Table 5.

Vasodilator therapies.

	Nitroglycerin	Nitroprusside	Nesiritide
Mechanism	Increase NO synthesis and cGMP	Increase NO synthesis and cGMP	Activate guanylate cyclase–linked NP receptor A to increase cGMP
Clinical effects	Vasodilator (venous > arterial)	Vasodilator (venous = arterial)	Vasodilator (venous = arterial)
Indication	Warm & wet, Cold & wet, HTN Crises, ACS	Warm & wet, Cold and wet, HTN Crises	Warm & wet, Cold & wet
Usual dosing	10–30 mcg/minute and titrate by 10–20 mcg/ minute every 10–20 minutes, to max 200 mcg/kg/min	0.1–0.2 mcg/ kg/minute and titrate by 0.1–0.2 mcg/kg/minute every 10–20 minutes, to max 2 mcg/kg/min	0.01 mcg/kg/minute and titrate by 0.005 mcg/kg/minute every 3 hours, to max 0.03 mcg/kg/min
Onset, Half-life	1-5 minutes, 1-4 minutes	< 1 minute, < 10 minutes	15-30 minutes, 20 minutes
Elimination	Inactive metabolites in urine (no renal/hepatic adjustment)	Cyanide (hepatic), thiocyanate (renal)	NP receptor C (no renal/hepatic adjustment)

ACS = acute coronary syndrome, cGMP = cyclic guanosine monophosphate, HTN = hypertensive, NO = nitric oxide, NP = natriuretic peptide.