Generic Dilacor cd (Diltiazem hcl 90/120/180mg)
DILTIAZEM HCI
Tablets: 30, 60, 90 and 120 mg (Rx) Various, Cardizem (Marion Merrell Dow)
Capsules, sustained-release: 60, 90, 120, Various, Cardizem SR (Marion Merrell Dow)
180, 240, 300 and 360 mg (Rx) Cardizem CD (Marion Merrell Dow),
Dilacor XR (Rhone-Poulenc Rorer), Tiazac (Forest)
Injections: 25 mg (5 mg/50 mL),
50 mg (5 mg/mL) (Rx) Cardizem (Marion Merrell Dow)
Oral-
Tablets: Start with 30 mg 4 times/day before meals and at bedtime; gradually increase dosage to 180 to 360 mg (given in divided doses 3 or 4 times/day) at 1-to 2-day intervals until optimum response is obtained.
Sustained release:
Cardizem SR -Start with 60 to 120 mg twice daily. Adjust dosage when maximum antihypertensive effect is achieved (usually by 14 days chronic therapy). Optimum dosage range is 240 to 360 mg/day, but some patients may respond to lower doses.
Cardizem CD -
Hypertension: 180 to 240 mg once daily; some patients may respond to lower doses. Maximum antihypertensive effect is usually achieved by 14 days chronic therapy; therefore, adjust dosage accordingly. Usual range is 240 to 360 mg once daily; experience with doses > 360 mg is limited.
Angina: Start with 120 or 180 mg once daily. Some patients may respond to higher doses of up to 480 mg once daily. When necessary, titration may be carried out over a 7- to 14-day period.
Cardizem CD may be opened and administered, but do not crush.
Dilacor XR -
Hypertension: 180 to 240 mg once daily; adjust dose as needed. Individual patients, particularly those > 60 years of age, may respond to a lower dose of 120 mg. Usual range is 180 to 480 mg once daily. Although current clinical experience with the 540 mg dose is limited, the dose may be increased to 540 mg with little or no increased risk of adverse reactions. Do not exceed 540 mg once daily. Angina: Adjust dosage to each patient's needs, starting with a dose of 120 mg once daily, which may be titrated to doses of up to 480 mg once daily, when necessary, titration may be carried out over a 7- to 14-day period.
Hypertensive or anginal patients treated with other formulations of diltiazem can safely be switched to Dilacor XR at the nearest equivalent total daily dose. However, subsequent titration to higher or lower doses may be necessary and should be initiated as clinically indicated.
Administration in the morning on an empty stomach is recommended.
Parenteral -
Direct IV single injections (bolus): The initial dose is 0.25 mg/kg as a bolus administered over 2 minutes (20 mg is a reasonable dose for the average patient). If response is inadequate, a second dose may be administered after 15 minutes. The second bolus dose should be 0.35 mg/kg administered over 2 minutes (25 mg is a reasonable dose for the average patient). Individualize subsequent IV bolus doses. Dose patients with low body weights on a mg/kg basis. Some patients may respond to an initial dose of 0.15 mg/kg, although duration of action may be shorter.
Continuous IV infusion: For continued reduction of the heart rate (up to 24 hours) in patients with atrial fibrillation or atrial flutter, an IV infusion may be administered. Immediately following bolus administration of 20 mg (0.25 mg/kg) or 25 mg (0.35 mg/kg) and reduction of heart rate, begin an IV infusion. The recommended initial infusion rate is 10 mg/hr. Some patients may maintain response to an initial rate of 5 mg/hr. The infusion rate may be increased in 5 mg/hr increments up to 15 mg/hr as needed, if further reduction in heart rate is required. The infusion may be maintained for up to 24 hours. Therefore, infusion duration > 24 hours and infusion rates > 15 mg/hr arc not recommended.
Concomitant therapy: Concomitant therapy with p-blockers or digitalis is usually well tolerated, but the effects of co-administration cannot be predicted, especially in patients with left ventricular dysfunction or cardiac conduction abnormalities. Use caution in titrating dosages for impaired renal or hepatic function patients, since dosage requirements are not available.
CARDIO & BLOOD – CHOLESTEROL
VASOPRESSORS USED IN SHOCK
Vasopressors: Sympathomimetic agents are used in shock to treat hypoperfusion in normovolemic patients and in patients unresponsive to whole blood or plasma volume expanders. These agents increase myocardial contractility, constrict capacitance vessels, and dilate resistance vessels. In cardiogenic shock or advanced shock from other causes associated with a low cardiac output, they may be combined with vasodilators (e.g., nitroprusside, nitroglycerin) to maintain blood pressure while the vasodilator improves myocardial performance. Nitroprusside is used to reduce preload and after-load and improve cardiac output. Nitroglycerin directly relaxes the venous vasculature and decreases preload.
Pharmacology: Sympathomimetic agents produce a-adrenergic stimulation (vasoconstriction), B1-adrenergic stimulation (increase myocardial contractility, heart rate, automaticity, and AV conduction), and B2-adrenergic activity (peripheral vasodilation). Dopamine also causes vasodilation of the renal and mesenteric, cerebral, and coronary beds by dopaminergic receptor activation.
Monitoring: Monitoring shock patients and their response to drugs requires special vigilance. Monitor heart rate, blood pressure, and ECG continuously. Record urine output and fluid intake frequently. Due to rapid and life-threatening changes that can occur in the hemodynamically unstable patient, optimal drug selection, dose titration, and management is probably best achieved with the use of invasive hemodynamic monitoring.
Administration: Administration only should be via the IV route using a large-bore, free flowing IV in the antecubital vein, or a central vein due to unpredictable absorption. Small IVs in the extremities are both unreliable and unsafe for vasopressor administration. Frequent monitoring of the IV sites for extravasation injury is essential when vasopressor agents arc being used.
Prolonged, high-dose therapy: Prolonged, high-dose therapy can produce cyanosis and tissue necrosis of distal extremities. The principle of using the lowest dose that produces an adequate response for the shortest period of time is very important when using these agents.
Plasma volume depletion: Prolonged use of vasopressors may result in plasma volume depletion; correct this by appropriate fluid and electrolyte replacement therapy. If plasma volumes are not corrected, hypotension may recur when these drugs are discontinued.
Acidosis: Acidosis lessens the response to vasopressors; therefore, correct acidosis if it exists or develops during the course of vasopressor therapy.
Avoid continuous IV therapy: Acute tolerance develops during continuous IV administration. High concentration/low volume (250 mL) vasopressor solutions administered with the aid of an infusion control device allows for maximum dosing flexibility because fluids and drugs can be regulated independently and the development of tolerance is minimized.
CARDIO & BLOOD – CHOLESTEROL
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