nesiritide

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.