antihypertensive and digoxin toxicity

Question 1

Which agents have toxidrome of bradycardia and hypotension

Answer 1

Beta blockers & calcium channel blockers

Question 2

CCB overdose/toxicity agents and effects

Answer 2

• non-DHP CCBs: Verapamil & Dilitazem
• cause vasodilation and av node depression
• Elevated blood sugar

Question 3

BB toxicity effects

Answer 3

• CNS depression, seizures, neg inotropic effects (dec heart rate and contractility)

Question 4

GI decontamination treatment for BB and CCB

Answer 4

Activated charcoal & Whole bowel irrigation

Question 5

Treatments for BB and CCB toxicity

Answer 5

• Fluids: Normal saline, lactated ringers
• Atropine: .5- 1mg q5 min x 3
• Calcium chloride or Gluconate (better)
• Glucagon (controversial)
• High dose insulin + glucose
• vasopressors
• inotropes
• cardiac pacing
• intralipids

Question 6

what is calcium chloride and gluconate used for

Answer 6

contractility

Question 7

Acute AEs of digoxin toxicity

Answer 7

• GI: n/v/d
• CNS: HA, confusion/delirium, visual changes
• Metabolic: Hyperkalemia (Goal is K<5)

Question 8

EKG changes w/ digoxin toxicity

Answer 8

• dec conduction, inc automaticity
  -prolonged PR intervals ( Salvador Dali’s Mustache)

Question 9

GI decontamination options for Digoxin

Answer 9

• activated charcoal w/ repeated doses in dec renal failure

Question 10

Treatment options for digoxin

Answer 10

• DigoxinFab treats hyperkalemia
  Given when K>5, level>20, progressing signs of toxicity
• Empirically 10 vials; clinically give 1-2 vials + titrate to max effect
• Phenytoin is alternative