Paramedic Drug Administration diltiazem

Questions and Answers

What is the trade name of diltiazem?

Adalat

Cardizem (correct)

Norvasc

Zestril

What is the mechanism of action for diltiazem?

Blocking beta-adrenergic receptors in the heart, reducing heart rate.

Increased secretion of norepinephrine leading to vasodilation.

Inhibitory effects on cardiac conduction system, principally at the AV node, slowing the ventricular rate associated with atrial fibrillation and atrial flutter, inhibits extracellular calcium ion influx across membranes of myocardial cells and vascular smooth muscle cells, resulting in inhibition of contraction and thereby dilating main coronary and systemic arteries. (correct)

Direct stimulation of the heart muscle, increasing heart contractions.

What is the class of diltiazem?

Antidysrhythmic, calcium channel blocker (correct)

ACE inhibitor

Beta blocker

Diuretic

What are the indications for diltiazem?

Narrow complex tachyarrhythmias – atrial fibrillation/atrial flutter. SVT not responding to adenosine. Signup and view all the answers

What are the contraindications for diltiazem?

Heart block/bradycardia, systolic blood pressure < 90 mmHg, WPW syndrome, sick sinus syndrome, ventricular tachycardia, diltiazem allergy Signup and view all the answers

What are the routes of administration for diltiazem?

IV/IO Signup and view all the answers

What is the typical duration of action for diltiazem?

1 to 3 hours Signup and view all the answers

What is the onset of action for diltiazem?

3 minutes Signup and view all the answers

What is the typical adult dose for diltiazem?

1st dose = 0.125 mg/kg, max 12.5mg, IV/IO over 2 minutes. Patients > 65 years old, max 10mg. 2nd dose = 0.125 mg/kg, max 12.5mg, IV/IO over 2 minutes, after 10 minutes as needed and as blood pressure allows. Patients > 65 years old, max 10mg Signup and view all the answers

What are the adverse reactions/side effects of Diltiazem?

Hypotension, dysrhythmias, bradycardia, dizziness, weakness, headache, nausea, vomiting. Signup and view all the answers

What are the special considerations for the administration of diltiazem in the prehospital setting?

Prolongation of AV node conduction may result in second- or third-degree AV block, diltiazem should not be administered to compromised myocardium (severe CHF, AMI, or cardiomyopathy) and consider decreasing the dosage for elderly patients. Signup and view all the answers

Study Notes

Diltiazem Overview

Trade name: Commonly known as Cardizem.
Class: Calcium channel blocker, specifically a non-dihydropyridine type.

Mechanism of Action

Inhibits calcium ions from entering cardiac and smooth muscle cells.
Causes relaxation of vascular smooth muscle, leading to vasodilation.
Decreases heart rate and contractility.

Indications

Management of hypertension (high blood pressure).
Treatment of angina pectoris (chest pain).
Control of certain types of arrhythmias (irregular heartbeats).

Contraindications

Severe hypotension (low blood pressure).
Atrioventricular block (unless a pacemaker is present).
Patients with sick sinus syndrome (unless receiving a permanent pacemaker).
Known hypersensitivity to diltiazem.

Routes of Administration

Available in oral tablets and capsules.
Injectable formulation for intravenous use.

Pharmacokinetics

Onset of action: Varies; generally within 30 to 60 minutes for oral forms, and immediate for IV administration.
Typical duration of action: Ranges from 6 to 8 hours; can be longer with extended-release formulations.

Typical Adult Dose

Initial doses vary based on indication, typically starting at 30 to 60 mg taken three times daily for oral administration; IV dosing can differ and is adjusted based on response.

Adverse Reactions/Side Effects

Common side effects include dizziness, fatigue, headache, and gastrointestinal discomfort.
May cause hypotension, bradycardia (slow heart rate), and peripheral edema.