacology started in our previous podcast titled Pure Vasopressors. Today's conversation focuses on left ventricular dysfunction and how inodilators such as dobutamine, and milrinone are used.See omnystudio.com/listener for privacy information.

Let’s face it: Dopamine and Dobutamine can be a bit confusing! This podcast covers these two medications and helps to dispel the confusion around these two meds. One is an inotrope while the other is an alpha agonist. Due to… The post Ep10: Dopamine vs Dobutamine appeared first on NURSING.com.