Home Drug Guide Nesiritide

Drug Guide

Generic Name

Nesiritide

Brand Names Natrecor

Classification

Therapeutic: Cardiovascular agent for acute decompensated heart failure

Pharmacological: B-type natriuretic peptide (BNP)

FDA Approved Indications

  • Acute management of decompensated heart failure with dyspnea

Mechanism of Action

Nesiritide is a recombinant form of human B-type natriuretic peptide (BNP). It binds to guanylyl cyclase receptors on vascular smooth muscle and coronary arteries, stimulating the production of cyclic GMP, leading to vasodilation, natriuresis, and diuresis, which reduces preload and afterload, alleviating symptoms of heart failure.

Dosage and Administration

Adult: Initial dose of 2 micrograms/kg IV bolus over 60 seconds, followed by a continuous infusion of 0.01 micrograms/kg/min. Adjust based on clinical response.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; consider renal function and blood pressure.

Renal Impairment: Monitor closely; dosage adjustment may be necessary.

Hepatic Impairment: Limited data, use with caution.

Pharmacokinetics

Absorption: Administered intravenously, so immediate IV absorption.

Distribution: Distributes rapidly in the plasma; volume of distribution approximately 20-30 L.

Metabolism: Cleaved by neutral endopeptidases and rapidly cleared from circulation.

Excretion: Primarily renal clearance of breakdown products.

Half Life: About 18 minutes.

Contraindications

  • Hypersensitivity to nesiritide or any component of the formulation.
  • Concurrent use of other intravenous vasodilators unless medically indicated.

Precautions

  • Use with caution in patients with systolic blood pressure <100 mm Hg; monitor blood pressure closely.
  • Monitor for hypotension, renal impairment, and arrhythmias.

Adverse Reactions - Common

  • Hypotension (Common)
  • Nausea (Less common)

Adverse Reactions - Serious

  • Significant hypotension leading to shock (Uncommon)
  • Renal impairment or failure (Uncommon)
  • Arrhythmias (Less common)

Drug-Drug Interactions

  • Other vasodilators may have additive effects

Drug-Food Interactions

  • No significant interactions known

Drug-Herb Interactions

  • Limited data

Nursing Implications

Assessment: Monitor blood pressure, renal function, and electrolytes.

Diagnoses:

  • Risk for hypotension
  • Acute pain related to dyspnea

Implementation: Administer as ordered, monitor vital signs closely, and adjust infusion rate as needed.

Evaluation: Assess for symptom improvement and adverse effects.

Patient/Family Teaching

  • Report symptoms of hypotension, dizziness, chest pain, or worsening renal function.
  • Do not discontinue medication abruptly.
  • Follow-up appointments for renal and cardiovascular assessment.

Special Considerations

Black Box Warnings:

  • Potential for hypotension leading to renal impairment or shock.

Genetic Factors: Not specifically impacted by genetic factors.

Lab Test Interference: May alter serum levels of renal function markers; interpret labs with caution.

Overdose Management

Signs/Symptoms: Hypotension, dizziness, syncope, renal impairment.

Treatment: Stop infusion, provide supportive care, and treat hypotension with fluids or vasopressors as needed.

Storage and Handling

Storage: Store vials at 2-8°C, in a refrigerator.

Stability: Stable for 24 hours at room temperature after reconstitution, but best stored refrigerated.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.