Norepinephrine Bitartrate (Levophed)

Question 1

Class

Answer 1

Sympathomimetic

Adrenergic agonist and inotrope

Question 2

Actions

Answer 2

Beta one effects like epinephrine.

Increases systemic vascular resistance through alpha adrenergic stimulation (vasoconstriction)

Question 3

Indications

Answer 3

Hypotension due to low peripheral resistance, such as septic and neurogenic shock.
Hypotension unresponsive to fluids.
Refractory hypotension in TCA ODs not responsive to bicarbonate.

Question 4

Contraindications

Answer 4

Hypersensitivity
Hypovolemic patients
Pheochromocytoma

Question 5

Side effects

Answer 5

HA
Arrhythmias
Tachycardia
Tremors
Restlessness
Angina
Reflex bradycardia
HTN
Intracerebral hemorrhage
Increased myocardial oxygen demand
Necrosis, tissue sloughing with extravasation

Question 6

Precautions

Answer 6

Select a large vein for infusion.
Inform ER MD of extravastion as regitine will be needed, to counteract tissue sloughing.
Causes renal and mesenteric constriction, even at low doses.
Do not administer in the same line as alkaline solutions.
Digoxin increases the risk of arrhythmias.
Beta blockers allow unopposed alpha effects.