Verapamil

Question 1

What is another name for Verapamil?

Answer 1

Isoptin

Question 2

What kind of drug is Verapamil?

Answer 2

Calcium channel blocker

Class IV antidysrhythmic

Question 3

How does Verapamil work?

Answer 3

Used as antidysrhythmic, antianginal, and antihypertensive agent. It works by inhibiting the movement of calcium ions across cell membranes.
It decreases atrial automaticity, reduces AV conduction velocity, and prolongs the AV nodal refractory period. It also depresses myocardial contractility, reduces vascular smooth muscle tone, and dilates coronary arteries in normal and ischemic tissues.
May be used as an alternative (after Adenosine) to terminate reentry SVT with narrow QRS complex and adequate BP and preserved LF function.

Question 4

What is the onset of Verapamil?

Answer 4

1-5 minutes

Question 5

What is the duration of Verapamil?

Answer 5

30-60 minutes, may persist longer

Question 6

What are indications for Verapamil?

Answer 6

• ONLY in narrow complex reentry supraventricular tachycardias or known SV dysrhythmias
• Aflutter with RVR
• Afib with RVR
• multi focal atrial tachycardia
• vasospastic and unstable angina

Question 7

What are contraindications for Verapamil?

Answer 7

• sick sinus syndrome (unless the patient has a functioning pacemaker)
• 2nd or 3rd degree heart block
• bradycardia
• hypotension
• cardiogenic shock
• severe CHF
• WPW syndrome
• patients receiving IV beta blockers
• wide complex tachycardias of uncertain origin

Question 8

What are some adverse reactions of Verapamil?

Answer 8

• dizziness, headache, N/V
• hypotension
• bradycardia
• complete AV block
• peripheral edema

Question 9

What are some drug interactions with Verapamil?

Answer 9

• Verapamil increases serum concentration of Digoxin
• beta-adrenergic blockers may have additive negative inotropic and chronotropic effects
• antihypertensives may potentiate hypotensive effects

Question 10

How is Verapamil supplied?

Answer 10

5mg/2mL in 2-, 4-, and 5-mL vials or 2-, 4-mL ampules

Question 11

What is the initial dose of Verapamil?

Answer 11

2.5-5mg slow IV over 2 minutes

Question 12

What is the repeat dose for Verapamil?

Answer 12

5-10mg bolus 15-30 minutes after initial dose
OR
5mg bolus every 15 minutes until desired response (max dose 30mg)

Question 13

What are some special considerations for Verapamil?

Answer 13

• pregnancy safety category C
• be prepared to resuscitate
• AV block or asystole may occur because of slowed AV conduction