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Levophed, Norphed, Inotrop, Levofin, Mephrin, Norepin

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Injection Solution: 1 mg/mL.

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Pharmacotherapeutic: Alpha, beta agonist.

Clinical: Vasopressor

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Stimulates beta1 -adrenergic receptors, alpha-adrenergic receptors, increasing contractility, heart rate and producing vasoconstriction.

Therapeutic Effect: Increases systemic B/P, coronary blood flow.

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Severe hypotension, treatment of shock persisting after fluid volume replacement.

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Hypersensitivity to norepinephrine.

Hypotension related to hypovolemia (except in emergency to maintain coronary/cerebral perfusion until volume replaced), Mesenteric/peripheral vascular thrombosis (unless it is a lifesaving procedure).

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Norepinephrine produces less pronounced, less frequent side effects than EPINEPHrine.

Occasional (5%–3%): Anxiety, bradycardia, palpitations.

Rare (2%–1%): Nausea, anginal pain, shortness of breath, fever.

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Extravasation may produce tissue necrosis, sloughing.

Overdose manifested as severe hypertension with violent headache (may be first clinical sign of overdose), arrhythmias, photophobia, retrosternal or pharyngeal pain, pallor, diaphoresis, vomiting.

Prolonged therapy may result in plasma volume depletion. Hypotension may recur if plasma volume is not maintained.

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Monitor BP every 2– 3 min until stabilized and every 5 min thereafter. Systolic BP is usually maintained at 80– 100 mm Hg or 30– 40 mm Hg below the previously existing systolic pressure in previously hypertensive patients. Consult physician for parameters. Continue to monitor BP frequently for hypotension  following discontinuation of norepinephrine.

ECG should be monitored continuously. CVP, intraarterial pressure, pulmonary artery diastolic pressure, pulmonary capillary wedge pressure (PCWP), and cardiac output may also be monitored.

Monitor urine output and notify health care professional if it decreases to 30 mL/hr.

Assess IV site frequently throughout infusion. A large vein should be used to minimize risk of extravasation, which may cause tissue necrosis. If prolonged therapy is required or if blanching along the course of the vein occurs, change injection sites to provide relief from vasoconstriction.

Toxicity and Overdose: If overdose occurs, discontinue norepinephrine and administer fluid and electrolyte replacement therapy. An alpha-adrenergic blocking agent may be administered intravenously to treat hypertension.

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Minitran, Nitro-Bid, Nitro-Dur, Nitrolingual, NitroMist, Nitrostat, Nitro-Time, Rectiv, Trinipatch

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Infusion, Pre-Mix: 25 mg/250 mL, 50 mg/500 mL, 50 mg/250 mL, 100 mg/250mL.

Injection, Solution: 5 mg/mL.

Ointment (Nitro-Bid): 2%.

Translingual Spray: 0.4 mg/spray.

Transdermal Patch: 0.1 mg/hr, 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr.

Capsules, Extended-Release: 2.5 mg, 6.5 mg, 9 mg.

Tablets, Sublingual: 0.4 mg.

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Pharmacotherapeutic: Nitrate.

Clinical: Antianginal, antihypertensive, coronary vasodilator.

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Dilates coronary arteries, improves collateral blood flow to ischemic areas within the myocardium. IV form produces peripheral vasodilation.

Therapeutic Effect: Decreases myocardial oxygen demand. Reduces left ventricular preload, afterload. Relief or prevention of anginal attacks. Increased cardiac output. Reduction of BP.

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Treatment/prevention of angina pectoris.

Extended-release, topical forms used for prophylaxis, long-term angina management.

IV form used in the treatment of HF, acute MI, perioperative hypertension, induction of intraoperative hypotension.

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Hypersensitivity to nitroglycerin

Allergy to adhesives (transdermal)

Increased ICP

Severe anemia

Concurrent use of sildenafil, tadalafil, vardenafil (PDE5 inhibitors).

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Frequent: Headache (possibly severe; occurs mostly in early therapy, diminishes rapidly in intensity, usually disappears during continued treatment), transient flushing of face/neck, dizziness (esp. if pt is standing immobile or is in a warm environment), weakness, orthostatic hypotension.

Sublingual: Burning, tingling sensation at the oral point of dissolution.

Ointment: Erythema, pruritus.

Occasional: GI upset.

Transdermal: Contact dermatitis.

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Discontinue drug if blurred vision, dry mouth occurs.

Severe orthostatic hypotension may occur, manifested by syncope, pulselessness, cold/clammy skin, diaphoresis.

Tolerance may occur with repeated, prolonged therapy; minor tolerance may occur with intermittent use of sublingual tablets.

High doses tend to produce severe headaches.

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Smiling nurse and happy elderly lady, horizontal

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Record onset, type (sharp, dull, squeezing), radiation, location, intensity, duration of anginal pain; precipitating factors (exertion, emotional stress).

Assess B/P, apical pulse before administration, and periodically the following dose.

Pt must have continuous EKG monitoring for IV administration. Rule out right-sided MI, if applicable (may precipitate life-threatening hypotension).

Receive full medication history, and screen for interactions, esp. use of PDE5 inhibitors.

Question medical history and screen for contraindications.

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Monitor B/P, heart rate. Assess for facial, neck flushing.

Cardioverter/defibrillator must not be discharged through paddle electrode overlying nitroglycerin (transdermal, ointment) system (may cause burns to pt or damage to paddle via electrical arcing).

Consider NS boluses for hypotension.

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Nursing Responsibilities: PATIENT & FAMILY TEACHING

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Nursing Responsibilities: PATIENT & FAMILY TEACHING

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Go from lying to standing slowly.

Take oral form on empty stomach (however, if headache occurs during therapy, take the medication with meals).

Use spray only when lying down.

Dissolve sublingual tablet under the tongue; do not swallow.

Take at the first sign of angina.

May take an additional dose every 5min if needed up to a total of 3 doses. If not relieved within 5 min, contact the physician or immediately go to the emergencyroom.

Do not change brands.

Keep the container away from heat, moisture.

Do not inhale lingual aerosol but spray onto or under the tongue (avoid swallowing after the spray is administered).

Expel from mouth any remaining lingual, sublingual, intrabuccal tablet after the pain is completely relieved.

Place transmucosal tablets under the upper lip or buccal pouch (between cheek and gum); do not chew/swallow tablet.

Avoid alcohol (intensifies hypotensive effect). If alcohol is ingested soon after taking nitroglycerin, a possible acute hypotensive episode (marked drop in B/P, vertigo, diaphoresis, pallor) may occur.

Do not use within 48 hrs of sildenafil, tadalafil, vardenafil (PDE5 inhibitors); may cause an acute hypotensive episode.

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Kizior, R., & Hodgson, K. (2018). Saunders Nursing Drug Handbook 2019 (1st ed.). Saunders.

Vallerand, A., & Sanoski, C. (2020). Davis’s Drug Guide for Nurses (Seventeenth ed.). F.A. Davis Company.

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As an Angelenean who lives by the core values of pagiging mabuti, magaling at may malasakit sa kapwa, I hereby commit that I complete my academic work with integrity. This means that I shall accomplish my academic work without receiving or giving unauthorized assistance. My work also observes scholarly and intellectual standards, rules on proper citation of sources, and appropriate collection and use of data.