Questions and Answers
What is the action of Norepinephrine?
What are the uses of Norepinephrine?
To restore blood pressure in acute hypotensive states.
What is a contraindication for administering Norepinephrine?
Hypotension due to blood volume deficits.
Norepinephrine administration alerts include monitoring the ______ continuously.
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Norepinephrine can cause severe peripheral vasoconstriction in all patients.
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What should be administered if extravasation occurs?
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What are some adverse effects of Norepinephrine?
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What is Norepinephrine's black box warning?
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Which drugs may antagonize the vasopressor effects of Norepinephrine?
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What treatment is advised for Norepinephrine overdose?
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What should be monitored while a patient is receiving Norepinephrine?
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Study Notes
Norepinephrine (Levophed) Overview
- Norepinephrine is a sympathomimetic agent that primarily stimulates alpha-adrenergic receptors, leading to rapid increases in blood pressure.
- It has limited action on beta receptors, influencing heart rate mainly through beta 1 receptors.
- Recognized as the vasopressor of choice for septic shock due to its proven ability to reduce mortality rates.
Mechanism of Action
- Induces vasoconstriction and cardiac stimulation, enhancing both systolic and diastolic blood pressure.
- Improves myocardial oxygenation and coronary artery blood flow, increasing the heart's workload.
Uses
- Administered to restore blood pressure in various acute hypotensive conditions, including:
- Shock states (e.g., septic, cardiogenic)
- Sympathectomy and pheochromocytoma
- Spinal anesthesia and poliomyelitis
- Myocardial infarction (MI), septicemia, and reactions to blood transfusions or medication.
Contraindications
- Avoid in patients with hypotension caused by blood volume deficits; existing vasoconstriction may worsen conditions.
- Caution in patients with mesenteric or peripheral vascular thrombosis due to risk of ischemia and infarction.
- Use cautiously in:
- Severe heart disease
- Older adults
- Patients who have received MAOIs within the last 14 days
- Patients on tricyclic antidepressants.
Administration Alerts
- Initiate infusion only after confirming IV potency, and monitor flow rate continuously.
- In case of extravasation, administer phentolamine to the affected area as soon as possible.
- Do not abruptly stop the infusion to prevent sudden drops in blood pressure.
Adverse Effects
- Requires continuous blood pressure monitoring to avoid hypertension.
- Reflex bradycardia may occur upon initial administration.
- Potential for dysrhythmias, though less frequent than with other vasopressors.
- Extravasation can cause serious skin and soft tissue injury.
- Symptoms of overdose include blurred vision and photophobia, with severe risks including hepatic necrosis, fatal arrhythmias, and cerebral hemorrhage.
Black Box Warning
- Immediate infiltration of the affected area with 5 to 10 mg of phentolamine is essential after extravasation to prevent tissue damage.
Drug Interactions
- Alpha and beta blockers can reduce the vasopressor effects of norepinephrine.
- Ergot alkaloids and tricyclic antidepressants may enhance its vasopressor effects.
- The risk of dysrhythmias may be increased when given with digoxin, halothane, or cyclopropane.
Overdose Management
- Discontinuation of norepinephrine infusion often leads to a rapid resolution of adverse effects, particularly hypertension.
Nursing Implications
- Constant monitoring is critical while administering norepinephrine, including establishing baseline blood pressure and pulse rates.
- Adjust the infusion rate to maintain blood pressure within a normal range.
- Record mental status and observe skin temperature and color of extremities, particularly in earlobes, lips, and nail beds.
- Monitor intake and output closely, as urinary retention and potential kidney shutdown can occur.
- Be vigilant for patient-reported symptoms indicating overdose, such as headache, vomiting, palpitations, arrhythmias, chest pain, photophobia, and blurred vision.
- Continue to observe vital signs and assess for signs of circulatory inadequacy after therapy cessation.
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Description
Test your knowledge of Norepinephrine (Levophed) with these flashcards. Learn about its action as a sympathomimetic, its effects on vascular smooth muscle, and its use in septic shock treatment. This quiz is essential for medical students and professionals eager to enhance their pharmacology understanding.
