NOREPINEPHRINE (LEVOPHED)

Question 1

CLASS

Answer 1

CATECHOLAMINE, VASOPRESSOR

Question 2

ACTIONS

Answer 2

• INCREASES SYSTEMIC VASCULAR RESISTANCE THROUGH ALPHA ADRENERGIC STIMULATION (VASOCONSTRICTION)
• BETA 1 EFFECTS LIKE EPINEPHERINE

Question 3

INDICATIONS

Answer 3

• HYPOTENSION DUE TO A LOW TOTAL PERIPHERAL RESISTANCE AS IN SEPTIC AND NEUROGENIC SHOCK
• ADEQUATE FLUID RESUSCITATION IS GENERALLY A PRECONDITION IN ITS USE.
• REFRACTORY HYPOTENSION IN TRICYCLIC ANTIDEPRESSANT OVERDOSE NOT RESPONSIVE TO SODIUM BICARBONATE.

Question 4

DOSE/ROUTE

Answer 4

• 4mg Norpinephrine in 250 cc NS resulting in a concentration of 16ug/cc
• initial dose of 0.5-1.0ug/min titrated to effect with average adult dose of 2-12 ug/min.
• some patients with refractory shock may require up to 30 ug/min to maintain adequate BP.

Question 5

STANDARD PREP

Answer 5

4 mg/ 4 ml

Question 6

CONTRAINDICATIONS

Answer 6

• Hypersensitivity
• Hypovolemic patients
• Pheochromocytoma

Question 7

SIDE EFFECTS

Answer 7

• HA, ARRYTHMIAS, TACHYCARDIA, R,EFLEX BRADYCARDIA, ANGINA, HTN, INTRACEREBRAL HEMORRHAGE, TREMORS, RESTLESSNESS.
• INCREASED MYOCARDIAL OXYGEN DEMAND.
• NECROSIS, TISSUE SLOUGHING WITH EXTRAVASATION.

Question 8

PRECAUTIONS

Answer 8

• SELECT A LARGE VEIN FOR INFUSION SITE.
• DO NOT ADMINISTER IN THE SAME LINE AS ALKALINE IV SOLUTIONS!
• NOREPINEPHRINE CAUSES RENAL AND MESENTERIC VASOCONSTRICTION EVEN AT LOW DOSES.
• EXTRAVASATION AND TISSUE SLOUGHING IF EXTRAVASATION OCCURS, INFORM ER RN OR MD SINCE REGITINE REQUIRED IF INFILTRATION OCCURED.