Norepinephrine or Norepinephrin bitartrate ( Levophed)

Question 1

Class

Answer 1

Catecholamine.

Vasopressor.

Question 2

Actions

Answer 2

Increases systemic vascular resistance through alpha adrenergic stimulation (vasoconstriction).
B1 effects like epinephrine.

Question 3

Indications

Answer 3

Hypotension due to a low total peripheral resistance as in septic and neurogenic shock.
Adequite fluid resuscitation is generally a precondition to its use.
Refractory hypotension in tricyclic antidepressant overdose not responsive to sodium bicarbonate.

Question 4

Dose/Route

Answer 4

4 mg norepinephrine in 250 cc NS resulting in a concentration of 16 mg/cc.
Initial dose of 0.5 -1.0 ug/min titrated to effect with average adult does of 2 - 12 ug/min.
Some pt’s 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

Contraindication

Answer 6

Hypersensitivity.
Hypovolemic pt’s.
Pheochromocytoma.

Question 7

Side effects

Answer 7

HA, arrhythmias, tachycardia, reflex 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 occurred.