Patients experiencing a CCB overdose tend to remain awake and alert, even in the event of profound hypotension and bradycardia, while patients with -blocker poisoning are more likely to have an altered mental status and respiratory depression. Subtleties in presenting symptoms can help differentiate CCB and -blocker poisoning. Depending on the amount of the offending drug ingested and the patient's underlying cardiovascular health, the patient could remain asymptomatic or progress to cardiovascular collapse. The manifestations of toxicity are generally extensions of the drugs' pharmacologic and therapeutic effects and often include hypotension, bradycardia, conduction block, and myocardial depression. Antidotes for Calcium-channel-blocker and -blocker Toxicities Toxicity due to calcium-channel blockers (CCBs) or -blockers results in significant morbidity and mortality. Key words: calcium-channel blocker, beta blocker, poisoning, overdose, toxicity, dihydropyridine, nondyhidropyridine, glucagon, insulin therapy, molecular adsorbent recirculating system, lipid resuscitation therapy, methylene blueĪm J Health Syst Pharm.2012 69(3):199-212. This system should include ready availability of the agents, defined treatment protocols, and pharmacy and nursing staff familiar with these therapies in advance of patient presentation. Some newer options, such as high-dose euglycemic insulin therapy and lipid rescue therapy, have shown promising results, but in order to apply these treatments effectively and in a timely fashion, emergency physicians must have a support system prepared to treat these critically ill patients. Historically accepted treatment modalities, such as administration of calcium or glucagon, are reviewed. This issue reviews the pharmacology of beta blocker and calcium-channel blocker agents as well as the pathophysiology and clinical course of their associated toxicity. Such cases present relatively infrequently in the spectrum of emergency medicine and critical care practice. Emergency Department Treatment Of Beta Blocker And Calcium-channel Blocker PoisoningĮmergency Department Treatment Of Beta Blocker And Calcium-Channel Blocker Poisoning The treatment of a patient who has sustained an overdose of a beta blocker and/or calcium channel-blocking agent can be challenging and time-sensitive, with few proven treatment options beyond supportive care.
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