nesiritide


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nesiritide

Natrecor

Pharmacologic class: Human B-type natriuretic peptide

Therapeutic class: Vasodilator

Pregnancy risk category C

Action

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.

Availability

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

Contraindications

• Hypersensitivity to drug or its components

• Systolic pressure below 90 mm Hg

• Primary therapy for cardiogenic shock

Precautions

Use cautiously in:

• restrictive or obstructive cardiomyopathy, constrictive pericarditis, pericardial tamponade, renal dysfunction, hypotension

• pregnant or breastfeeding patients.

Administration

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.

Adverse reactions

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

Interactions

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

Patient monitoring

• Monitor vital signs and pulmonary artery wedge pressure continuously during and for several hours after infusion.

• Assess cardiovascular status closely.

Patient teaching

• 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.

Natrecor

A 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. 

Adverse effects
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.

nesiritide

A commercial form of recombinant human natriuretic peptide that has been promoted in the USA. It was approved by the FDA for the treatment of acute, decompensated congestive heart failure. There were reports in mid-2005 of adverse effects on survival and kidney function.
References in periodicals archive ?
Nesiritide Peptide was also tried in congestive heart failure but it did not show any mortality benefits.
Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial.
Nesiritide in congestive heart failure associated with acute coronary syndromes: a pilot study of safety and efficacy.
Acute study of clinical effectiveness of nesiritide in decompensated heart failure: nesiritide redux.
In a study of nesiritide, another B-type natriuretic peptide, approximately 80% of the participants had LV dysfunction and many showed dose-dependent decreases in BP, with no confirmed improvements in prognostic predictors [5].
It includes milrinone, tolvaptan, nesiritide, levosimendan, tezosentan, low-dose dopamine, and ultrafiltration.
Shimada et al., "Long-term outcome of patients treated with prophylactic nesiritide for the prevention of acute kidney injury following cardiovascular surgery," Clinical Cardiology, vol.
Estas sugerencias se fortalecieron con la publicacion del discutido estudio CARRESS HF, (47) en donde se aleatorizaron 188 pacientes con sindrome cardio renal I a recibir dosis de diureticos escalonada, si habia necesidad de dobutamina, nitroglicerina, nesiritide o soporte ventricular asistido se podia utilizar en este grupo, comparado contra unicamente UF programado a 200ml/hr.
For these two patients, inotropic agents, nesiritide, diuretics, beta blockers, and vasodilators were used in combination.
(13.) Mentzer RM, Oz MC, Sladen RN, Graeve AH, Hebeler RF, Luber JM, et al; NAPA Investigators: Effects of perioperative nesiritide in patients with left ventricular dysfunction undergoing cardiac surgery: The NAPA Trial.