Diltiazem

INTRODUCTION

Indications

Hypertension. Angina pectoris and vasospastic (Prinzmetal's) angina. Supraventricular tachyarrhythmias and rapid ventricular rates in atrial flutter or fibrillation. Unlabeled Use: Management of Raynaud's syndrome.

Action

Inhibits transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction. Therapeutic Effects: Systemic vasodilation resulting in decreased blood pressure. Coronary vasodilation resulting in decreased frequency and severity of attacks of angina. Suppression of arrhythmias.

Adverse Reactions/Side Effects

CNS: abnormal dreams, anxiety, confusion, dizziness, drowsiness, headache, nervousness, psychiatric disturbances, weakness. EENT: blurred vision, disturbed equilibrium, epistaxis, tinnitus. Resp: cough, dyspnea. CV: ARRHYTHMIAS, CHF, peripheral edema, bradycardia, chest pain, hypotension, palpitations, syncope, tachycardia. GI: abnormal liver function 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, leukopenia, thrombocytopenia. Metab: weight gain. MS: joint stiffness, muscle cramps. Neuro: paresthesia, tremor. Misc: STEVENS-JOHNSON SYNDROME, gingival hyperplasia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Although intended to treat certain arrhythmias, this drug can unmask or precipitate new arrhythmias (proarrhythmic effect). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.

• Monitor rashes or other skin reactions (hives, abnormal sweating, itching/burning, exfoliation). Notify physician immediately because certain skin reactions may indicate serious hypersensitivity reactions (Stevens-johnson syndrome).

• Assess routinely for signs of CHF and pulmonary edema (dyspnea, cough, shortness of breath, rales/crackles, jugular venous distention). Report these signs to the physician.

• Assess blood pressure periodically and compare to normal values (see Appendix F) to help document antihypertensive effects.

• Assess episodes of angina pectoris at rest and during exercise. Document whether drug therapy is helpful in reducing the frequency and severity of anginal attacks.

• If used to treat Raynaud's syndrome, monitor the incidence and severity of vasospastic attacks to document whether diltiazem is successful in helping manage this condition.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to peripheral vasodilation.

• Assess signs of paresthesia (numbness, tingling) or muscle twitching. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Watch for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual ...