Nesiritide MCQs With Answer

Nesiritide MCQs With Answer

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Nesiritide MCQs With Answer provides B. Pharm students a focused review of nesiritide—a recombinant B‑type natriuretic peptide used for acute decompensated heart failure. This introduction and the subsequent questions cover mechanism of action (NPR‑A activation and cGMP elevation), pharmacokinetics (rapid onset, short half‑life, neprilysin degradation), clinical indications, dosing (bolus and infusion), adverse effects (notably hypotension and renal concerns), monitoring, drug interactions, contraindications, and formulation/handling considerations. Questions are designed to deepen understanding of therapeutic rationale, safety monitoring, and evidence from clinical trials. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. What is the primary mechanism of action of nesiritide?

  • Inhibition of angiotensin‑converting enzyme
  • Stimulation of soluble guanylate cyclase via nitric oxide
  • Activation of particulate guanylate cyclase (NPR‑A) increasing intracellular cGMP
  • Blockade of beta‑adrenergic receptors

Correct Answer: Activation of particulate guanylate cyclase (NPR‑A) increasing intracellular cGMP

Q2. Nesiritide is best described as:

  • A synthetic angiotensin II analogue
  • Recombinant human B‑type natriuretic peptide (BNP)
  • A small‑molecule neprilysin inhibitor
  • A long‑acting vasopressin analogue

Correct Answer: Recombinant human B‑type natriuretic peptide (BNP)

Q3. The approved primary clinical indication for nesiritide is:

  • Chronic stable angina
  • Acute decompensated heart failure with dyspnea at rest
  • Chronic outpatient management of systolic heart failure
  • Hypertensive emergency

Correct Answer: Acute decompensated heart failure with dyspnea at rest

Q4. What is the usual route of administration for nesiritide in clinical practice?

  • Oral tablet once daily
  • Subcutaneous injection
  • Intravenous bolus followed by continuous infusion
  • Intramuscular injection

Correct Answer: Intravenous bolus followed by continuous infusion

Q5. A common initial dosing regimen for nesiritide is:

  • Bolus 2 mcg/kg then infusion 0.01 mcg/kg/min
  • Oral 5 mg twice daily
  • Continuous infusion 2 mcg/kg/hr without bolus
  • Bolus 50 mcg then infusion 5 mcg/min

Correct Answer: Bolus 2 mcg/kg then infusion 0.01 mcg/kg/min

Q6. The most frequent clinically important adverse effect of nesiritide is:

  • Severe hyperglycemia
  • Marked hypotension
  • Thrombocytopenia
  • Prolonged QT interval

Correct Answer: Marked hypotension

Q7. The approximate elimination half‑life of nesiritide after IV administration is:

  • 2–4 hours
  • 18–20 minutes
  • 24–48 hours
  • 5–6 seconds

Correct Answer: 18–20 minutes

Q8. Nesiritide is primarily degraded and cleared by:

  • CYP3A4 hepatic metabolism
  • Renal tubular secretion via OCT2
  • Neprilysin (neutral endopeptidase) and receptor‑mediated clearance
  • Glucuronidation in the liver

Correct Answer: Neprilysin (neutral endopeptidase) and receptor‑mediated clearance

Q9. Key parameters to monitor during nesiritide therapy include:

  • Blood pressure, urine output, and renal function
  • Fasting blood glucose and hemoglobin A1c
  • Liver enzymes only
  • Serum amylase and lipase

Correct Answer: Blood pressure, urine output, and renal function

Q10. Nesiritide is contraindicated or should be avoided in patients with:

  • Stable hypertension controlled on therapy
  • Cardiogenic shock or systolic BP < 90 mmHg
  • Asymptomatic left ventricular hypertrophy
  • Mild intermittent claudication

Correct Answer: Cardiogenic shock or systolic BP < 90 mmHg

Q11. Combining nesiritide with nitrates or ACE inhibitors primarily increases risk of:

  • Renal stone formation
  • Severe hypotension
  • Hyperkalemia without blood pressure change
  • Thromboembolism

Correct Answer: Severe hypotension

Q12. Administration of nesiritide interferes with which cardiac biomarker measurement?

  • Troponin I
  • BNP assay (exogenous BNP increases measured levels)
  • Creatine kinase‑MB only
  • Serum albumin concentration

Correct Answer: BNP assay (exogenous BNP increases measured levels)

Q13. Clinical trial data raised concerns that nesiritide may cause or worsen:

  • Thyroid dysfunction
  • Renal dysfunction and creatinine elevation
  • Iron deficiency anemia
  • Cataract formation

Correct Answer: Renal dysfunction and creatinine elevation

Q14. The pregnancy risk category most commonly assigned to nesiritide is:

  • Category A
  • Category B
  • Category C
  • Category X

Correct Answer: Category C

Q15. Nesiritide exerts renal effects primarily by:

  • Stimulating aldosterone release
  • Increasing glomerular filtration and promoting natriuresis
  • Directly blocking ENaC channels permanently
  • Inhibiting atrial natriuretic peptide release

Correct Answer: Increasing glomerular filtration and promoting natriuresis

Q16. Which of the following is NOT a pharmacological effect of nesiritide?

  • Venodilation reducing preload
  • Arterial dilation reducing afterload
  • Stimulation of myocardial contractility as primary action
  • Promotion of natriuresis and diuresis

Correct Answer: Stimulation of myocardial contractility as primary action

Q17. For long‑term outpatient management of chronic heart failure, nesiritide is:

  • Recommended as first‑line chronic therapy
  • Commonly used as a monthly subcutaneous injection
  • Not indicated for routine long‑term outpatient therapy
  • Prescribed for all patients with NYHA class II disease

Correct Answer: Not indicated for routine long‑term outpatient therapy

Q18. The natriuretic action of nesiritide is due to which cellular effect in the kidney?

  • Inhibition of guanylate cyclase in tubular cells
  • Increased cGMP leading to reduced proximal sodium reabsorption and altered GFR
  • Direct blockade of loop of Henle Na‑K‑2Cl cotransporter
  • Stimulation of aldosterone release enhancing sodium retention

Correct Answer: Increased cGMP leading to reduced proximal sodium reabsorption and altered GFR

Q19. Which precaution is appropriate when initiating nesiritide?

  • Start a high oral dose and taper to IV
  • Avoid bolus or infusion in patients with systolic BP < 100 mmHg
  • Combine immediately with neprilysin inhibitor for synergy
  • No monitoring is required during infusion

Correct Answer: Avoid bolus or infusion in patients with systolic BP < 100 mmHg

Q20. Concomitant use of nesiritide with ACE inhibitors primarily requires caution because both agents:

  • Increase myocardial oxygen demand
  • Can synergistically lower blood pressure causing hypotension
  • Cause severe hyperglycemia when combined
  • Neutralize each other’s renal effects

Correct Answer: Can synergistically lower blood pressure causing hypotension

Q21. In patients with renal impairment, nesiritide dosing should be:

  • Always doubled to overcome reduced clearance
  • Unchanged and requires no monitoring
  • Used with caution; monitor renal function and consider dose adjustment
  • Stopped because it is completely contraindicated

Correct Answer: Used with caution; monitor renal function and consider dose adjustment

Q22. Which adverse effect is least likely to be directly caused by nesiritide?

  • Symptomatic hypotension
  • Worsening renal function
  • Marked hyperkalemia as a primary effect
  • Headache and dizziness

Correct Answer: Marked hyperkalemia as a primary effect

Q23. Concomitant administration of nesiritide with a neprilysin inhibitor (e.g., sacubitril) would most likely:

  • Reduce nesiritide plasma levels and efficacy
  • Increase natriuretic peptide levels and risk of hypotension
  • Cause immediate thrombocytopenia
  • Prevent nesiritide from binding its receptor

Correct Answer: Increase natriuretic peptide levels and risk of hypotension

Q24. A pharmacodynamic marker that increases in plasma after nesiritide administration is:

  • cGMP concentration
  • Serum INR
  • Plasma renin activity to very high levels
  • Liver transaminases dramatically

Correct Answer: cGMP concentration

Q25. The molecular size/structure of nesiritide corresponds to:

  • A 32‑amino acid peptide identical to human BNP
  • A 200‑amino acid recombinant protein
  • A small lipid-soluble molecule
  • A 5‑amino acid peptide fragment

Correct Answer: A 32‑amino acid peptide identical to human BNP

Q26. Best practice for handling and administration of reconstituted nesiritide solution is to:

  • Store reconstituted solution at room temperature for 7 days
  • Use immediately or within recommended refrigerated timeframe; do not freeze
  • Administer orally after dilution
  • Freeze reconstituted vials for later use

Correct Answer: Use immediately or within recommended refrigerated timeframe; do not freeze

Q27. The predominant hemodynamic effects of nesiritide on the circulation are:

  • Increase in preload and increase in afterload
  • Reduction in preload and reduction in afterload (venous and arterial dilation)
  • Exclusive coronary vasoconstriction
  • Direct increase in myocardial contractility as the main effect

Correct Answer: Reduction in preload and reduction in afterload (venous and arterial dilation)

Q28. Which biomarker is directly increased by exogenous nesiritide administration?

  • NT‑proBNP only
  • BNP (measured by BNP assays)
  • Serum troponin T specifically
  • Serum creatinine kinase only

Correct Answer: BNP (measured by BNP assays)

Q29. Major concerns from clinical trials of nesiritide included:

  • Clear mortality benefit in all heart failure patients
  • No effect on hemodynamics but improved renal function universally
  • Possible increased risk of worsening renal function without mortality benefit
  • Guaranteed prevention of rehospitalization in all cases

Correct Answer: Possible increased risk of worsening renal function without mortality benefit

Q30. At the cellular level in vascular smooth muscle, nesiritide causes relaxation by:

  • Decreasing intracellular cGMP and increasing Ca2+
  • Activating particulate guanylate cyclase to raise cGMP and reduce Ca2+
  • Blocking L‑type calcium channels directly
  • Stimulating IP3 production to release calcium

Correct Answer: Activating particulate guanylate cyclase to raise cGMP and reduce Ca2+

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