Brand name: Dilzem Generic name: Diltiazem Indications: Angina pectoris including Prinzmetal’s angina, hypertension, supraventricular tachyarrythmias

and rapid ventricular rates in atrial flutter of fibrillation. Drug Classification: Calcium antagonist Mechanism of action: Block calcium entrance into cardiac and vascular smooth muscle cells by blocking the L-type voltage sensitive calcium channel which is abundant in cardiac and smooth muscle. In smooth muscle, calcium binds to calmodulin resulting in activating myosin light chain kinase, an enzyme that phosphorylates the myosin light chain. This phosphorylation is essential for muscle contraction, thus by decreasing calcium levels in the vascular smooth muscle these agents lessen contraction. In the heart, calcium binding to troponin removes the inhibitory effect of troponin on the actin-myosin interaction thus allowing contraction. Thus, blockade of the slow calcium channel by these agents can result in negative inotropic effect.

Dosage: Angina pectoris, 90-360 mg daily in divided dosage. Hypertension, 180-360 mg/24 hr in divided doses. Special Precaution: Impaired renal or hepatic function; heart failure Pregnancy Risk Category: C Adverse Reactions: CNS: abnormal dreams, anxiety, confusion, dizziness, drowsiness, headache, nervousness, psychiatric disturbances, weakness EENT: blurred vision, disturbed equilibrium, epistaxis, tinnitus Resp: cough, dyspnea CV: Arrythmias, CHF, peripheral edema, bradycardia, chest pain, hypotension, palpitations, syncope, tachycardia GI: abnormal function liver studies, anorexia, constipation, diarrhea, dry mouth, dysgeusia, dyspepsia, nausea, vomiting GU: dysuria, nocturia, polyuria, sexual dysfunction, urinary frequency Derm: dermatitis, erythema multiforme, flushing, increased sweating, photosensitivity, pruritus/ urticaria, rash Endo: gynecomastia, hyperglycemia Hemat: anemia, leucopenia, thrombocytopenia

(continuation Dilzem) Metab: weight gain MS: joint stiffness, muscle cramps Neuro: paresthesia, tremor Misc: Stevens- Johnson syndrome, gingival hyperplasia Contraindications: sick sinus syndromes; 2nd or 3rd degree AV block; hypotension, pregnancy acute MI Form: Tablet- 30mg, 60mg, 90 mg, 120 mg Nursing Responsibilities:  Monitor BP & pulse before therapy, during titration, and periodically during therapy. Monitor ECG periodically during prolonged therapy.  Monitor intake & output ratios and daily weight.  Angina: Assess location, duration, intensity, & precipitating factors of patient’s anginal pain.  Arrythmias: Monitor ECG continuously during administration. Monitor BP and pulse before and frequently during administration.  Monitor serum potassium and renal hepatic functions periodically.

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