Diltiazem drip / Cardizem drip

Pharmacy and Therapeutics

In PowerChart, search and from the drop-down, choose: Diltiazem 125mg in 125ml D5W

Type in the rate to be, 5ml/hr

Under Order Comments section, add the following instructions:

Start at 5 mg/hr
Titrate by 2.5 mg/hr
Every 15 minutes
For a goal HR less than 110 (and SBP greater than 100) if the patient is asymptomatic at HR < 110.
The goal HR should be <85 (and SBP greater than 100) if the patient is symptomatic at higher HR.
Max Dose 15 mg/hr

See this diltiazem protocol from the ACC.

Pearls of Atrial Fibrillation Treatment

  • A goal heart rate on rate control of less than 85 bpm is reasonable in symptomatic patients. For asymptomatic pts with permanent  AF, a rate control goal of <110 beats/min is reasonable.
  • Beta blockers and non-dihydropyridine calcium channel blockers are preferred as first-line agents in most patients.
  • “The decision between IV or PO treatment depends on the clinical presentation and the need and urgency for controlling the rate. IV drugs are preferred to oral drugs when rapid rate control is necessary.”
  • Calculate a CHA2DS2-VASc score for every patient.
  • In pts with AF less than 48 hrs duration, cardiologists differ in how they approach anticoagulation. Some start unfractionated heparin, low molecular weight heparin, or a DOAC prior to cardioversion in all patients, while some go ahead without anticoagulation in patients with AF of very short duration who have a low stroke risk profile.
  • “For pts with AF of longer than 48hrs duration, do at least three consecutive weeks of effective oral anticoagulation before cardioversion, as opposed to immediate cardioversion. Alternatively, you may do a TEE screening for the presence of atrial thrombi before cardioversion. The TEE strategy doesn’t require at least three weeks of anticoagulation. Even though that’s so, all patients who undergo cardioversion (even those who have no thrombus seen on TEE) should be on therapeutic anticoagulant therapy at the time of TEE/cardioversion as well as for one month after the cardioversion.”
  • http://www.acc.org/tools-and-practice-support/clinical-toolkits/atrial-fibrillation-afib/anticoagulant-dosing-table

 

Reference:

http://www.acc.org/tools-and-practice-support/clinical-toolkits/atrial-fibrillation-afib/anticoagulant-dosing-table Last Accessed 11/10/2017

See the Uptodate.com article titled: Management of new onset atrial fibrillation.

print