ALL INDIA INSTITUTE OF MEDICAL SCIENCES
JODHPUR
COLLEGE OF NURSING
DRUG PRESENTATION ON:
NORADRENALINE/NOREPINEPHRINE
Subject: MEDICAL SURGICAL NURSING
Submitted to: Submitted by:
Mrs. Priya Prakash chand meena
Nursing tutor MSc Nursing 1st year
College of Nursing College of Nursing
AIIMS, Jodhpur AIIMS, Jodhpur
Date of submission: 05/12/2020
1
NORADRENALINE/NOREPINEPHRINE
Norepinephrine is a sympathomimetic used in the control of blood pressure during various
hypotensive states and as an adjunct treatment during cardiac arrest.
• Norepinephrine is a adrenergic agonist, used as a presser agent to treat life threatening low
blood pressure.
• . Classification:
• Autonomic nervous system agent
• alpha and beta-adrenergic agonist
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Trade name - Norad
Generic name - NOREPINEPHRINE
Pharmacological name – Norepinephrine Bitartrate
Pregnancy Category – D
Prototype – Epinephrine
Availability - 1 mg/ml inj.
Molecular formula- C8H11NO3
Molecular weight- Average: 169.1778
Monoisotopic: 169.073893223 Structure-
Composition-
Noradrenaline (Norepinephrine) 1 mg/ml Concentrate for Solution for Infusion
Each 50 mL vial contains 8 mg noradrenaline tartrate, equivalent to 4 mg
noradrenaline base.
Actions-
Direct-acting sympathomimetic amine identical to body catecholamine
norepinephrine. Acts directly and predominantly on alpha-adrenergic receptors; little
action on beta receptors except in heart (beta 1 receptors). Vasoconstriction and cardiac
stimulation; also powerful constrictor action on resistance and capacitance blood
vessels..
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Therapeutic Effects
Norepinephrine, also known as noradrenaline, is both a neurotransmitter and a
hormone. It plays an important role in your body's “fight-or-flight” response. As a
medication, norepinephrine is used to increase and maintain blood pressure in limited,
short-term serious health situations.
Peripheral vasoconstriction and moderate inotropic stimulation of heart result in
increased systolic and diastolic blood pressure, myocardial oxygenation, coronary
artery blood flow, and work of heart. Cardiac output varies with systemic BP.
Indications
Hypotension
Sympathectomy
Pheochromocytomectomy
Spinal anesthesia
Poliomyelelitis
MI,Septicemia, Bloodtransfusion
Contraindications
Hypovolemic
Thrombosis
Cyclopropane, halothane
Pregnancy ( category D )
Lactation
Cautious Use
. Hypotension
Severe heart disease
Older adult patients
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pt recieving tricyclic antidepressant
ADVERSE EFFECTS
Body as a whole – restlessness,anxiety,tremors,weakness,renal
necrosis,hemorrhage,profuse sweating
Cardiovascular – palpitation, reflex bradycardia,severe HTN
GI - vomiting
Metabolic - hyperglycemia
CNS – headache, cerebral hemorrhage, convulsions
Respiratory – respiratory difficulty
Skin- tissue necrosis; special senses- blurred vision
Route & Dosage
IV infusion - dilute 4 ml amp. In NS
Don’t use solution if discoloration or precipitate is present
Protect from light
Interactions
Drug: ALPHA AND BETA BLOCKERS antagonize pressor effects; ERGOT ALKALOIDS,
furazolidone, guanethidine, methyldopa, TRICYCLIC ANTIDEPRESSANTS may potentiate
pressor effects;
halothane, cyclopropane increase risk of arrhythmias.
Pharmacokinetics
Onset: Very rapid.
Duration: 1–2 min after termination of infusion.
Distribution: Localizes in sympathetic nerve endings; crosses placenta.
Metabolism: Metabolized in liver and other tissues by catecholamine o-methyl transferase and
monoamine oxidase.
Elimination: Excreted in urine.
Nursing Implications
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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.
Adjust flow rate to maintain BP at low normal (usually 80–100 mm Hg systolic) in
normotensive patients. In previously hypertensive patients, systolic is generally
maintained no higher than 40 mm Hg below preexisting systolic level.
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.
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.
Be alert to patient's 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.
Continue to monitor vital signs and observe patient closely after cessation of therapy
for clinical sign of circulatory inadequacy.
2. Patient & Family Edycation
Monitor s/s
Pregnancy
Lactation
REFERRENCES
Tripathi KD, Essentials of Medical Pharmacology, 7th edition, Jaypee brothers medical
publication, Page no. 128-130.
Shanbag T.V., textbook of Pharmacology for nurses, 2 nd edition, Elsevier Publication,
Page no. 78-84.
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