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Diltiazem
Antiarrhythmic, Antihypertensive, Antianginal -Intern Revision
| Question | Answer |
|---|---|
| List the classes that diltiazem belongs to | Non-dihydropyridine CCB, Class IV antiarrhythmic, antianginal, antihypertensive |
| What are the indications that diltiazem is used for? | AF, atrial flutter, HTN, angina |
| What are the recommended doses for using diltiazem for Angina, AF, or atrial flutter? | Adult, oral start 30mg 3-4 x d, titrate as needed, max dose 360mg in 3-4 daily doses. Adult, oral CR tabs 180mg initially, titrate as needed up to 360mg once daily. |
| What are the recommended doses for using diltiazem for hypertension? | Adult, oral start 180-240mg once daily, titrate if required to 360mg once daily. |
| What is the recommendation for using diltiazem in pregnant and breastfeeding women? | Refer to specialist for both |
| Explain the MOA for diltiazem | Blocks L Type Ca channels, blocking entry of ca2+ ions into cardiac smooth muscle, arteriolar myocardum and conducting system. Slows depolarisation and prolongs refractory period. Slows SA node firing, reducesHR, contractility, conduction. |
| List the contraindications dor diltiazem | severe bradycardia, sick sinus syndrome, 2nd or 3rd degree AV block, hypotension < 90mmHG, AF/Flutter complicating WPW syndrome, HF. |
| List the precautions for diltiazem | Combinations with other drugs i.e. dabigatran, other antiarrhythmics, other meds that can cause bradycardia, treatment with beta blockers. Renal and hepatic impairment (increase risk of ADR’s) |
| What are the diltiazem specific adverse effects? | Common: bradycardia, peripheral oedema Infr: AV block, onset or worsening of HF |
| What ADR's associated with diltiazem would you refer someone back to a doctor? | SOB, pounding heartbeat, weakness, bradycardia, gingival hyperplasia, |
| What are the monitoring considerations for someone taking diltiazem? | Onset of ADR's HR (especially elderly starting treatment), BP, ECG Worsening/improvement of condition (especially arrhythmias) Drug interactions - there are many, check references |
| What are the key drug interactions associated with diltiazem? What are the outcomes for each interaction? | Cyclosporin (increases conc of cyclo, risk of nephrotoxicity), digoxin (increases digoxin conc, risk of cardiac suppression - bradycardia) lithium (increases risk of lithium toxicity) |
| What are the counselling points for diltiazem? | Ask Dr/Pharm before starting any new medications (RX + OTC) (5) Do not stop taking abruptly (9) Can affect mental alertness/coordination (12) May cause dizziness (16) Avoid grapefruit juice (18) CR only = swallow whole (A) |
Created by:
LDM
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