amiodarone and cardizem for a flutter

[dms811]

I'm fairly new to critical care nursing. I was wondering if anyone could help me out here.

I had a patient admitted with dka. His heart rate was 150-160. Ekg showed a flutter. Dr ordered 150 bolus of amiodarone and to start a cardizem gtt 30 min after the amiodarone.

It ended up working, pt converted to sinus rhythym.

What is the reasoning he ordered it that way? I thought it was always one or the other. I tried researching it, but have found no answers. Thanks in advance.

[/username, BSN, RN]

I'm confused about your question. While cardizem has some anitarrhythmic properties, it is primarily a anti-hypertensive due to its vasodilation properties and reduction of afterload. Amiodarone is primarily an antiarrythimic. What was the patient's blood pressures averaging to be?

[RN_Student14]

From what I have read on the American Heart associate website, potassium channel blockers treats abnormal rhythms while calcium channel Blockers treat tachycardia. They both are pretty much used for the same purpose but work differently to achieve the same outcome.

[VANurse2010]

I'm confused about your question. While cardizem has some anitarrhythmic properties, it is primarily a anti-hypertensive due to its vasodilation properties and reduction of afterload. Amiodarone is primarily an antiarrythimic. What was the patient's blood pressures averaging to be?

That is not true. Diltiazem (Cardizem) is primarily used for rate control in supraventricular arrythmias - not as an anti-hypertensive. Many of your chronic A-fibbers with a history of RVR will take an extended release capsule of diltiazem daily.

[MunoRN, RN]

Amiodarone is an anti-arrhythmic, diltiazem is a calcium channel blocker with primarily chronotropic effects and has no established anti-arrhythmic properties. Amiodarone will also lower heart rate and lower blood pressure to varying degrees.

As for why a Doc would want an amio bolus followed by a dilt drip, there are some docs who only order amio boluses and then use rate control in addition, which is basically what this doc is ordering, I think there's a belief that if the patient doesn't convert with an Amio bolus, then a continuous drip only limits your ability to control rate because of the BP effects of amio.

[VANurse2010]

Amiodarone is an anti-arrhythmic, diltiazem is a calcium channel blocker with primarily chronotropic effects and has no established anti-arrhythmic properties. Amiodarone will also lower heart rate and lower blood pressure to varying degrees.

As for why a Doc would want an amio bolus followed by a dilt drip, there are some docs who only order amio boluses and then use rate control in addition, which is basically what this doc is ordering, I think there's a belief that if the patient doesn't convert with an Amio bolus, then a continuous drip only limits your ability to control rate because of the BP effects of amio.

I agree with your first paragraph but would add that sometimes once the rate is sufficiently slowed on a diltiazem drip (e.g. A fib with RVR) the SA node will recapture and patient will covert to SR.

[MunoRN, RN]

I agree with your first paragraph but would add that sometimes once the rate is sufficiently slowed on a diltiazem drip (e.g. A fib with RVR) the SA node will recapture and patient will covert to SR.

Personally I've found that there does seem to be some sort of antiarrhythmic effect that rate control has, which would seem to make sense if it's possible that controlling the ventricular response effect of an atrial arrhythmia could cause some sort of 'retrograde' effect on the atrial ectopy, however such an effect has never been sufficiently established to say for sure that's how it works.