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Pharmacology · Adrenergic drugs: dobutamine
Sample itemA 60-year-old man with acute decompensated heart failure has pulmonary congestion, cold peripheries and low urine output. Blood pressure is 96/60 mmHg. Which drug is the most appropriate inotrope?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. Dobutamine
Dobutamine is a relatively selective beta1 agonist that increases contractility and cardiac output with only mild vasodilatation, so it suits low-output heart failure with preserved blood pressure. Raising afterload with a pure vasoconstrictor worsens pump failure, and beta-blockers are avoided while the patient is decompensated.
Option by option
A. Clonidine
Clonidine is a central alpha2 agonist used to lower pressure, with no inotropic effect.
B. Dobutamine (correct)
Correct. Dobutamine increases contractility and output with little rise in afterload.
C. Propranolol
Propranolol has negative inotropic action and can precipitate worsening acute failure.
D. Phenylephrine
Phenylephrine is a pure alpha1 agonist; it raises afterload and can further reduce cardiac output.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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