Question

1. What are the therapeutic actions for diltiazem and propranolol?
2. What are the indications for diltiazem?
3. What are the key nursing considerations prior to and after administration?
4. What are the key nursing teaching points for patients receiving antiarrhythmic agents?

Answer 1

1). Diltiazem is a benzothiazepine derivative with anti-hypertensive, antiarrhythmic properties. Diltiazem blocks voltage-sensitive calcium channels in the blood vessels, by inhibiting the ion-control gating mechanisms, thereby preventing calcium levels increase by other revenues.

Propranolol medication 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 (angina).

2). Indications of Diltiazem are

Hypertension.

Angina pectoris and vasospastic (Prinzmetal's) angina.

Supraventricular tachyarrhythmias and rapid ventricular rates in atrial flutter or fibrillation.

3). Monitor BP and pulse prior to therapy, during dose titration, and periodically during therapy. Monitor ECG periodically during prolonged therapy. May cause prolonged PR interval.

Monitor intake and output ratios and daily weight. Assess for signs of HF (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).

Monitor frequency of prescription refills to determine adherence.

Patients receiving digoxin concurrently with calcium channel blockers should have routine serum digoxin levels checked and be monitored for signs and symptoms of digoxin toxicity.

Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or eosinophilia.

Assess location, duration, intensity, and precipitating factors of patient's anginal pain.

Monitor ECG continuously during administration. Report bradycardia or prolonged hypotension promptly. Emergency equipment and medication should be available. Monitor BP and pulse before and frequently during administration.

Lab Test Considerations:

Total serum calcium concentrations are not affected by calcium channel blockers.

Monitor serum potassium periodically. Hypokalemia ↑ the risk of arrhythmias and should be corrected.

Monitor renal and hepatic functions periodically during long-term therapy. May cause ↑ in hepatic enzymes after several days of therapy, which return to normal on discontinuation of therapy.

4). Patient/Family Teaching

Advise patient to take medication as directed at the same time each day, even if feeling well. Take missed doses as soon as possible unless almost time for next dose; do not double doses. May need to be discontinued gradually.

Advise patient to avoid large amounts (6–8 glasses of grapefruit juice/day) during therapy.

Instruct patient on correct technique for monitoring pulse. Instruct patient to contact health care professional if heart rate is <50 bpm.

Caution patient to change positions slowly to minimize orthostatic hypotension.

May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.

Instruct patient on importance of maintaining good dental hygiene and seeing dentist frequently for teeth cleaning to prevent tenderness, bleeding, and gingival hyperplasia (gum enlargement).

Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to avoid concurrent use of alcohol or OTC medications and herbal products, especially NSAIDs and cold preparations, without consulting health care professional.

Advise patient to notify health care professional if rash, irregular heartbeats, dyspnea, swelling of hands and feet, pronounced dizziness, nausea, constipation, or hypotension occurs or if headache is severe or persistent.

Caution patient to wear protective clothing and use sunscreen to prevent photosensitivity reactions.

Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Instruct patient on concurrent nitrate or beta-blocker therapy to continue taking both medications as directed and to use SL nitroglycerin as needed for anginal attacks.

Advise patient to contact health care professional if chest pain does not improve, worsens after therapy, or occurs with diaphoresis; if shortness of breath occurs; or if severe, persistent headache occurs.

Caution patient to discuss exercise restrictions with health care professional before exertion.

Encourage patient to comply with other interventions for hypertension (weight reduction, low-sodium diet, smoking cessation, moderation of alcohol consumption, regular exercise, and stress management). Medication controls but does not cure hypertension.

Instruct patient and family in proper technique for monitoring BP. Advise patient to take BP weekly and to report significant changes to health care professional.