Norepinephrine

Question 1

What is the trade name for norepinephrine?

Answer 1

Levophed

Question 2

What is the generic name for Levophed?

Answer 2

norepinephrine

Question 3

Classification - norepinephrine

Answer 3

adrenergic agonist (sympathomimetic), vasopressor

Question 4

How is norepinephrine supplied?

Answer 4

4mg/4mL

Question 5

Actions (Pharmacodynamics) - norepinephrine

Answer 5

❑ Vasopressor: direct stimulation of alpha-adrenergic receptors to constrict blood vessels. This results in increased total peripheral vascular resistance, increased systolic and diastolic blood pressure, and decreased blood flow to vital organs, skin, skeletal muscle and renal blood flow.
❑ Produces a positive inotropic response of the heart (beta1 receptors).

Question 6

Indications - norepinephrine

Answer 6

❑ Hypotension (< 70mmHg) refractory to other adrenergic agonists (sympathomimetics)
❑ Septic, Cardiogenic and Neurogenic shock
❑ Treatment of shock after fluid resuscitation
❑ Beta & Calcium Channel Blocker OD, Cholinesterase inhibitor poisoning, Cyclic Antidepressant OD, Digoxin OD, Ethanol
poisoning, Head injury with MAP <80mmHg, Non-cyclic Antidepressant OD, Salicylate OD, Sedative OD
❑ Vasopressor infusions may be administered after ROSC to support cardiac output, especially blood flow to the heart and brain

Question 7

Dosage - norepinephrine

Answer 7

Adult/Pediatric 0.1 – 1.0 mcg/kg/min. IV infusion (*start at low dose and titrate to desired blood pressure);

Mix 4 mg in 250 mL D5W or NS (16 mcg/mL)

Question 8

Contraindications - norepinephrine

Answer 8

❑ Mesenteric or peripheral vascular thrombosis
❑ Hypotension related to hypovolemia (except in an emergency to maintain coronary/cerebral perfusion until volume is replaced

Question 9

Precautions - norepinephrine

Answer 9

❑ Do not mix with alkaline solutions as it can be deactivated (e.g. sodium bicarbonate).
❑ If given with Beta blockers a markedly elevated BP can occur
❑ Extravasation causes tissue necrosis; check frequently for signs of extravasation, stop infusion if this occurs.
❑ Use with caution if patient is taking MAOI or TCA; may precipitate hypertension

Question 10

You’re starting an IV to give norepinephrine, what should you consider?

Answer 10

Norepinephrine should be administered into a large vein.

Question 11

Does norepinephrine effect myocardial oxygen demand?

Answer 11

Yes. It increases myocardial oxygen requirements as it raises HR and BP (May induce dysrhythmias).