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Drawing

Generic Name
Brand Name
Classification

Norepinephrine
Levophed
Vasopressor
Stimulates alpha adrenergic receptors located mainly in blood vessels, causing
constriction of both capacitance and resistance vessels
Action
Also has minor beta adrenergic activity (myocardial simulation)
Therapeutic Effects: Increased BP. Increased cardiac output.
IV (Adults): 0.5 1 mcg initially, followed by maintenance infusion of - 12
mcg/min titrated by BP response
Dosage
IV (Children): 0.1 mcg/kg/min initially, may be followed by infusion titrated o
BP response, up to 1 mcg/kg/min
Produces vasoconstriction and myocardial stimulation, which may be required after
Indication
adequate fluid replacement in the treatment of severe hypotension and shock.
Vascular, mesenteric or peripheral thrombosis, Hypoxia, Hypercabia, Hypotension
Contraindication secondary to hypovolemia (without appropriate volume replacement),
Hypersensitivity to bisulfites.
Use with cyclopropane or halothane anesthesia, cardiac glycosides, doxapram
or local use of cocaine may result in increased myocardial irritation ability
Use wit MAO inhibitors, methyldopa, doxapram or tricyclic antidepressants
may result in severe hypertension
Drug Interaction
Alpha- adrenergic blockers an prevent pressor response
Beta blockers my exaggerate hypertension or block cardiac stimulation
Concurrent use with ergot alkaloids (ergotamine, ergonovine, methylergonovine
or oxytocin) may result in enhanced vasoconstriction and hypertension
Anxiety, dizziness, headache, insomnia, restlessness, tremor, weakness
Dyspnea
Arrhythmias, bradycardia, chest pain hypertension
Side Effects and Decreased urine output, renal failure
Adverse Effects Hyperglycemia
Metabolic acidosis
Phlebitis at IV site
Fever

Nursing
Responsibilities

1. Monitor constantly while patient is receiving norepinephrine. Take baseline BP


and pulse before start of therapy, then q2min from initiation of drug until
stabilization occurs at desired level, then every 5 min during drug
administration.
2. Adjust flow rate to maintain BP at low normal (usually 80100 mm Hg systolic)
in normotensive patients. In previously hypertensive patients, systolic is
generally maintained no higher than 40 mm Hg below preexisting systolic level.
3. Observe carefully and record mental status (index of cerebral circulation), skin
temperature of extremities, and color (especially of earlobes, lips, nail beds) in
addition to vital signs.
4. Monitor I&O. Urinary retention and kidney shutdown are possibilities,
especially in hypovolemic patients. Urinary output is a sensitive indicator of the
degree of renal perfusion. Report decrease in urinary output or change in I&O
ratio.
5. Be alert to patients complaints of headache, vomiting, palpitation, arrhythmias,
chest pain, photophobia, and blurred vision as possible symptoms of
overdosage. Reflex bradycardia may occur as a result of rise in BP.
6. Continue to monitor vital signs and observe patient closely after cessation of
therapy for clinical sign of circulatory inadequacy.
7. Monitor ECG during administration continuously.
8. Asses for paresthesia and coldness of extremities, peripheral blood flow may
decrease.