High BP but Low HR... Which med will you give/hold?

[gelman]

Patient with SBP in the 170s, HR in the 50s. Carvedilol (Coreg) and Diltiazem (Cardizem) are both scheduled to be administered without parameters. Which one will you give and which one will you hold? And why?

Please help me understand...

[mortalol]

i agree with amnesty. if they take these meds long term they'll probably not make much difference on the HR. Depends on the doses as well i suppose, if they are on a starting dose of cardedilol again it wouldn't affect HR that much. But to be on the safe side i would contact the MD

[William2]

Assess the patient first. What's their rhythm and rate? Could it be a junctional, some type of escape beat, or block requiring future pacer? What about neuro status like? Cusioning's triad?

I'd call for some hydralazine if all above negative and reassess.

[Workitinurfava, BSN, RN]

Need more hx.

[nille1178]

Cardizem absolutely can slow the HR down I work a cardiac step down unit and this is the drug of choice always when a patient has a afib w/ RVR or SVT its used to control the rate. There are times when we have to cut the drip off if the HR is too low.

[AliNajaCat]

Calling the prescriber regarding decision-making on altering a prescribed medication (which is what a hold would be) is not an option. It's ra required element. I agree with many of the above rationales, assessments, and actions, but for that one: calling the prescriber isn't just a nice-to-do, it's essential.