Diltiazem (Cardizem) Nursing Considerations

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Generic Name


Trade Name



Hypertension, angina, SVT, AFib, aflutter


Inhibits calcium transport resulting in inhibition of excitation and contraction,
leads to depression of AV and SA node leading to decreased HR, leads to vasodi-
latation and decreased blood pressure.

Therapeutic Class

Antianginals, antiarrhythmics, antihypertensive

Pharmacologic Class

Ca Channel Blocker (Benzothiazepine)

Nursing Considerations

• Contraindicated in 2nd and 3rd AV block
• May cause arrhythmias, CHF, bradycardia, peripheral edema, gingival
• Increases digoxin levels
• Don’t drink grapefruit juice
• Assess for signs of CHF
• Monitor EKG continuously
• Tell patient to change positions slowly
• Monitor serum potassium
• Instruct pt on how to take blood pressure

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Hey guys, let’s talk about, Diltiazem also known as Cardizem. This is an oral medication, as you can see here with the capsules, but it also comes in other forms like IV. So remember when we talk about the therapeutic class versus the pharmacologic class, the therapeutic class is how the drug works in the body while the pharmacologic class is the actual chemical effect. So for Diltiazem, the therapeutic class is antianginal, antihypertensive and antiarrhythmic while the pharmacologic class is a calcium channel blocker. So how does Diltiazem work? Well, it works by inhibiting calcium transport, which results in the inhibition of excitation and contraction, which leads to the depression of the AV and SA node here and here, a decreased heart rate, vasodilation, and decreased blood pressure. It makes sense why it is indicated for hypertension, angina, supraventricular tachycardia, atrial fibrillation in a flutter. So with Diltiazem, there are some pretty serious side effects that can occur and should be watched out for things like bradycardia, arrhythmias, and even peripheral edema.
So let’s take a look at a few nursing considerations for Diltiazem. You are going to want to assess your patient for signs of congestive heart failure while on this medication, monitor your patient’s EKG, as well as their serum potassium levels. Diltiazem is contraindicated in patients who have a second or third-degree AV block, and it may cause congestive heart failure or even gingival hyperplasia, which is an overgrowth of the gums. Be sure to teach your patient not to drink grapefruit juice and to also change positions slowly as orthotic hypotension could be caused by this medication. And teach your patient how to take their blood pressure, whether it’s at home or in their local pharmacy. An interesting thing to note about Diltiazem, there are ethnic differences that do exist with the treatment of hypertension with calcium channel blockers like Diltiazem; for instance, in the black population, calcium channel blockers are more effective than ACEI or ARBs, which makes calcium channel blockers the first-line treatment in this population. That’s it for Diltiazem or Cardizem. Now go out and be your best self today. And as always happy nursing.

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