Calcium Channel Blockers CCBs

Question 1

CCB Verapamil & Diltiazem Risk Assessment

Answer 1

• 2-3x n dose verapamil or Diltiazem XR toxic
• deliberate= lethal
• > 10 tablets life threatening
• Onset: std release 2 hr XR 16 hrs
• co ingestion Increases risk
• Old + comorbidities

Question 2

CCB clinical

Answer 2

CVS: brady/ hypo/ heart blocks/ refractory shock & death/ MI/ Stroke/ non occlusive mesenteric ischaemia
CNS: sz/ coma rare
Metabolic: hyperglycaemia/ lactic acidosis

Question 3

CCB Life threats

Answer 3

Hypotension
cardiac dysrhythmias
Cardiac arrest

Question 4

CCB Mx priorities

Answer 4

Early invasive monitoring
- Fluid resus: 10-20ml/kg N-Saline
- Calcium: AIM level > 2 mEq/L (boluses upto 3x)
Calcium gluconate 10% 60ml (0.6-1ml/Kg)
Calcium Chloride 10% 20 ml (0.2ml/kg)
-Atropine 0.6mg max 3 mg
-Catecholamine infusion: adrenaline/ Norad/ dopamine
- HIET
-Bicarb: for metabolic acidosis
-Cardiac Pacing: ventricular should bypass AV node rate 60bpm
- Cardiopulmonary bypass + IABP

Question 5

CCB Decontamination

Answer 5

Standard release < 4 hr
AC 50 g
Give to all intubated patients
WBI: commence cooperative without established toxicity

Question 6

CCB Enhanced elimination

Answer 6

None

Question 7

CCB Antidote

Answer 7

Calcium
Atropine
HIET

Question 8

CCB Disposition

Answer 8

Normal ECG & no tox

• 4 hrs post standard release
• 16 hrs post XR