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                                      DILTIAZEM

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                                      DILTIAZEM

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Generic Name

Diltiazem Hydrochloride

Brand Name
Cardizem

Drug Classification

Diltiazem belongs to the calcium channel blockers which block the entry of calcium into muscle cells that make up the heart and that surround the arteries.

Mechanism of Action

Diltiazem inhibits  calcium  from  entering  myocardial  and vascular  smooth muscle  cells, thereby depressing myocardial and smooth muscle contraction and decreasing impulse formation and conduction velocity. As a result, systolic and diastolic pressures decrease.

Stock Dosage

Capsules (extended release, sustained release): 60 mg, 90 mg, 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg

Injection: 5 mg/ml in 10 ml vials, 100 mg Monovial

Tablets: 30 mg, 60 mg, 90 mg, 120 mg

Indications

Indicated for the management of hypertension, to lower blood pressure, alone or in combination with other antihypertensive agents.

Indicated for use to improve exercise tolerance in patients with chronic stable angina.

Indicated for the management of variant angina (Prinzmetal's angina).

Contraindications

Congestive heart failure

SA Node or AV conduction disturbances

Low blood pressure

Side Effects

Swollen hands, ankles or feet

Headaches

Dizziness

Fatigue

Feeling hot (flushing) and redness of the skin

Itching or burning on the skin

Stomach pain, indigestion and constipation

Adverse Reactions
Stop taking diltiazem and call a doctor right away if there is a presence of:

Severe pain in the stomach

Yellow skin or the whites of the eyes turn yellow – this can be a sign of liver problems.

Nursing Responsibilities

1. Check blood pressure, heart rate, and cardiac monitor prior to administering diltiazem. Withhold dose if systolic pressure is below 90 mm Hg.

2. Assess baseline renal (BUN, Cr) and liver function (AST, ALT) lab tests.

3. Monitor for signs of heart failure (e.g., pulmonary edema, weakness, dyspnea).

4. Provide analgesic for headache.

5. Use caution during position changes to prevent orthostatic hypotension.

Diltiazem (Cardizem) Uses, Side Effects & Dosage. (n.d.). MedicineNet. Retrieved September 16, 2021, from https://www.medicinenet.com/diltiazem/article.htm#:%7E:text=It%20belongs%20to%20a%20class,and%20that%20surround%20the%20arteries.

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Generic Name

Propranolol Hydrochloride

Brand Name
Inderal

Drug Classification

Propranolol Hydrochloride belongs to beta-blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.

Mechanism of Action

Propranolol Hydrochloride is a nonselective β-adrenergic receptor antagonist. Blocking of these receptors leads to vasoconstriction, inhibition of angiogenic factors like vascular endothelial growth factor (VEGF) and basic growth factor of fibroblasts (bFGF), induction of apoptosis of endothelial cells, as well as down regulation of the renin-angiotensin-aldosterone system.

Stock Dosage

For acute heart attack:

For oral dosage form (tablets):

Adults—At first, 40 milligrams (mg) three times a day.

For chest pain (angina):

For oral dosage form (tablets):

Adults—80 to 320 milligrams (mg) per day, given in divided doses.

For high blood pressure (hypertension):

For oral dosage form (tablets):

Adults—At first, 40 milligrams (mg) two times a day.

Indications
Propranolol Hydrochloride is a beta-blocker used to treat high blood pressure, irregular heartbeats, shaking (tremors), and other conditions. It is used after a heart attack to improve the chance of survival. It is also used to prevent migraine headaches and chest pain.

Contraindications

Propranolol Hydrochloride is contraindicated in cardiogenic shock, sinus bradycardia, and in patients with known hypersensitivity to propranolol hydrochloride.

Side Effects

Dry eyes

Nausea

Drowsiness

Diarrhea

Wheezing or symptoms of bronchitis

Fatigue, feeling weak

Hair loss

Slower heart rate

Changes in sex drive

Changes in sexual performance

Adverse Reactions
Stop taking propranolol hydrochloride and call a doctor straight away if there is a presence of:

Breathing problems or bronchospasms

Slow heart rate

Allergic reactions, such as itching, rashes and hives, or swelling in the face or tongue

Sudden weight gain

Swelling of legs, ankles, or feet

Circulation problems such as cold hands and feet

Sudden changes in blood sugar

Trouble sleeping or nightmares

Hallucinations

Nursing Responsibilities

1. Obtain careful medical history to rule out allergies, asthma, and obstructive pulmonary disease.

2. Monitor apical pulse, respiration, BP, and circulation to extremities closely throughout period of dosage adjustment.

3. Evaluate adequate control or dosage interval for patients being treated for hypertension by checking blood pressure near end of dosage interval or before administration of next dose.

4. Be aware that adverse reactions occur most frequently following IV administration soon after therapy is initiated; however, incidence is also high following oral use in the older adult and in patients with impaired kidney function. Reactions may or may not be dose related.

5. Obtain periodic hematologic, kidney, liver, and cardiac functions when it is given for prolonged periods.

6. Monitor I&O ratio and daily weight as significant indexes for detecting fluid retention and developing heart failure.

7. Consult physician regarding allowable salt intake. Drug plasma volume may increase with consequent risk of CHF if dietary sodium is not restricted in patients not receiving concomitant diuretic therapy.

8. Fasting for more than 12 h may induce hypoglycemic effects fostered by it.

9. If patient complains of cold, painful, or tender feet or hands, examine carefully for evidence of impaired circulation. Peripheral pulses may still be present even though circulation is impaired. Caution patient to avoid prolonged exposure of extremities to cold.

PROPRANOLOL HYDROCHLORIDE. (n.d.). Retrieved September 16, 2021, from http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/P090.html