Medical toxo (cardiovascular)DONE

Question 1

uses of Beta Adrenergic Blockers & Calcium Channel Blockers

Answer 1

Hypertension, ischemic heart disease, congestive heart failure, and certain arrhythmias.

Question 2

Moderate lipid soluble BB

Answer 2

Labetalol and Pindolol.

Question 3

high lipid soluble BB

Answer 3

Propranolol

Question 4

Low lipid soluble BB

Answer 4

Atenolol and Sotalol.

Question 5

.Non-dihydropyridine agents.

non DHB

Answer 5

Verapamil, and Diltiazem.

Question 6

moa of CCB

Answer 6

Inhibit Ca+, entry through calcium channels
located on
- Vascular smooth muscle
- Cardiac myocytes
- Cardiac nodal tissue (SA & AV nodes).

Question 7

CVS manifestations of BB and CCB

Answer 7

a- Two cardinal signs: Hypotension and bradycardia.
b-A prolonged PR interval is an early sign
c- Prolongation of QRS interval may occur (in Propranolol).
d-Prolonged QT intervals, ventricular arrhythmia & Torsade’s de pointes may occur (in Sotalol & Bepridil).

Question 8

Prolongation of QRS interval in

Answer 8

propranololarge dose of diphenhydramine
phenothiazine
TCA
Cocaine
Propranololl

Question 9

block sodium channel

Answer 9

large dose of diphenhydramine
phenothiazine
TCA
Cocaine
Propranolol

Question 10

other manifestations of BB and CCB

Answer 10

a- CNS manifestations: seizures and coma.
b- Respiratory: pulmonary edema (due to anoxia as a result of hypotension).
c- Metabolic acidosis
d-Hyperglycemia (in CCBs only): due to suppression of insulin release coupled with body insulin resistance.
e- Hypoglycemia (in BBs only).
f- Hyperkalemia (in BBs only).
g- Bronchospasm occurs only in susceptible patients (in BBs only).

Question 11

investigations of BB and CCB

Answer 11

Blood glucose: decreased (in BBs) & increased in CCBs
electrolytes increased K in BBs
ABG
toxicological screening
ECG & cardiac monitoring

Question 12

Treatment of BB and CCB toxicity

Answer 12

ABC
- Gastric Lavage.
- Activated charcoal
- Multiple dose activated charcoal (MDAC) is indicated in sustained-release pills.
- Whole-bowel irrigation (WBI) is indicated in sustained-release pills.

Question 13

antidotes of CCB

Answer 13

Calcium chloride
Calcium Gluconate

Question 14

treat bradycardia result from BB and CCb toxicity

Answer 14

Atropine 0.5 mg IV if no response:
Glucagon IV (In BBs toxicity only)
Norepinephrine continuous infusion.
cardiac pacing or intra aortic ballon pumps

Question 15

Hyperinsulinemic euglycemic therapy (HIET). is indicated in

Answer 15

BB and CCb toxicity

Question 16

specific treatment of BB and CCB

Answer 16

Maintenance of hemodynamic stability d65 s90
Treat bradycardia
ii. Hyperinsulinemic euglycemic therapy (HIET).
iii. Intravenous lipid emulsion.

Question 16

Intravenous lipid emulsion is indicated in

Answer 16

BB and CCB toxicity

Question 17

moa of digoxin

Answer 17

Slows conduction through the atrioventricular (AV) node.

-It inhibits Na”—Ka” ATPase in the cardiac muscle fibers&raquo_space; increased intracellular Na* and Ca‘ and increased extracellular Ka”.

Question 18

uses of digoxin

Answer 18

treatment of congestive heart disease and cardiac arrhythmias.

Question 19

clinical presentation of digoxin toxicity

Answer 19

Tachyarrhythmias
Bradyarrhythmias
Hypotension
GIT: nausea, vomiting, colic and diarrhea.
Visual: blurring, halos (yellow / green halos).
CNS: headache, drowsiness, and disorientation.
Hyperkalemia in acute toxicity and hypokalemia in chronic patients

Question 20

causes blurring and blue green halos

Answer 20

Digoxin

Question 21

first manifestation to occur in digoxin toxicity

Answer 21

IT: (the first to occur) nausea, vomiting, colic and diarrhea.

Question 22

investigations of digoxin toxicicty

Answer 22

Hyperkalemia in acute toxicity
- Hypokalemia in chronic toxicity.
-Kidney function tests: (renal impairment alters elimination of digoxin).
- Serum caicium levels
- toxicological screening 10 (serious prognosis)

Question 23

treatment of digoxin

Answer 23

GIT contamination: GL, AC, MDAC
antidote: Digi-bind [Fab]
symptomatic: treatment of arrhythmias and hypokalemia
hyperkalemia: insulin in 5% glucose
avoid the use of calcium as it may increase digitalis toxicity

Question 24

antibody of digoxin

Answer 24

Digi-bind [Fab] (Digoxin-specific antibody fragments)

Question 25

indication of digi bind fab

Answer 25

acute ingestion >10 in adults, >4 in childeren
serum digoxin level >10 in adults, > in children
serum hyperkalemia (>5)
life threating arrhythmias: asystole, ventricular fibrillation or complete heart block.
end-organ damage (e.g., renal failure, altered mental status)