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Norepinephrine, also known as noradrenaline and sold under the brand name Levophed among others, is a medication used to treat people with very low blood pressure. [2] It is the typical medication used in sepsis if low blood pressure does not improve following intravenous fluids . [ 3 ]
Drug titration is the process of adjusting the dose of a medication for the maximum benefit without adverse effects. [ 1 ] When a drug has a narrow therapeutic index , titration is especially important, because the range between the dose at which a drug is effective and the dose at which side effects occur is small. [ 2 ]
In pharmacokinetics, the rate of infusion (or dosing rate) refers not just to the rate at which a drug is administered, but the desired rate at which a drug should be administered to achieve a steady state of a fixed dose which has been demonstrated to be therapeutically effective. Abbreviations include K in, [1] K 0, [2] or R 0.
The Surviving Sepsis Campaign guidelines recommend the very early management of the sepsis focusing on the hour-1 bundle. This includes use of Vasopressin 0.03 units/minute as add-on to norepinephrine (NE) with intent of either raising the mean arterial pressure or decreasing the norepinephrine dosage (i.e. de-catecholaminization). [13]
Norepinephrine is a catecholamine and a phenethylamine. [4] Its structure differs from that of epinephrine only in that epinephrine has a methyl group attached to its nitrogen, whereas the methyl group is replaced by a hydrogen atom in norepinephrine. [4]
Many charts derive their data from studies conducted on opioid-naive patients. Patients with chronic (rather than acute) pain may respond to analgesia differently. Repeated administration of a medication is also different from single dosing, as many drugs have active metabolites that can build up in the body. [ 6 ]
The pharmacology of antidepressants is not entirely clear.. The earliest and probably most widely accepted scientific theory of antidepressant action is the monoamine hypothesis (which can be traced back to the 1950s), which states that depression is due to an imbalance (most often a deficiency) of the monoamine neurotransmitters (namely serotonin, norepinephrine and dopamine). [1]
Banana bags (more narrowly, thiamine) are under-used when alcoholics present to the hospital with illnesses other than alcohol withdrawal, especially for critical illnesses such as sepsis, traumatic brain injury, and diabetic ketoacidosis. [6] Using thiamine on septic alcoholics seems to reduce the rate of death. [7]