| Name: |
VERAPAMIL (IsoptinR) |
| Classification: |
calcium channel blocker
- decreases supraventricular tachyarrhythmias
- decreases cardiac output
- coronary vasodilator (in presence of cardiac disease, beta blockers, or hepatic failure)
|
| Dose: |
- Bolus:
- 5-10mg IV direct (over one minute)
|
| Administration: |
IV Infusion:
50mg/100 mL D5W, NS, RL (maximum concentration 100mg/100mL)
|
| Adverse Effects: |
- hypotension (especially with rapid administration)
- decreased cardiac output
- arrhythmias
- bradycardia
- AV block, asystole
- prolonged QT
- flushing
- hepatic dysfunction
- dizziness
- dyspnea
- headache
|
| Caution: |
- 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
- use cautiously with digoxin and beta blockers
- use with caution in heart failure
- do not administer to wide complex tachycardias unless VT has been ruled out
|
| Antidote: |
- toxic cardiac effects may be treated with 1-2g calcium gluconate IV or 1mg atropine IV
|
| Drug Interactions: |
- verapamil + digoxin = increased serum digoxin levels; depression of AV node
- verapamil + propranolol = additive negative inotropic effects and cardiac depressant effects
- verapamil + beta-agonists = decreased action of verapamil
- verapamil + theophylline = increased theophylline level
|
| Monitoring Therapy: |
- ECG: HR, rhythm, PR interval, QT interval
- BP
- cardiac index
- SVRI (may drop SVRI)
- PWP (may cause increase due to myocardial depression)
- breath sounds, chest xray
|
| CCTC Protocol: |
- May be administered by IV infusion or IV direct by an approved nurse in CCTC.
- Must be infused via a central line.
- Continuous infusion must be administered via an infusion pump.
- Patient requires placement of an arterial line to monitor BP.
|
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