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Pharmacologic class: Human B-type natriuretic peptide
Therapeutic class: Vasodilator
Pregnancy risk category C
Binds to receptors on vascular smooth muscle and endothelial cells, causing smooth muscle relaxation and vasodilation. As a result, systemic and pulmonary pressures decrease and diuresis occurs.
Injection: 1.5 mg in single-use vials
Indications and dosages
➣ Acutely decompensated heart failure in patients who have dyspnea at rest or with minimal activity
Adults: 2 mcg/kg I.V. bolus, followed by continuous I.V. infusion of 0.01 mcg/kg/minute
• Hypersensitivity to drug or its components
• Systolic pressure below 90 mm Hg
• Primary therapy for cardiogenic shock
Use cautiously in:
• restrictive or obstructive cardiomyopathy, constrictive pericarditis, pericardial tamponade, renal dysfunction, hypotension
• pregnant or breastfeeding patients.
Know that nesiritide is a high-alert drug.
• For I.V. use, prime tubing before connecting to patient. Withdraw bolus and infuse over 60 seconds into I.V. port of tubing. Follow immediately with constant infusion delivering 0.01 mcg/kg/minute.
• Know that drug should be mixed and infused in dextrose 5% in water, normal saline solution, or dextrose in half-normal saline solution.
Don't mix with other drug solutions. Always administer through separate line.
• Know that nesiritide therapy beyond 48 hours has not been studied.
CNS: dizziness, headache, insomnia, anxiety
CV: hypotension, angina pectoris, bradycardia, ventricular extrasystole, ventricular tachycardia
GI: nausea, vomiting, abdominal pain
Musculoskeletal: leg cramps, back pain
Respiratory: cough, hemoptysis, apnea
Other: injection site reactions
Drug-drug. Angiotensin-converting enzyme inhibitors, nitrates: increased hypotension
Bumetanide, enalaprilat, ethacrynate sodium, furosemide, heparin, hydralazine, insulin: physical and chemical incompatibility with nesiritide
Drug-diagnostic tests. Hematocrit, hemoglobin: decreased values
• Monitor vital signs and pulmonary artery wedge pressure continuously during and for several hours after infusion.
• Assess cardiovascular status closely.
• Tell patient he'll be monitored closely during and for several hours after infusion.
• Inform patient that drug may cause serious adverse effects. Reassure him that he'll receive appropriate interventions to relieve symptoms.
• Instruct patient to report chest pain, dizziness, palpitations, and other uncomfortable symptoms.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
NatrecorA recombinant brain (B-type) natriuretic peptide given intraveinously to patients with acutely decompensated heart failure and dyspnoea at rest. Natrecor relaxes blood vessels, increases natriuresis and diuresis, and decreases neurohormones.
Hypotension, ventricular tachycardia, headache, nausea, back pain, decreased renal function. It has been linked to increased mortality or renal damage; it is to be used only on severely ill patients.