|calcium channel blocker
- prolongs the refractory periods of the AV node and intranodal conduction
- provides temporary control of rapid ventricular rate in atrial fibrillation and atrial flutter, but rarely converts to normal sinus rhythm
- may provide rapid conversion of paroxysmal supraventricular tachycardias to sinus rhythm
- has been used as intracoronary injection to prevent vasospasm during coronary angioplasty
- used post radial artery coronary bypass graphs to prevent spasm
- 0.1-0.3mg/kg IV direct over 2 minutes
- a subsequent dose of 0.35mg/kg may be administered after 15 minutes if the initial response is inadequate
- 5-10 mg/h immediately following direct injection
- may be increased by 5 mg/h to a maximum of 15mg/h to achieve target
dilute 125 mg in 100ml D5W or NS for final concentration of 1 mg/ml
- hypotension, decreased SVRI
- decreased cardiac output
- AV block
- prolonged QT
- contraindicated in patients with hypotension, sick sinus syndrome, second and complete AV block, and in patients with acute myocardial infarction and pulmonary edema
- use cautiously in patients with AV conduction delays or transient sinus pauses
- diltiazem + beta blockers = decreased HR, CI and prolonged PR interval
- diltiazem + digoxin = increased digoxin plasma concentrations
- diltiazem + cyclosporin = increased cyclosporin plasma concentrations
- diltiazem + amiodardone = increased diltiazem plasma concentrations
- diltiazem + cisapride = prolonged QT with Torsades de Pointes
- ECG: HR, rhythm, PR interval, QT interval
- cardiac index
- SVRI (may decrease)
- PWP (may increase due to myocardial depression)
- breath sounds, chest xray
- May be administered by IV infusion by an approved nurse in CCTC.
- Continuous infusion must be administered via an infusion pump.
- Should not be administered via the proximal injectate port (blue) of the Swan Ganz catheter.
- Patient requires placement of an arterial line to monitor BP if intravenous infusion is used.