Question

Discuss the indications for use of each medication(Nitroprusside, and Dobutamine)  the parameters/titration of each medication, and the expected patient response for the medication

Answer 1

Nitroprusside indicated for immediate reduction of blood pressure in adults and pediatrics, it manages hypertensive crisis, congestive heart failure, and controls hypotension during surgery and help in angina.
Dobutamine is a direct-acting inotropic agent. Indicated for a patient who needs positive inotropic support in cardiac decompensation due to depressed contractility. it is used for organic heart disease from cardiac surgical procedures. it corrects the hemodynamic imbalance.
Nitroprusside infusion should be started at a low rate(0.3mcg/kg/min with upward tritration every few minutes till the desire effects achieved to maximum recommended infusion 10mcg/kg/min is achieved.
Dobutamine infusion should be started at low rate(0.5 to 1mcg/kg/min and triturated intervals of few minutes according to patient response, system blood pressure, ectopic activity frequency, urine flow, heart rate, and cardiac output level, CVP, pulmonary capillary wedge pressure, optimize infusion rates differ from patient to patient in between 2 to 20mcg/kg/min.
the expected patient response that nitroprusside has a net hemodynamic response that causes arterial and venous dilatation, reduce the afterload, and lowers the systemic BP, increases output, maintains heart rate, and decreases ventricular filtration rates.
the patient response that dobutamine who has arterial titration and rapid ventricular response, inotropic support with cardiac decompensation it causes vasodilation effect. dobutamine increases systolic blood pressure and heart rate.