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1 2 Dithia 5 8 11 14 17 20 23 26 29 32 35 38 41 44 47 50 Hexadecaazacyclotripentacontane Cyclic Peptide Derivative


Presentation

  • Nesiritide should be considered for patients presenting with acutely typical or useful decompensated heart failure, especially those with dyspnea at rest or with minimal activity.[ncbi.nlm.nih.gov]
  • MHS, Associate Professor, Duke Clinical Research Institute, presented the results during a late-breaking clinical trial presentation during the Scientific Sessions of the American Heart Association.[cardiobrief.org]
  • Presented by Dr. Adrian Hernandez at the American Heart Association Scientific Sessions, Chicago, IL, November 14, 2010.[acc.org]
  • Medical experts say the results, presented Sunday at the American Heart Association meeting, show there is a lesson to be learned about the effectiveness of small studies over all.[nytimes.com]
Pain
  • Adverse effects Hypotension, ventricular tachycardia, headache, nausea, back pain, decreased renal function.[medical-dictionary.thefreedictionary.com]
  • […] abdominal pain catheter-related pain headache nausea does not interact with enalapril interactions with IV vasodilators (including IV ACE inhibitors) and other cardiovascular drugs have not been formally studied bolus of 2 mcg/kg followed by infusion[aic.cuhk.edu.hk]
  • Body as a Whole: Headache, back pain, catheter pain, fever, injection site pain, leg cramps. CNS: Insomnia, dizziness, anxiety, confusion, paresthesia, somnolence, tremor.[robholland.com]
  • (abnormally slow heart rate) Headache Abdominal pain Back pain Insomnia Dizziness Anxiety Nausea Vomiting Mechanism of Action Human BNP binds to the particulate guanylate cyclase receptor of vascular smooth muscle and endothelial cells, leading to increased[centerwatch.com]
  • • Body as a Whole : Headache, abdominal pain and back pain. • Heart : Low blood pressure, fast/slow heart rate and chest pain. • Central Nervous System : Sleeplessness, dizziness, drowsiness and anxiety. • Gastrointestinal : Nausea and vomiting.[medindia.net]
Intravenous Administration
  • As a peptide, nesiritide has poor bioavailability and therefore is only available for intravenous administration. With a short half-life of less than 20 minutes, it is administered as a continuous infusion following a bolus injection.[cvpharmacology.com]
  • A meta-analysis of five randomized studies with 1269 ADHF patients has demonstrated that intravenous administration of nesiritide significantly increase the risk of WRF and may cause renal toxicity [ 6 ].[journals.plos.org]
Intravenous Drugs
  • Here is the AHA press rel ease: Large study of patients with severe heart failure confirms nesiritide safe, but shows no significant benefit on symptoms or mortality In a large clinical trial of the intravenous drug nesiritide in severe heart failure,[cardiobrief.org]
Dyspnea at Rest
  • It is effective in managing dyspnea at rest in patients with acute congestive heart failure (CHF). Acute treatment of decompensated CHF in patients who have dyspnea at rest or with minimal activity.[robholland.com]
  • […] at rest or with minimal activity.[cms.gov]
  • CHF and arrhythmias: Indications for NATRECOR: Acutely decompensated CHF with dyspnea at rest or with minimal activity. Adult: 2mcg/kg IV bolus once, then 0.01mcg/kg per minute by continuous IV infusion; limited experience with therapy 96 hours.[empr.com]
  • Nesiritide should be considered for patients presenting with acutely typical or useful decompensated heart failure, especially those with dyspnea at rest or with minimal activity.[ncbi.nlm.nih.gov]
  • 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[medical-dictionary.thefreedictionary.com]
Rales
  • Included: Hospitalized for HF (regardless of EF) Within 24h of initiation of in-hospital IV treatment of HF Dyspnea at rest or with minimal activity (ie leading to NYHA functional class 3-4) Plus at least 1 of: RR 20 , pulmonary congestion/edema with rales[nerdcat.org]
  • Study Design Blinded Parallel Placebo Controlled Randomized Patient Populations: Hospitalization for ADHF Dyspnea at rest or with minimal activity Presence of one clinical sign: respiratory rate 20 breaths/minute or rales 1/3 base Presence of one objective[acc.org]
  • […] discharge (up to Day 30) ] Clinical manifestations of worsening or persistent decompensated heart failure were defined by at least one of the following: new, persistent or worsening: dyspnea, orthopnea, paroxysmal nocturnal dyspnea, edema, pulmonary basilar rales[clinicaltrials.gov]
  • More recently, the mineralocorticoid-receptor antagonist (MRA) spironolactone, yielded clear-cut survival benefits, which were additional to those of ACEI, in patients with advanced disease (class III or IV systolic HF) (RALES trial) 11.[cardio-debate.com]
  • A 63-year-old male with NYHA III ischaemic cardiomyopathy presented with rales and hepatomegaly, and serum creatinine of 11.1 mg/dl. He was treated with nesiritide, ASA, carvedilol, hydralazine, isordil, digoxin and enalapril.[ndt.oxfordjournals.org]
Cough
  • […] aldosterone secretion Diuresis results, which decreases preload, or the left ventricular end-volume, and the work of the heart Examples: lisinopril, enalapril, fosinopril, quinapril, captopril, ramipril, trandolapril, and perindopril Side effects: dry, hacky cough[quizlet.com]
  • 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[medical-dictionary.thefreedictionary.com]
  • Respiratory: Cough, hemoptysis, apnea. Skin: Sweating, pruritus, rash. Special Senses: Amblyopia. Renal: Renal failure in acutely decompensated heart failure patients. Drug: No interaction trials conducted.[robholland.com]
  • Side effects of the sacubitril-valsartan combination include hypotension, hyperkalemia, angioedema, cough, and renal failure, largely due to the valsartan. Furthermore, the presence of valsartan makes this combination unsuitable in pregnancy.[cvpharmacology.com]
  • Tell your doctor about the allergy and what signs you had, like rash; hives ; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs. If you have low blood pressure . If you have heart problems.[drugs.com]
Hemoptysis
  • 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[medical-dictionary.thefreedictionary.com]
  • Respiratory: Cough, hemoptysis, apnea. Skin: Sweating, pruritus, rash. Special Senses: Amblyopia. Renal: Renal failure in acutely decompensated heart failure patients. Drug: No interaction trials conducted.[robholland.com]
Orthopnea
  • All-Cause Mortality [ Time Frame: Randomization to hospital discharge (up to Day 30) ] Clinical manifestations of worsening or persistent decompensated heart failure were defined by at least one of the following: new, persistent or worsening: dyspnea, orthopnea[clinicaltrials.gov]
Abdominal Pain
  • pain catheter-related pain headache nausea does not interact with enalapril interactions with IV vasodilators (including IV ACE inhibitors) and other cardiovascular drugs have not been formally studied bolus of 2 mcg/kg followed by infusion of 0.01 mcg[aic.cuhk.edu.hk]
  • 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[medical-dictionary.thefreedictionary.com]
  • • Body as a Whole : Headache, abdominal pain and back pain. • Heart : Low blood pressure, fast/slow heart rate and chest pain. • Central Nervous System : Sleeplessness, dizziness, drowsiness and anxiety. • Gastrointestinal : Nausea and vomiting.[medindia.net]
  • pain Back pain Insomnia Dizziness Anxiety Nausea Vomiting Mechanism of Action Human BNP binds to the particulate guanylate cyclase receptor of vascular smooth muscle and endothelial cells, leading to increased intracellular concentrations of guanosine[centerwatch.com]
  • GI: Abdominal pain, nausea, vomiting. Respiratory: Cough, hemoptysis, apnea. Skin: Sweating, pruritus, rash. Special Senses: Amblyopia. Renal: Renal failure in acutely decompensated heart failure patients. Drug: No interaction trials conducted.[robholland.com]
Vomiting
  • […] digoxin (Lanoxin) (cont'd) Cardiovascular Dysrhythmias, including bradycardia or tachycardia CNS Headaches, fatigue, malaise, confusion, convulsions Eye Colored vision (seeing green, yellow, purple), halo vision, flickering lights GI Anorexia, nausea, vomiting[quizlet.com]
  • 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[medical-dictionary.thefreedictionary.com]
  • […] include (but are not limited to) the following: Hypotension Ventricular tachycardia (abnormally fast heart rate) Angina pectoris (chest pain) Bradycardia (abnormally slow heart rate) Headache Abdominal pain Back pain Insomnia Dizziness Anxiety Nausea Vomiting[centerwatch.com]
  • GI: Abdominal pain, nausea, vomiting. Respiratory: Cough, hemoptysis, apnea. Skin: Sweating, pruritus, rash. Special Senses: Amblyopia. Renal: Renal failure in acutely decompensated heart failure patients. Drug: No interaction trials conducted.[robholland.com]
Hypotension
  • Notify physician immediately if systolic BP Establish hypotension parameters prior to initiating therapy. Reduce the dose or withhold the drug if hypotension occurs during administration.[robholland.com]
  • Adverse effects Hypotension, ventricular tachycardia, headache, nausea, back pain, decreased renal function.[medical-dictionary.thefreedictionary.com]
  • […] usually resolves spontaneously or responds to fluid challenge of 250 ml or less duration of episode longer than hypotensive episodes associated with glyceryl trinitrate not proarrhythmic Non-cardiovascular Less common than with glyceryl trinitrate general[aic.cuhk.edu.hk]
  • Rates of hypotension were similar between these 2 groups.[nerdcat.org]
  • Interactions: Hypotension potentiated by ARBs and/or ACE inhibitors. Adverse Reactions: Hypotension, headache, nausea, back pain, dizziness; hypersensitivity. How Supplied: Single-use vials—1[empr.com]
Tachycardia
  • Adverse effects Hypotension, ventricular tachycardia, headache, nausea, back pain, decreased renal function.[medical-dictionary.thefreedictionary.com]
  • CV: Hypotension, ventricular tachycardia, ventricular extrasystoles, angina, bradycardia, tachycardia, atrial fibrillation, AV node conduction abnormalities. GI: Abdominal pain, nausea, vomiting. Respiratory: Cough, hemoptysis, apnea.[robholland.com]
  • […] enalapril, fosinopril, quinapril, captopril, ramipril, trandolapril, and perindopril Side effects: dry, hacky cough, fatigue, hyperkalemia from long term use and kidosis digoxin (Lanoxin) (cont'd) Cardiovascular Dysrhythmias, including bradycardia or tachycardia[quizlet.com]
  • However, levosimendan therapy showed higher risks of hypotension, ventricular tachycardia, cardiac arrest, bradycardia, headache and abdominal pain than control therapy did.[bmjopen.bmj.com]
  • Side Effects Adverse events that occurred during the first 24 hours of Natrecor infusion in clinical trials include (but are not limited to) the following: Hypotension Ventricular tachycardia (abnormally fast heart rate) Angina pectoris (chest pain) Bradycardia[centerwatch.com]
Chest Pain
  • . • 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[medical-dictionary.thefreedictionary.com]
  • Side Effects Adverse events that occurred during the first 24 hours of Natrecor infusion in clinical trials include (but are not limited to) the following: Hypotension Ventricular tachycardia (abnormally fast heart rate) Angina pectoris (chest pain) Bradycardia[centerwatch.com]
  • Tell your caregivers at once if you have: confusion, feeling light-headed, fainting ; fast, slow, or irregular heartbeats; urinating less than usual; chest pain ; or fever , unusual weakness or tiredness.[emedicinehealth.com]
Orthostatic Hypotension
Palpitations
  • . • 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[medical-dictionary.thefreedictionary.com]
Pruritus
  • Skin: Sweating, pruritus, rash. Special Senses: Amblyopia. Renal: Renal failure in acutely decompensated heart failure patients. Drug: No interaction trials conducted. No clinically significant interactions reported. Onset: 15 min.[robholland.com]
Back Pain
  • Adverse effects Hypotension, ventricular tachycardia, headache, nausea, back pain, decreased renal function.[medical-dictionary.thefreedictionary.com]
  • Common side effects of nesiritide include low blood pressure, nausea, headache, and back pain. Nesiritide can also cause dizziness. Do not drive or operate heavy machinery until you know how nesiritide affects you.[rxwiki.com]
  • Adverse Reactions: Hypotension, headache, nausea, back pain, dizziness; hypersensitivity. How Supplied: Single-use vials—1[empr.com]
  • • Body as a Whole : Headache, abdominal pain and back pain. • Heart : Low blood pressure, fast/slow heart rate and chest pain. • Central Nervous System : Sleeplessness, dizziness, drowsiness and anxiety. • Gastrointestinal : Nausea and vomiting.[medindia.net]
  • pain Insomnia Dizziness Anxiety Nausea Vomiting Mechanism of Action Human BNP binds to the particulate guanylate cyclase receptor of vascular smooth muscle and endothelial cells, leading to increased intracellular concentrations of guanosine 3'5'-cyclic[centerwatch.com]
Leg Cramp
  • 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[medical-dictionary.thefreedictionary.com]
  • Body as a Whole: Headache, back pain, catheter pain, fever, injection site pain, leg cramps. CNS: Insomnia, dizziness, anxiety, confusion, paresthesia, somnolence, tremor.[robholland.com]
Insomnia
  • 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[medical-dictionary.thefreedictionary.com]
  • Natrecor infusion in clinical trials include (but are not limited to) the following: Hypotension Ventricular tachycardia (abnormally fast heart rate) Angina pectoris (chest pain) Bradycardia (abnormally slow heart rate) Headache Abdominal pain Back pain Insomnia[centerwatch.com]
  • CNS: Insomnia, dizziness, anxiety, confusion, paresthesia, somnolence, tremor. CV: Hypotension, ventricular tachycardia, ventricular extrasystoles, angina, bradycardia, tachycardia, atrial fibrillation, AV node conduction abnormalities.[robholland.com]
Paresthesia
  • CNS: Insomnia, dizziness, anxiety, confusion, paresthesia, somnolence, tremor. CV: Hypotension, ventricular tachycardia, ventricular extrasystoles, angina, bradycardia, tachycardia, atrial fibrillation, AV node conduction abnormalities.[robholland.com]
Renal Impairment
  • Number of Patients With Renal Impairment [ Time Frame: Study drug initiation to Day 30 ] Renal impairment was defined as a greater than 25% decrease from baseline in the Modification of Diet in Renal Disease calculated glomerular filtration rate.[clinicaltrials.gov]
  • Also unknown was whether nesiritide caused kidney (renal) impairment or increased the risk of death, which previous, much smaller studies have indicated. An important finding from this trial is that the drug did not increase these risks.[cardiobrief.org]
  • There was no significant difference between the nesiritide group and the placebo group with respect to the proportion of patients with renal impairment at any time from randomization through day 30 (31.4% and 29.5%, respectively; odds ratio with nesiritide[nejm.org]
Decreased Renal Function

Workup

Hemoglobin Decreased
  • 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.[medical-dictionary.thefreedictionary.com]

Treatment

  • […] with standard care. 1, 2, 5 However, nesiritide may cause renal function to worsen and may increase the risk of death within 30 days. 3 Patients should be notified about the potential risks of treatment; nesiritide is not indicated for serial treatments[aafp.org]
  • Acute Heart Failure (AHF) 1 2 Completed Treatment Congestive Heart Failure (CHF) 2 2 Completed Treatment Congestive Heart Failure (CHF) / Impaired Renal Function 1 2 Completed Treatment Heart Failure 1 2 Recruiting Treatment Diastolic Dysfunction / Type[drugbank.ca]
  • Currently ACEI and BB represent the cornerstone of HF treatment.[cardio-debate.com]
  • […] the current FDA indication for intravenous treatment of patients with acutely decompensated CHF who have dyspnea at rest or with minimal activity.[cms.gov]
  • But when nesiritide was approved by the Food and Drug Administration (FDA) in 2001, it was designated for the treatment of acute, decompensated congestive heart failure.[nejm.org]

Prognosis

  • […] predicts outcome in patients with heart failure 13–17 and in those after infarction. 10,18,19 In parallel with the prognostic importance of the presence of renal dysfunction, worsening renal function immediately after coronary bypass portends a worse prognosis[circ.ahajournals.org]
  • All in all there has been no convincing beneficial effect on prognosis, and the use of this agent is mainly limited to the relief of dyspnea in the hospitalized HF patient with normal blood pressure.[cardio-debate.com]
  • B-Type natriuretic peptide (BNP) 1 and N-terminal proBNP (NT-proBNP) are now being used to confirm the diagnosis and, in some studies, to aid in the assessment of prognosis in patients with heart failure.[clinchem.aaccjnls.org]

Etiology

  • There were no clinical characteristic differences between infusion responders and nonresponder patients in etiology of heart failure, left ventricular ejection fraction, presence of biventricular failure, estimated GFR, serum potassium and sodium, body[clinchem.aaccjnls.org]
  • VMAC would accept patients who required hospitalization and had heart failure with shortness of breath regardless of etiology or ventricular function.[clinicalleader.com]

Epidemiology

  • Renal dysfunction in patients with heart failure with preserved versus reduced ejection fraction impact of the new chronic kidney disease-epidemiology collaboration group formula.[journals.plos.org]
  • .); Monash University, and Department of Epidemiology and Preventive Medicine, Alfred Hospital, Prahan, VIC, Australia (H.K.); Vilnius University Hospital, Santariskiu Klinikos, Department of Cardiology and Angiology, Vilnius, Lithuania (A.L.); University[nejm.org]
Sex distribution
Age distribution

Pathophysiology

  • Natriuretic peptides in the pathophysiology of congestive heart failure. Curr Cardiol Rep 2000;2:198–205. Google Scholar 4. Zellner C, Protter AA, Ko E, et al.[link.springer.com]
  • Renal insufficiency may increase risk of heart failure progression, and the pathophysiology of renal dysfunction during the process of heart failure is complex.[bmjopen.bmj.com]
  • 1243 Percutaneous Coronary Intervention 1258 Percutaneous Cardiac Procedures 1273 Coronary Artery Bypass Surgery 1290 Approaches to the Patient with Prior Bypass Surgery 1306 Percutaneous Valve Dilatations 1316 Global Pandemic of Heart Failure 1330 Pathophysiology[books.google.com]
  • Pathophysiologically, nesiritide not only could directly influence the glomerular arterioles, mesangial cells and renal tubules to improve renal function, but also could indirectly regulate the systemic hemodynamics, renin-angiotensin-aldosterone axis[journals.plos.org]

Prevention

  • Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. ‏[books.google.com]
  • Acute Myocardial Infarction (AMI) 1 2 Completed Prevention Cardiopulmonary Bypass / Congestive Heart Failure (CHF) / Coronary Artery Bypass Graft Surgery Patients / Coronary Heart Disease (CHD) / Ischaemic Heart Diseases 1 2 Completed Prevention Renal[drugbank.ca]
  • Prevent sodium and water resorption by inhibiting aldosterone secretion Diuresis results, which decreases preload, or the left ventricular end-volume, and the work of the heart Examples: lisinopril, enalapril, fosinopril, quinapril, captopril, ramipril[quizlet.com]
  • Moreover, they stated that a large, multi-center, prospective RCT is needed to evaluate the therapeutic potential of ANP or BNP in preventing and treating AKI in the cardiovascular surgical setting.[aetna.com]

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