| Diltiazem: |
Calcium Channel Bloccker |
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IVP DOSING |
| 0.25 mg/kg |
Give slow IVP over 2 minutes... If you can't seem to find it, get out of the Pyxis and look in the fridge (its gotta be kept cold). |
| 0.35 mg/kg |
Try this dose in 15 minutes if that HR is still a bit too zippy... Again, it's given slow IVP over 2 minutes. |
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INFUSION DOSING |
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Titrate to your favorite HR. Don't go above 15 mg/hr for more than 24 hours (because all the books say so...) |
5-15 mg/hr |
Diltiazem,
like Verapamil, inhibits calcium mediated depolarization in the AV node,
decreasing conduction,
and inhibits the influx of calcium across cardiac and smooth muscle cell
membranes, decreasing O2 demand by decreasing myocardal contractility. The
binding site for Diltiazem is in a different location than does Verapamil.
It has the same desired non-DHP effects, equally dilating both arteries
and veins in coronary and peripheral vessels.
It is used for PSVT, rapid A fib/flutter, HTN, vasospastic angina
(Prinzmetal's variant), and effort angina.
Unlike Verapamil, only about 35% of the drug is excreted through the
kidneys, the rest goes out via the GI tract.
It undergoes significant first-pass hepatic metabolism, leaving only
about half left over for effect.
Side
Effects: AV block, ¯
HR, ¯
BP, VF, asystole, CHF, dizziness, HA, nausea, rash, elevated liver enzymes,
increases dig levels.
Contraindicated:
LV dysfunction, VT, 2°
or 3°
AV block, SSS, WPW, short PR, ¯
BP, shock, oral b-blocker
use, do not mix in line with Lasix.
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