Norepinephrine (Levophed)

Question 0

Actions (2)

Answer 0

• Increases systematic vascular resistance through alpha adrenergic stimulation (vasoconstriction)
• B1 effects like epinephrine

Question 1

Class (2)

Answer 1

• Catecholamine

- Vasopressor

Question 2

Indications (3)

Answer 2

• Hypotension due to a low peripheral resistance as in septic and neurogenic shock
• Adequate fluid resuscitation is generally a precondition to its use
• Refractory hypotension in TCA overdose not responsive to sodium bicarbonate

Question 3

Dose/Route

Answer 3

• 4 mg in 250 CC NS resulting in a concentration if 16 ug/CC
• Initial dose of 0.5-1.0 ug/min titrated to effect with average adult dose of 2-12 ug/min
• Some pts with refractory shock may require up to 30 ug/min to maintain adequate BP

Question 4

Standard Prep

Answer 4

4 mg/4 ml

Question 5

Contraindications (3)

Answer 5

• Hypersensitivity
• Hypovolemic pts
• Pheochromocytoma

Question 6

Side Effects (11)

Answer 6

• HA
• Arrhythmias
• Tachycardia
• Reflex bradycardia
• Angina
• HTN
• Intracerebral hemorrhage
• Tremors
• Restlessness
• Increased myocardial O2 demand
• Necrosis, tissue sloughing with extravasation

Question 7

Precautions

Answer 7

• 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, informER RN or MD since Regitine required if infiltration occurred