NORADRENALINE (LEVOPHED)

NORADRENALINE (LEVOPHED)

CLASSIFICATION

� Inotrope - sympathomimetic amine

MODE OF ACTION

Acts predominantly on alpha adrenergic activity and minor beta 1 receptors in the heart.

CENTRALLY

� Positive Inotrope. � Dilation of coronary arteries which results in an increase in systemic blood pressure and coronary artery blood flow. � Increased coronary blood flow.

PERIPHERALLY

� Causes peripheral vasoconstriction � Increases venous return � Increase systemic blood pressure

ONSET of action immediately after the infusion begins DURATION 1 - 2 minutes after infusion ends.

INDICATIONS

� Restore blood pressure in acute hypotensive states ie shock. � Severe hypotension after cardiac arrest, sepsis, spinal anaesthesia, sympathectomy anaphylaxis. � As an adjunct in cardiac arrest to improve blood pressure post arrest.

CONTRA INDICATIONS

� Hypotension due to hypovolaemia, except to maintain cerebral and coronary perfusion until transfusion is possible. � Mesenteric or peripheral vascular thrombosis due to the risk of increasing ischaemia, and extending the infarct. � Profound hypoxia or hypercarbia. � During anaesthetic with cyclopropane or halothane � Pregnant patients.

PRECAUTIONS

� Avoid hypertension, headache maybe a symptom of hypertension due to overdose. � Patients receiving MAO inhibitors, tricyclic antidepressant. � Use cautiously in patients with hypertension, hyperthyroidism, severe cardiac disease.

ADVERSE REACTIONS

� CVS - Reflex bradycardia, severe hypertension, increased peripheral resistance, decreased CO, arrhythmias including ventricular tachycardia, ventricular fibrillation, bigeminy, and AV dissociation, chest pain and increased myocardial oxygen consumption. � CNS - Headache, anxiety, weakness, dizziness, tremor, restlessness, insomnia � RESPIRATORY - Respiratory difficulties. � RENAL- Decreased urine output. � OTHER - Local irritation and necrosis with extravasation. Glucose intolerance.

PRESENTATION 1:1000, 2 mg in 2 ml ampoule.

DOSAGE AND ADMINISTRATION

IV INFUSION

� add 6 mg of noradrenaline to 1000 l of 5 % dextrose 0r 3 mg 100 ml � NB do not use normal saline s oxidation can occur causing lack of potency.

mls/hr 3 mg/100 ml 6 mg/100 ml 5 ml/hr 2.5 mcg/min 5 mcg/min 10 5 10 15 7.5 15 20 10 20 25 12.5 25 30 15 30 35 17.5 35 40 20 40

TITRATE INFUSION RATE AS PER VITAL SIGNS AND DOCTORS GUIDELINES.

� Usual dosage range is 3 mcg - 15 mcg per minute. � Up to 100 mcg/min may be required in severe causes of septic shock. � WEAN infusion gradually monitoring vital signs and watch for severe hypotension.

NURSING CONSIDERATIONS

� The infusion must be changed every 24 hours � Monitor urine output hourly and check distal pulses � Monitor serum glucose. � Treat hypovolaemia before administering Noradrenaline. � Give via volumetric pump to regulate flow. � Use CVC or large vein eg antecubial fossa or femoral vein to minimise risk of extravasation. � During infusion monitor ECG,BP, CO, CVP, PAWP, HR, urine output, colour and temperature of extremities initially every 2 minutes. � Check infusion site frequently for signs of extravasation. If occurs stop infusion immediately, infiltrate the area with 5 - 10 mg Phentolamine diluted in 10 - 15 ml 0.9 % normal saline subcutaneously and liberally.