Drug Induced CD

Question 1

TX: Abrupt Clonidine Withdrawal

Answer 1

SBP 180+ or DBP 120+ or organ damage (AKI/AMS/CP/R)

YES =
-Nicardipine IV 2.5-5 mg/hr (max 15 mg/hr)
-Clevidipine IV 1-5 mg/hr (max 30 mg/hr)
*Reduce BP by 25% max in 1st hour then to 160/110-100 over next 2-6 hr, then normal in 24-48 hr
*Then restart clonidine

NO =
-Restart clonidine at home dose

Question 2

Clonidine Withdrawal TX: If home clonidine was patch

Answer 2

Patches take 3 days to work
-Day 1: place patch + administer 100% of dose as oral
-Day 2: continue patch, 50% oral dose
-Day 3: continue patch, 25% oral dose
-Day 4: continue patch (DC oral dosing)

Question 3

How to Prevent Abrupt Clonidine Withdrawal

Answer 3

Question 4

TX of Drug-Induced ACS

Answer 4

1. NTG 0.4 mg SL
   -Aspirin 324
   -Heparin 60, 12 u/kg
2. STEMI/High Risk
   -Standard ACS tx
3. Low Risk
   -Standard Med Management

*Carvedilol over metoprolol if cocaine, amphetamine, methamphetamine induced

Question 5

TX: Bradycardia, AV Block from OD

Answer 5

1. Charcoal 50-100 g
   then

UNSTABLE
-Atropine 0.5 (3mg max)
+/- Epi, dopamine
-Ca, glucagon, insulin

STABLE
-Monitor vitals, let them metabolize drug

Question 6

Digoxin OD

Answer 6

Digibind, Digifab

Acute OD
# vials = ( 0.8 x ingested dose ) / 0.5

Chronic OD
# vials = ( dig level x kg ) / 100

Question 7

DI HF TX

Answer 7

Mirrors standard HF tx
-BB
-ACEI/ARB/ARNI
-MRA
-SGLT2i

Question 8

Drugs: Prolong QTc

Answer 8

-Antiarrhythmics
-Antibiotics
-Antidepressants
-Antiemetics
-Antifungals
-Antipsychotics
-Opioids

Question 9

TX: Torsades de Pointes

Answer 9

UNSTABLE
-Cardioversion if < 90 or Defibrillation if no heart pulse
-Mg Sulf 2 g IVP then 1-4 g/hr (until Mg over 2)
-Iso 2-20 mcg (until HR over 60)

STABLE
-Mg Sulf 2 g IVP then 1-4 g/hr (until Mg over 2)
-Iso 2-20 mcg (until HR over 60)