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Key Points

  • Mechanism
    • Catecholamine
    • Vasoconstrictor
      • Acts on alpha-adrenergic receptors to cause peripheral vasoconstriction
      • Vasoconstriction increases vascular resistance and increases blood pressure (mean arterial pressure)
    • Mild increase in cardiac output
      • Acts on beta-adrenergic receptors to increase heart rate and contractility
    • Clinical Use
      • Hypotension (severe)
        • Shock
          • If patient is hypovolemic, fluids and/or blood must be administered prior to norepinephrine
      • Heart failure
    • Side Effects and Adverse Reactions
      • Tissue necrosis at IV site
        • Extravasation of drug around injection site causes vasoconstriction, leading to decreased perfusion
        • Can lead to local skin death around IV site
          • Monitor IV site closely
          • Infuse through a central line when possible.
          • Phentolamine can be used to reduce tissue damage if extravasation occurs
      • Myocardial ischemia
        • May result from vasoconstriction at coronary arteries
      • May cause reflex bradycardia
        • Sudden increases in blood pressure by way of vasoconstriction can lead to baroreceptor-mediated slowing of the heart
      • Dysrhythmias