TY  - CHAP
M1  - Book, Section
TI  - NOREPINEPHRINE
A1  - Minns, Alicia B.
A2  - Olson, Kent R.
A2  - Anderson, Ilene B.
A2  - Benowitz, Neal L.
A2  - Blanc, Paul D.
A2  - Clark, Richard F.
A2  - Kearney, Thomas E.
A2  - Kim-Katz, Susan Y.
A2  - Wu, Alan H. B.
PY  - 2018
T2  - Poisoning & Drug Overdose, 7e
AB  - Pharmacology.  Norepinephrine,  an  endogenous  catecholamine,  is  a  potent  alpha1-adrenergic  receptor  agonist  with  some  beta1-adrenergic  receptor  activity.  It  is  used  primarily  as  a  vasopressor  to  increase  systemic  vascular  resistance  and  venous  return  to  the  heart.  It  also  may  increase  heart  rate  and  cardiac  contractility  because  of  its  beta1  effects.  Norepinephrine  is  not  effective  orally  and  is  absorbed  erratically  after  subcutaneous  injection.  After  intravenous  administration,  the  onset  of  action  is  nearly  immediate,  and  the  duration  of  effect  is  1–2  minutes  after  the  infusion  is  discontinued.Indications.  Norepinephrine  is  used  to  increase  blood  pressure  and  cardiac  output  in  patients  with  shock  caused  by  venodilation,  low  systemic  vascular  resistance,  or  both.  Hypovolemia,  depressed  myocardial  contractility,  hypothermia,  and  electrolyte  imbalance  should  be  corrected  first  or  concurrently.ContraindicationsUncorrected  hypovolemia.Norepinephrine  is  relatively  contraindicated  in  patients  who  have  mesenteric  or  peripheral  arterial  occlusive  vascular  disease  with  thrombosis,  or  ergot  poisoning.Use  with  caution  in  patients  intoxicated  with  chloral  hydrate  or  halogenated  or  aromatic  hydrocarbon  solvents  or  anesthetics.Adverse  effectsSevere  hypertension,  which  may  result  in  intracranial  hemorrhage,  pulmonary  edema,  or  myocardial  necrosis.Reflex  bradycardia.Ventricular  dysrhythmias.Aggravation  of  tissue  ischemia,  resulting  in  gangrene.Tissue  necrosis  after  extravasation.Anxiety,  restlessness,  tremor,  and  headache.Anaphylaxis  induced  by  sulfite  preservatives  in  sensitive  patients.  Use  with  extreme  caution  in  patients  with  known  hypersensitivity  to  sulfite  preservatives.Increased  cardiac  irritability  due  to  myocardial  sensitization  of  catecholamines  in  the  setting  of  exposures  to  halogenated  hydrocarbons,  such  as  certain  anesthetics,  solvents,  and  medications.Use  in  pregnancy.  FDA  category  C.  This  drug  crosses  the  placenta;  it  can  cause  placental  ischemia  and  reduce  uterine  contractions.Drug  or  laboratory  interactionsEnhanced  vasopressor  response  may  occur  in  the  presence  of  cocaine  and  cyclic  antidepressants  (owing  to  inhibition  of  neuronal  reuptake)  or  with  other  vasoactive  drugs  (eg,  dihydroergotamine).Enhanced  vasopressor  response  may  occur  in  patients  taking  monoamine  oxidase  inhibitors  or  COMT  inhibitors  owing  to  inhibition  of  neuronal  metabolic  degradation.Alpha-  and  beta-blocking  agents  may  antagonize  the  adrenergic  effects  of  norepinephrine.Anticholinergic  drugs  may  block  reflex  bradycardia,  which  normally  occurs  in  response  to  norepinephrine-induced  hypertension,  enhancing  the  hypertensive  response.Chloral  hydrate  overdose,  cyclopropane,  and  halogenated  or  aromatic  hydrocarbon  solvents  and  anesthetics  may  enhance  myocardial  sensitivity  to  the  arrhythmogenic  effects  of  norepinephrine.Dosage  and  method  of  administrationBlack  box  warning:  Avoid  extravasation.  The  intravenous  infusion  must  be  free-flowing,  and  the  infused  vein  should  be  observed  frequently  for  signs  of  infiltration  (pallor,  coldness,  or  induration).If  extravasation  occurs,  immediately  infiltrate  the  affected  area  with  phentolamine,  5–10  mg  in  10–15  mL  of  normal  saline  (children:  0.1-  0.2  mg/kg;  maximum,  10  mg),  via  a  fine  (25-27-gauge)  hypodermic  needle;  improvement  is  evidenced  by  hyperemia  and  return  to  normal  temperature.Alternatively,  nitroglycerin  topical  2%  ointment  can  be  applied  to  the  affected  area.  Infiltration  of  terbutaline  has  been  reportedly  successful;  1  mg  diluted  in  10  mL  of  normal  saline  for  a  large  extravasation  site  or  1  mg  diluted  in  1-mL  normal  saline  for  a  small  site.Intravenous  infusion.  Initial  dose  8–12  mcg/min  with  a  usual  maintenance  range  of  2–4  mcg/min;  dose  range  varies  depending  on  clinical  situation  (children:  1–2  mcg/min  or  0.05-0.1  mcg/kg/min)  and  increases  as  needed  every  5–10  minutes.Formulations.  Norepinephrine  bitartrate  is  oxidized  rapidly  on  exposure  to  air;  it  must  be  kept  in  ...
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/24
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1179993021
ER  -