Anticoagulation, endocrine and GI

Diltiazem (Cardizem) drip

Cardizem

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

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Dosing

Line and administration

• Peripheral or central

Watch for

• Hypotension and bradycardia
• Avoid in decompensated HFrEF and in AF with WPW

In the one-pagers

• Rhythm GallerySinus, atrial and junctional: Atrial fibrillation: irregularly irregular, no P waves, wavy baseline. Stable: IV beta-blocker, or diltiazem only if EF is over 40%. Unstable: synchronized cardioversion.
• ACLS Algorithms in BriefTachycardia with a pulse: Then a beta-blocker or calcium channel blocker (not diltiazem or verapamil in suspected systolic heart failure)
• After Cardiac SurgeryPost-op atrial fibrillation: Unstable POAF gets synchronized cardioversion (STS 2026 Class I). In stable patients, rate control (beta-blocker or diltiazem, amiodarone if pressure or EF is low) and rhythm control (amiodarone, then cardioversion) gave equal hospital days, and most patients were in sinus rhythm by 60 days (CTSN 2016). Replace K and Mg. Anticoagulation waits until bleeding risk settle
• Aortic Dissection and Hypertensive EmergencyAnti-impulse therapy in depth: An IV beta-blocker comes first (Class 1). A vasodilator alone triggers reflex tachycardia and a steeper upstroke, so it is added only if BP stays high after rate control (Class 1): nicardipine or clevidipine, or nitroprusside, which is fastest but releases cyanide above about 2 mcg/kg/min (label). Esmolol (half-life about 9 min) wears off in minutes if it is not tole
• Endocarditis and Valve EmergenciesObstructive emergencies and LVOT obstruction: Obstructive HCM therapies with ICU consequences. Mavacamten, a cardiac myosin inhibitor, lowers contractility; it is interrupted if LVEF falls below 50%, its label says to avoid disopyramide, ranolazine, and verapamil or diltiazem with a beta-blocker, to consider interruption during intercurrent illness, and to delay dose increases with arrhythmia such
• Heart FailureDecompensated HF in the ICU: the first hours: Find the trigger: nonadherence, ACS, arrhythmia, uncontrolled hypertension, infection, PE, thyroid disease, NSAIDs, nondihydropyridine calcium channel blockers or thiazolidinediones. For AF with rapid ventricular response in decompensated HFrEF, use amiodarone or digoxin, a cautious β-blocker if perfusion allows, or cardioversion if unstable; diltiazem

Other anticoagulation, endocrine and gi

• Heparin
• Insulin (regular)
• Amiodarone
• Octreotide
• Pantoprazole
• Furosemide
• Argatroban
• Bivalirudin
• Procainamide
• Lidocaine
• Magnesium sulfate
• Naloxone
• Eptifibatide
• Bumetanide

For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.