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Dobutamine is a direct-acting agent whose primary activity results from stimulation of the β 1-adrenoceptors of the heart, increasing contractility and cardiac output. Since it does not act on dopamine receptors to inhibit the release of norepinephrine (another α 1 agonist), dobutamine is less prone to induce hypertension than is dopamine.
Specifically, dobutamine selectively binds to β1 receptors located on the surface of specialised cardiac muscle cells. [16] Relative to β2 receptors, β1 is the predominant type in terms of quantity and function within the heart.
Some substances do both (e.g. dopamine, dobutamine). If low blood pressure is due to blood loss, then preparations increasing volume of blood circulation—plasma-substituting solutions such as colloid and crystalloid solutions (salt solutions) [1] —will raise the blood pressure without any direct vasopressor activity.
Achieve superior vena cava oxygen saturation (ScvO2) of > 70% OR mixed venous oxygen saturation (SvO2) of > 65%. If initial fluid resuscitation fails to achieve adequate oxygen saturation, additional options include dobutamine infusion (maximum 20 μg/kg/min) or transfusion of packed red blood cells to a hematocrit ≥ 30%. If a ScvO2 is ...
Most agonists of the beta receptors are selective for one or more beta-adrenoreceptors. For example, patients with low heart rate are given beta agonist treatments that are more "cardio-selective" such as dobutamine, which increases the force of contraction of the heart muscle.
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The mechanisms of sympathomimetic drugs can be direct-acting (direct interaction between drug and receptor), such as α-adrenergic agonists, β-adrenergic agonists, and dopaminergic agonists; or indirect-acting (interaction not between drug and receptor), such as MAOIs, COMT inhibitors, release stimulants, and reuptake inhibitors that increase the levels of endogenous catecholamines.
The high dropout rates have provoked neither an internal crisis nor a re-evaluation of programming. Stamper dismissed dropouts as “attrition by personal choice.” An addict’s failure is considered a result of not being ready for treatment, never an indication that there might be a problem with the treatment itself.