Norepinephrine

Question 1

Norepinephrine (Levophed)

Class

Answer 1

Sympathomimetic

Question 2

Norepinephrine (Levophed)

Mechanism of Action

Answer 2

Potent alpha agonist resulting in intense vasoconstriction; positive chronotropic and inotropic effect with increased cardiac output

Question 3

Norepinephrine (Levophed)

Indications

Answer 3

Cardiogenic shock, significant hypotensive states ( <70 mm Hg )

Question 4

Norepinephrine (Levophed)

Contraindications

Answer 4

Hypotensive patients with hypovolemia, pregnancy (relative

contraindication).

Question 5

Norepinephrine (Levophed)

Adverse Reactions

Answer 5

Headache, arrhythmias, tachycardia, reflex bradycardia, angina pectoris, hypertension; decreased blood flow to the GI tract, kidneys, skeletal muscle, and skin.

Question 6

Norepinephrine (Levophed)

Drug Interactions

Answer 6

Can be deactivated by alkaline solutions. Sympathomimetics and phosphodiesterase, inhibitors may exacerbate arrhythmias. Bretylium may potentiate the effects of catecholamines.

Question 7

Norepinephrine (Levophed)

Adult Dosage

Answer 7

Dilute 8 mg in 500 mL of D5W or 4 mg in 250 mL of D5W; infuse by IV piggyback at 0.5 – 30.0 mcg/min IV infusion, titrated to patient response.

Question 8

Norepinephrine (Levophed)

Pediatric Dosage

Answer 8

0.1 – 1.0 mcg/min infusion; titrated to patient response.

Question 9

Norepinephrine (Levophed)

Onset

Answer 9

1-3 minutes

Question 10

Norepinephrine (Levophed)

Peak Effect

Answer 10

Variable

Question 11

Norepinephrine (Levophed)

Duration

Answer 11

5-10 minutes

Question 12

Norepinephrine (Levophed)

Answer 12

Must be infused through a large stable vein to prevent necrosis. Often used in conjunction with low-dose Dopamine to spare renal and mesenteric blood flow.