noradrenaline


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norepinephrine

 [nor″ep-ĭ-nef´rin]
a catecholamine that is the neurotransmitter of most sympathetic postganglionic neurons and also of certain tracts in the central nervous system. It is also a neurohormone stored in the chromaffin granules of the adrenal medulla and released in response to sympathetic stimulation, primarily in response to hypotension. It produces vasoconstriction, an increase in heart rate, and elevation of blood pressure. It is administered intravenously in the form of the bitartrate salt as a vasopressor to restore blood pressure in certain cases of acute hypotension and to improve cardiac function during decompensation associated with congestive heart failure or cardiovascular surgery. Called also noradrenaline.

norepinephrine bitartrate

Levophed, Noradrenaline (UK)

Pharmacologic class: Sympathomimetic

Therapeutic class: Alpha- and beta-adrenergic agonist, cardiac stimulant, vasopressor

Pregnancy risk category C

FDA Box Warning

If extravasation occurs, infiltrate area promptly with 10 to 15 ml of saline solution containing 5 to 10 mg phentolamine to prevent sloughing and necrosis. Use syringe with fine hypodermic needle, and infiltrate solution liberally throughout area. Give phentolamine as soon as possible; its sympathetic blockade causes immediate local hyperemic changes if area is infiltrated within 12 hours.

Action

Stimulates beta1 and alpha1 receptors in sympathetic nervous system, causing vasoconstriction, increased blood pressure, enhanced contractility, and decreased heart rate

Availability

Injection: 1 mg/ml

Indications and dosages

Severe hypotension

Adults: 8 to 12 mcg/minute I.V.; then titrate based on blood pressure response. For maintenance, 2 to 4 mcg/minute.

Contraindications

• Concurrent cyclopropane or halo-thane anesthesia

• Hypotension caused by blood volume deficit (except in emergencies until blood volume replacement is completed), profound hypoxia or hypercarbia

• Mesenteric or peripheral vascular thrombosis

Precautions

Use cautiously in:

• sulfite sensitivity (some products), especially in asthmatic patients

• arterial embolism, cardiac disease, peripheral vascular disease, hypertension, hyperthyroidism

• patients receiving MAO inhibitors or tricyclic antidepressants concurrently

• elderly patients

• pregnant or breastfeeding patients

• children (safety and efficacy not established).

Administration

• Mix with dextrose 5% in water or dextrose 5% in normal saline solution.

• Inspect solution to make sure it's clear and colorless. Don't infuse if it's brown or pink.

• Administer through infusion pump. Titrate infusion rate to achieve and maintain low-normal systolic blood pressure (80 to 100 mm Hg).

• Continue infusion until adequate blood pressure and tissue perfusion persist without drug therapy.

• Gradually titrate dosage downward.

• To avoid extravasation, administer only into large vein (antecubital) or through central line. Don't use femoral vein in patients who are elderly or have occlusive vascular disorders.

To prevent delivery of large drug concentrations, avoid line stasis and flushing.

Adverse reactions

CNS: headache, anxiety

CV: bradycardia, severe hypertension, arrhythmias

Respiratory: respiratory difficulty

Skin: irritation with extravasation, necrosis

Other: ischemic injury

Interactions

Drug-drug. Alpha-adrenergic blockers: antagonism of norepinephrine effects Antihistamines, ergot alkaloids, guanethidine, MAO inhibitors, oxytocin, tricyclic antidepressants: severe hypertension Bretylium, inhalation anesthetics: increased risk of arrhythmias

Patient monitoring

Check blood pressure every 2 minutes until desired pressure is achieved. Recheck every 5 minutes for duration of infusion.

• Maintain continuous ECG monitoring and blood pressure monitoring.

Be aware that headache may signal extreme hypertension and overdose.

• Monitor infusion site for extravasation.

Watch for signs and symptoms of peripheral vascular insufficiency (decreased capillary refill, pale to cyanotic to black skin color).

Never leave patient unattended during infusion.

Patient teaching

• When patient is alert, explain why he's receiving drug.

• Reassure patient he'll be monitored continuously until he's stable.

nor·ep·i·neph·rine (NE),

(nōr'ep-i-nef'rin),
A catecholamine hormone the natural form of which is d, although the l form has some activity; the base is considered to be the postganglionic adrenergic mediator, acting on α and β receptors; it is stored in chromaffin granules in the adrenal medulla in much smaller amounts than epinephrine and secreted in response to hypotension and physical stress; in contrast to epinephrine it has little effect on bronchial smooth muscle, metabolic processes, and cardiac output, but has strong vasoconstrictive effects and is used pharmacologically as a vasopressor, primarily as the bitartrate salt.

noradrenaline

/nor·adren·a·line/ (nor″ah-dren´ah-lin) norepinephrine.

noradrenaline

(nôr′ə-drĕn′ə-lĭn)

noradrenaline

Norepinephrine, see there.

nor·ep·i·neph·rine

(nōr'ep-i-nef'rin)
A catecholamine hormone, acting on α- and β-receptors; it is stored in chromaffin granules in the medulla of suprarenal gland in much smaller amounts than epinephrine and secreted in response to hypotension and physical stress; used pharmacologically as a vasopressor.
Synonym(s): noradrenaline.

noradrenaline

Norepinephrine, an important adrenergic NEUROTRANSMITTER released by POSTGANGLIONIC adrenergic nerve endings and secreted by the MEDULLA of the adrenal gland. Noradrenaline acts chiefly on alpha-adrenergic receptors and causes constriction of arteries and a rise in the blood pressure. This is a SYMPATHOMIMETIC action. One of the catecholamines. A brand name is Levophed.

noradrenaline

a transmitter substance produced at the nerve endings of ADRENERGIC nerves giving effects very similar to those of ADRENALINE and having a closely related structure. After transmission it is inactivated by monoaminoxidase in order to prevent a build-up. The action of noradrenaline can be inhibited by various drugs, such as mescaline, which produce hallucinatory effects.

norepinephrine

; noradrenaline postganglionic neurotransmitter (catecholamine hormone); has similar excitatory action to adrenaline but little/no inhibitory action (see Table 1)
Table 1: Effects of stimulation of alpha, beta and dopamine receptors
ReceptorActionStimulating drug
Alpha-1 (a1); postsynapticVasoconstriction; positive inotropism; antidiuresisAdrenaline +
Noradrenaline +++
Alpha-2 (a2); presynapticVasodilatation; inhibition of noradrenaline releaseAdrenaline +
Noradrenaline +++
Dopamine +
Alpha-2 (a2); postsynapticConstriction of coronary arteries; promotion of salt and water excretionAdrenaline +
Noradrenaline +++
Dopamine +
Beta-1 (ß1); postsynapticPositive inotropism; chronotropism; renin releaseAdrenaline ++
Noradrenaline ++
Isoprenaline ++
Dopamine +
Beta-2 (ß2); presynapticNoradrenaline release accelerated; positive inotropism; chronotropismAdrenaline +
Isoprenaline +++
Beta-2 (ß2); postsynapticVasodilatation; relaxation of bronchial smooth muscleAdrenaline +
Isoprenaline +++
Dopamine1; postsynapticVasodilatation; diuresisDopamine ++
Dopamine1; presynapticInhibits noradrenaline releaseDopamine +

Plus signs indicate degree of effect.

noradrenaline (nōrˈ··drenˑ··lin),

noradrenaline (norepinephrine)

A neurohumoral transmitter for most postganglionic sympathetic fibres. It is produced with adrenaline (epinephrine) in the adrenal medulla. It is a powerful excitator of α-adrenergic receptors. See adrenaline (epinephrine); adrenergic receptors; mydriatic; neurotransmitter.

noradrenaline

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Although a direct comparison of adrenaline and noradrenaline concentrations was not possible, the levels 'broadly agreed with previous studies'.
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That's because your brain releases the chemical noradrenaline when you're standing, but not when lying down.

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