| Name: |
NOREPINEPHRINE (LevophedR) |
| Classification: |
sympathomimetic, vasopressor
- stimulates alpha adrenergic receptors, producing vasoconstriction and decreased heart rate
- at low doses, stimulates beta adrenergic receptors to enhance myocardial contractility
|
| Dose: |
- beta/alpha:
- 2.5 - 5 mcg/min by infusion
- alpha:
- > 5 mcg/min by infusion
- dose is titrated to maintain systolic blood pressure
|
| Administration: |
IV Infusion:
8 mg/250mL D5W, NS, RL
- Protect from light
- Colour change from clear to brown indicates a loss of potency
- Hypovolemia, hypoxemia and acidosis should be corrected concurrently with initiation of therapy
- Should be weaned off
|
| Adverse Effects: |
- inadvertent boluses may precipitate profound hypertension which may result in myocardial infarction, cerebral ischemia
- norepinephrine alone, without inotropic therapy may worsen stroke volume in left ventricular dysfunction by increasing systemic afterload
- bradycardia
- renal ischemia resulting in decreased urine output
- mesenteric ischemia
- increased blood glucose
- extravasation of drug may cause tissue necrosis (Rx with 5-15mg phentolamine in NS - see phentolamine monograph)
|
| Drug Interactions: |
- norepinephrine + anaesthetics = increased risk of cardiac arrhythmias
|
| Monitoring Therapy: |
- BP
- HR, ECG
- urine output, BUN, creatinine
- cardiac index
- SVRI
- arterial lactate
- PWP
- changes in skin colour or tempurature
- chest pain
|
| CCTC Protocol: |
- May be administered by IV infusion by an approved nurse in CCTC.
- May be titrated by an approved nurse in CCTC.
- Must be administered via a central line.
- Continuous infusion must be administered via an infusion pump.
- Should not be administered through the proximal injectate (blue) port of the Swan Ganz Catheter.
- Patient requires placement of an arterial line to monitor BP.
|
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