Unique Plan Description: Diltiazem (Cardizem) Protocol
Plan Selection Display: Diltiazem (Cardizem) Protocol
PlanType: Medical                                 
Version: 3          
Begin Effective Date: 2020-04-19 12:50:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 10:05:32
Available at all facilities: No

Diltiazem (Cardizem) Protocol
IV Solutions
	Cardizem 100 mg/100 mL NS Premix IV
		100 mg, EVERY BAG, 10 mg/hr
		100 mL, IV, Routine, Start: T;N, Maintain Parameter Goal: HR< 100, Increment Increase: 5 mg/hr, Increment Decrease: 5 mg/hr, Increment Freq: 15 min(s), Max Dose: 15 mg/hr
			Comment: ACTIVATION REQUIRED PRIOR TO USE.  increase infusion to 15mg/hr if heart rate greater than or equal to 120 after second bolus.  Discontinue Diltiazem infusion 1 hour after oral dose initiated.  Begin  Tiazac 180 mg po when HR rate has been less than 100 bpm for 4 hours, and or sinus rhythm has returned, if infusion rate 5mg/hr. Begin Tiazac 240 mg po when heart rate has been less than 100 bpm for 4 hours, and or sinus rhythm has returned, if infusion rate 10 mg/h.  Begin Tiazac 300 mg po when heart rate has been less than 100 bpm for 4 hours, and or sinus rhythm has returned, if infusion rate 15 mg/hr.  Enter oral diltiazem order from Atrial Fibrillation Powerplan.
	Cardizem 100 mg/100 mL NS Premix IV (JE)
		100 mg, EVERY BAG, 10 mg/hr
		100 mL, IV, Routine, Start: T;N, Maintain Parameter Goal: HR< 100, Increment Increase: 5 mg/hr, Increment Decrease: 5 mg/hr, Increment Freq: 15 min(s), Max Dose: 15 mg/hr
			Comment: ACTIVATION REQUIRED PRIOR TO USE.  increase infusion to 15mg/hr if heart rate greater than or equal to 120 after second bolus.  Once HR rate has been less than 100bpm for 4 hours, and or sinus rhythm has returned, contact MD for further oral orders.
	diltiazem 100 mg/NS 100 mL (FH)
		100 mg, EVERY BAG, 10 mg/hr
		100 mL, IV, Routine, Start: T;N, Maintain Parameter Goal: HR< 100, Increment Increase: 5 mg/hr, Increment Decrease: 5 mg/hr, Increment Freq: 15 min(s), Max Dose: 15 mg/hr
Medications
	Cardizem
		0.25 mg/kg, Injection, IV Push, Once, PRN see comment
			Comment: PRN heart rate >/= 120bpm, for 20 minutes. Give over 2 minutes, then begin diltiazem infusion at 10mg/hr. Max dose 20mg
		0.35 mg/kg, Injection, IV Push, Once, PRN see comment
			Comment: PRN heart rate > 120bpm 30 min after 1st bolus given. Give over 2 minutes, if heart rate greater than 120 bpm after bolus, increase infusion to 15mg/hr.  Max dose 25mg
Oral
	Tiazac
		180 mg, Capsule-Extended-Release, By Mouth, Q24H
			Comment: begin when heart rate has been less than 100 bpm for 4 hours, and or sinus rhythm has returned, if infusion rate 5mg/hr
		300 mg, Capsule-Extended-Release, By Mouth, Q24H
			Comment: begin when heart rate has been less than 100 bpm for 4 hours, and or sinus rhythm has returned, if infusion rate 15 mg/hr
		240 mg, Capsule-Extended-Release, By Mouth, Q24H
			Comment: begin when heart rate has been less than 100 bpm for 4 hours, and or sinus rhythm has returned, if infusion rate 10 mg/hr
Patient Care

	Notify MD
		Notify Cardiologist in AM of initiation of protocol
		Notify Cardiologist if systolic BP < 100mmHg, ventricular response > 120 bpm, angina/chest pain. After initiation of protocol.
Therapies
	Pulse Oximetry Spot Check RT
		Stat

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase