Diltiazem

• Diltiazem

• Cardizem

Classification:

• Calcium channel blocker

Mechanism of Action:

• Slows the influx on calcium ions into cardiac and smooth muscle cells
• Slows conduction through the AV node
• Decreases blood pressure
• Dilates peripheral arterioles and coronary arteries preventing spasm
• Decreases myocardial O₂ demand

Indications:

• Rate control in rapid narrow complex tachycardia (a-fib, a-flutter, PSVT)

Contraindications:

• Patients with sick sinus syndrome (SSS)
• Atrial fibrillation or atrial flutter associated with WPW
• Any WPW
• Bradycardia
• 2^nd and 3^rd degree block
• Hypotension.  Withhold for SBP <90 and/or DBP <60
• Severe heart failure/cardiogenic shock
• Pregnancy and with lactating mothers
• Renal disease
• Malignant hyperthermia
• DO NOT USE IN ADDITION TO BETA-BLOCKERS

Precautions:

• Use cautiously in patients with hepatic or renal failure
• Use cautiously in patients with history of heart failure

Adverse Effects:

• Bradycardia
• Hypotension
• Decrease myocardial contractility
• May exacerbate CHF

Dose:

• Initial: 20 mg or 0.25 mg/kg slow IV push
• Repeat: If ineffective in 15 minutes, may give 20 mg or 0.35 mg/kg IV

• IV

• The effects of diazepam can be accentuated by CNS depressants such as opioids and alcohol.
• Pregnancy category D [potential benefits may warrant use of the drug in pregnant women despite potential risks (e.g., if it is required in a life-threatening situation)].

• Compendium of Pharmaceuticals and Specialties (CPS)
• Pharmacology for the Prehospital Professional 2^nd Edition