BB and CCB Toxicity Flashcards
Clinical manifestation of BB toxicity
hypotension
bradycardia
dysrhythmias (prolonged QRS and QTc intervals)
hypoglycemia
seizures
respiratory depression and apnea
coma
Clinical manifestation of CCB toxicity: what are the hallmark symptoms
hypotension and bradycardia, hyperglycemia
Clinical manifestation of CCB toxicity: lack of perfusion to the CNS can cause what?
Fatigue, dizziness, lightheadedness
A severe CCB OD can cause what?
Syncope, coma, sudden death, ARDS
Diagnostic tests for BB and CCB toxicity
12-lead ECG
Continuous cardiac and hemodynamic monitoring
Chest x-ray and oxygen saturation
BMP with serum glucose, magnesium, calcium
Digoxin level (to rule out digoxin toxicity)
Thyroid function tests
Cardiac enzymes
Lactate
BB and CCB OD treatment: GI decontamination treatment options
AC, MDAC, gastric lavage, WBI
What GI decontamination technique should you use for patients who OD’ed on SR CCBs and beta-blockers?
AC
What should you do to patients who OD’ed on CCBs or BBs before administering AC?
Protect their airway to prevent aspiration!
BB and CCB OD treatment: if the patient is hypotensive
Any crystalloid fluid 10-20ml/kg, repeat PRN
What kinds of BB and CCB OD patients won’t respond to IV crystalloids?
Patients who are severely poisoned
BB and CCB OD treatment: bradycardia
Atropine 0.5-1mg IV push q2-3mins, MDD 3mg
What kinds of BB and CCB OD patients won’t respond to atropine?
Patients who are severely poisoned
BB and CCB OD treatment: calcium
Calcium chloride 10% 10-20ml, or calcium gluconate 30-60ml over 10 minutes administered q10min x2 doses, then q20-60min PRN
What is the purpose of administering calcium in a CCB or BB OD and what are the effects?
Increase extracellular calcium → improves hypotension, reverses negative inotropy, and impaired conduction
When to NOT give calcium in CCB or BB OD treatment and what it can cause if you do
If digoxin toxicity is also suspected; it can cause stone heart phenomenon
When to administer calcium first
CCB OD
(can give glucagon after if it fails)
When to administer glucagon first
BB OD
(can give calcium after if it fails)
BB and CCB OD treatment: glucagon
3-5mg IV over 1-2 minutes, may repeat with 4-10mg after 5 minutes with no improvement in hemodynamics
What is the purpose of administering glucagon in a CCB or BB OD and what are the effects?
Has inotropic and chronotropic effects; is able to bypass beta-adrenergic receptors and activates adenylate cyclase in myocardium
When can glucagon infusions be considered?
If an effect is achieved with glucagon administration
Reason glucagon infusions aren’t used often
ADEs
ADEs of glucagon infusion
vomiting, hyperglycemia
If you decide to proceed with a glucagon drip, what dose do you start with?
The starting rate is based on the dose the patient responded to
What ADE is expected with glucagon infusions and what do you have to do to manage the patient’s hemodynamics?
Tachyphylaxis is expected; you may need higher doses or other interventions
