Drug Flaschards 13.08.26 Epi and Norepi

Question 1

Norepi Other Names?

Answer 1

noradrenaline, Levophed

Question 2

Norepi Drug Class…
Pharmacologic Class?
Therapeutic Class?

Answer 2

• pharmacologic class—direct-acting adrenergic agonist

* therapeutic class—vasopressor, vasoconstrictor

Question 3

Norepi Pharmacodynamics?
What is the major action?
What is the minor action?
What are the main effects?

Answer 3

• Major action is to stimulate peripheral alpha-1 adrenoceptors, thereby leading to vasoconstriction (resistance arterioles, increase SVR) and venoconstriction (in capacitance vessels, increase preload).
• This increases CO, SVR, and MAP, but decreases blood flow to vulnerable tissues like skin, muscle, and kidney.
• Minor action stimulates beta-1 receptors in the heart, increasing HR and contractility
• Main effects are vasoconstriction and cardiac stimulation.

Question 4

Norepi stimulates peripheral _____ receptors which leads to increases CO, SVR, and MAP.
Norepi stimulates heart _____ receptors which increases HR and Contractility

Answer 4

Alpha-1

Beta-1

Question 5

Norepi Pharmacokinetics?
What is F %?
How is it administered?
What enzyme metabolizes Norepi and in what organ?
Where are metabolites of Norepi excreted?
What is the half-life of Norepi?
What Blood-Tissue barriers can Norepi cross and not cross?

Answer 5

• F ~100%.
• Given IV only.
• Metabolized by COMT and MAO, mostly in liver.
• Metabolites are excreted in urine.
• Half-life 1-2 minutes (e.g. can be titrated quickly IV).
• Can cross the placenta, but not the blood/brain barrier.

Question 6

Norepi…
What is F%?
How is it administered?

Answer 6

• F ~100%.

* Given IV only

Question 7

Norepi…
What enzymes metabolizes Norepi and in what organ?
How are the metabolites excreted?

Answer 7

• Metabolized by COMT and MAO, mostly in liver.

* Metabolites are excreted in urine.

Question 8

What is the Half-Life of Norepi?

Answer 8

• Half-life 1-2 minutes (e.g. can be titrated quickly IV)

Question 9

What Blood-Tissue barriers can Norepit cross and not cross?

Answer 9

• Can cross the placenta, but not the blood/brain barrier.

Question 10

Norepi Toxicity

What physiologic events occur with Norepi Toxicity?

Answer 10

• excessive vasoconstriction in mesenteric vessels
• peripheral arterioles causing ischemia, infarction, and gangrene
• reflex bradycardia

Question 11

Norepi…

Which drug interactions are a concern?

Answer 11

MAO inhibitors (phenelzine) [use lower doses of norepi]
Propranolol [risk of causing hypertension]

Question 12

Norepi…

What special considerations are there?

Answer 12

• correct volume depletion with IV fluids BEFORE giving NE infusion
• select infusion site carefully—extravasation is a major problem
• monitor patient and BP continuously in ICU setting
• use cautiously in pediatric and geriatric patients

Question 13

Norepi…

What are indications and dose/route?

Answer 13

• for adults with acute hypotension and shock (related to low SVR)
• infuse 2-12 mcg/min

Question 14

Norepi…

How should the patient be monitored if given norepi?

Answer 14

BP, HR, infusion site, evidence of extravasation

Question 15

Epi…

Other names?

Answer 15

Adrenaline

EpiPen

Question 16

Epi…
Pharmacologic class?
Therapeutic Class?

Answer 16

• pharmacologic class—direct-acting adrenergic agonist
• therapeutic class—vasopressor, cardiac stimulant, bronchodilator, adjunct to local anesthetics, treatment for anaphylaxis

Question 17

Epi…
What are the pharmacodynamics…
Major actions (3)?
(Comprehensive flashcard)

Answer 17

• major action is to stimulate peripheral alpha-1 adrenoceptors, thereby leading to vasoconstriction (resistance arterioles, increase SVR) and venoconstriction (in capacitance vessels, increase preload)
• beta-1 receptors leading to tachycardia and increased contractility
• beta-2 receptors leading to bronchodilation these actions are also helpful in severe allergic reactions (e.g. anaphylaxis) by stabilizing mast cells

Question 18

Epi… which receptors?

• major action is to stimulate peripheral ____ adrenoceptors, thereby leading to vasoconstriction (resistance arterioles, increase SVR) and venoconstriction (in capacitance vessels, increase preload)
• ____ receptors leading to tachycardia and increased contractility
• ____ receptors leading to bronchodilation these actions are also helpful in severe allergic reactions (e.g. anaphylaxis) by stabilizing mast cells

Answer 18

Alpha-1
Beta-1
Beta-2

Question 19

Epi again…
What do Alpha-1 receptors do in peripheral vessels?
What do Beta-1 receptors do to the heart?
What do Beta-2 receptors do to the lungs and to mast cells?

Answer 19

• peripheral alpha-1 adrenoceptors, thereby leading to vasoconstriction (resistance arterioles, increase SVR) and venoconstriction (in capacitance vessels, increase preload)
• beta-1 receptors leading to tachycardia and increased contractility
• beta-2 receptors leading to bronchodilation these actions are also helpful in severe allergic reactions (e.g. anaphylaxis) by stabilizing mast cells

Question 20

Epi Pharmacokinetics…
What are routes of administration?
What enzyme metabolizes epi?
How are the metabolites excreted?

Answer 20

can be given iv (immediate), IM (variable), SC 5-15 min), inhalation (1-5 min onset), ophthalmic topical

metabolized by COMT and then renally excreted

Question 21

Epi…

What are syptoms of toxicity?

Answer 21

excessive vasoconstriction, HTN, hemorrhagic stroke, angina, arrhythmias

Question 22

Epi…

What are special considerations (ie, when is it used)?

Answer 22

• utility with local anesthetics

* drug of choice in severe anaphylactic reactions (along with others)

Question 23

Epi…

What are indications for use?

Answer 23

Anaphylaxis

Cardiac arrest

Question 24

Epi...
What are the dosages and route of administration for
Anaphylaxis?
Cardiac Arrest?
Infusion of epi?

Answer 24

anaphylaxis, 0.1-0.5 mg SC or IM
cardiac arrest, 1-5 mg IV push
infusion, 1-4 mcg/min

Question 25

Epi... | What patient symptoms should be monitored?

Answer 25

BP, HR, rhythm, infusion site, evidence of extravasation