β-Adrenergic Blocker Poisoning Management Quiz

Propranolol has a membrane depressant effect which contributes to its cardiac depressant effects

Most poisonings involve propranolol

High doses of β-adrenergic blockers with intrinsic sympathomimetic activity can cause tachycardia & hypertension

The high lipid solubility of certain β-adrenergic blockers, especially propranolol, accounts for the CNS effects

In overdose, pharmacokinetic parameters may change drastically due to decreased cardiac output with subsequently reduced hepatic & renal blood flow

Blood drug level determination alone is reliable for assessing possible overdose

The most commonly reported signs & symptoms of β adrenergic blocker poisoning are listed in (Table 2)

Certain disease states like chronic obstructive pulmonary disease (COPD) & congestive heart failure (CHF) can improve the prognosis of poisoning

An overdose of β-adrenergic blockers causes an increase in myocardial contractility

Electrographic changes consist of first degree AV block, widening of the QRS complex, absence of P waves, prolongation of the QT interval

Sotalol & acebutolol prolong the QT interval

The prolonged QT interval by sotalol predisposes to torsades de pointes & ventricular dysrhythmias

β-adrenergic blockers are used for the treatment of hypertension, arrhythmia, angina, glaucoma, and migraine prophylaxis.

β-adrenergic blockers have significant pharmacologic and pharmacokinetic differences.

The toxicity of β-adrenergic antagonists is primarily due to their ability to enhance the action of catecholamines at cardiac β-adrenergic receptors.

Pharmacokinetic differences do not influence the therapeutic applications, incidence of side effects, and type & severity of toxic reactions when β-adrenergic blockers are taken in overdose.

Bradycardia is not a symptom of propranolol poisoning.

Ventricular tachydysrhythmias may occur in β-adrenergic blocker poisoning.

Orogastric lavage carries the risk of worsening bradycardia.

Activated charcoal can only be given once within the first 24 hours of poisoning.

Whole bowel irrigation with polyethylene glycol is not recommended for sustained release preparations.

Glucagon may be given if the patient is compromised hemodynamically.

Phosphodiesterase inhibitors inamrinone and milrinone are not beneficial in β-adrenergic antagonist overdose.

Hemoperfusion and hemodialysis are not considered in cases involving nadolol and atenolol.

Management of poisoning includes giving atropine after laryngoscopy.

Inotropes are not required for patients who fail to respond to atropine and fluids.

It is preferable to introduce medications sequentially, starting with insulin euglycemia therapy followed by glucagon.

Phosphodiesterase inhibitors improve AV conduction in β-adrenergic antagonist overdose.

______ poisoning is characterized by coma, seizures, hypotension, bradycardia, impaired AV conduction, and prolonged QRS interval.

Ventricular tachydysrhythmias may also occur in β-adrenergic blocker ______.

Activated ______ can be given repeatedly during the first 24 hours and whole bowel irrigation with polyethylene glycol should be considered for sustained release preparations.

In the treatment of bradycardia, ______ may be given if the patient is compromised hemodynamically and the hypotensive patient may respond to fluids in the absence of pulmonary edema.

Patients who fail to respond to atropine and fluids require management with ______.

______ produces positive inotropic and chronotropic activity and improves AV conduction.

The phosphodiesterase inhibitors inamrinone and milrinone are ______oretically beneficial in β-adrenergic antagonist overdose, and hemoperfusion and hemodialysis may be considered in cases involving nadolol and atenolol.

______ of β-Adrenergic Blocker Poisoning includes maintaining airway ventilation, giving atropine before laryngoscopy, orogastric lavage, and activated charcoal administration.

______ areas of management include giving glucose for hypoglycemia, diazepam for convulsions, and monitoring potassium levels.

When ______ permits, it is preferable to introduce medications sequentially, starting with glucagon followed by calcium, high dose insulin euglycemia therapy, a catecholamine, and if this fails, phosphodiesterase inhibitors.

‫الكاتيكوالمينات في المستقبالت األدرينالية بيتا القلبية‬ A ______ depressant effect likely contributes to the cardiac depressant effects of propranolol.‫من المحتمل أن يساهم التأثير المثبط للغشاء في التأثيرات المثبطة للقلب للبروبرانولول‬

Most poisonings involve ______ ‫معظم حاالت التسمم تنطوي على بروبرانولول‬

High doses of β-adrenergic blockers with intrinsic sympathomimetic activity (ISA) (e.g., acebutolol & pindolol can cause ______ & hypertension ‫) (على سبيل‬ISA( ‫الجرعات العالية من حاصرات بيتا األدرينالية ذات النشاط الودي الداخلي‬

The high ______ solubility of certain β-adrenergic blockers, especially propranolol accounts for the CNS effects ،‫ وخاصة البروبرانولول‬،‫إن القابلية العالية للذوبان في الدهون لبعض حاصرات بيتا األدرينالية‬.‫مسؤولة عن تأثيرات الجهاز العصبي المركزي‬

In overdose, pharmacokinetic parameters may change drastically due to decreased ______ output with subsequently reduced hepatic & renal blood flow ‫ قد تتغير معلمات الحركية الدوائية بشكل كبير بسبب‬،‫في حالة تناول جرعة زائدة‬ ‫ انخفاض النتاج القلبي مع انخفاض تدفق الدم الكبدي والكلوي الح ًقا‬

Blood drug level ______ alone is unreliable for assessing possible overdose because clinical symptoms might persist beyond the drug’s half life ‫تحديد مستوى الدواء في الدم وحده ال يمكن االعتماد عليه لتقييم الجرعة الزائدة المحتملة ألن‬ ‫األعراض السريرية قد تستمر بعد نصف عمر الدواء‬

Characteristics of poisoning The most commonly reported signs & symptoms of β adrenergic blocker poisoning are listed in (______) Certain disease states can worsen the prognosis. For example, in case of chronic obstructive pulmonary disease (COPD) & congestive heart failure (CHF) ‫ في‬،‫ على سبيل المثال‬.‫بعض الحاالت المرضية يمكن أن تؤدي إلى تفاقم التشخيص‬ )CHF( ‫) وقصور القلب االحتقاني‬COPD( ‫حالة مرض االنسداد الرئوي المزمن‬

An overdose causes a ______ of myocardial contractility, producing bradycardia & severe hypotension leading to cardiogenic shock ‫ مما يؤدي إلى بطء القلب‬،‫تؤدي الجرعة الزائدة إلى انخفاض انقباض عضلة القلب‬ ‫وانخفاض ضغط الدم الشديد مما يؤدي إلى صدمة قلبية‬

Electrographic changes consist of first degree ______ block (prolonged PR interval), widening of the QRS complex, absence of P waves, prolongation of the QT interval ،)‫ طويل‬PR ‫ من الدرجة األولى (فاصل‬______ ‫تتكون التغييرات الكهربية من إحصار‬ QT ‫ وإطالة فترة‬،P ‫ وغياب موجات‬،QRS ‫واتساع مجمع‬

______, & acebutolol prolong the QT interval The prolonged QT interval by sotalol predisposes to torsades de pointes & ventricular dysrhythmias may complicate the therapeutic use of sotalol ‫ قد تؤدي النقاط واضطراب النظم‬.

Certain disease states like chronic obstructive pulmonary disease (COPD) & congestive heart failure (CHF) can ______ the prognosis of poisoning

Most poisonings involve ______

______ produces positive inotropic and chronotropic activity and improves AV conduction

The most commonly reported signs & symptoms of β adrenergic blocker poisoning are listed in (______)

The high ______ solubility of certain β-adrenergic blockers, especially propranolol accounts for the CNS effects

β-adrenergic blockers are used for the treatment of hypertension, arrhythmia, angina, glaucoma, and migraine prophylaxis

In overdose, pharmacokinetic parameters may change drastically due to decreased ______ output with subsequently reduced hepatic & renal blood flow

Toxicity of β adrenergic blockers Most of the toxicity of β adrenergic antagonists is because of their ability to competitively antagonize the action of catecholamines at cardiac β-adrenergic receptors

Activated ______ can be given repeatedly during the first 24 hours and whole bowel irrigation with polyethylene glycol should be considered for sustained release preparations

______ areas of management include giving glucose for hypoglycemia, diazepam for convulsions, and monitoring potassium levels

Certain disease states like chronic obstructive pulmonary disease (COPD) & congestive heart failure (CHF) can ______ the prognosis of poisoning

Most of the toxicity of β adrenergic ______ is because of their ability to competitively antagonize the action of catecholamines at cardiac β-adrenergic receptors.

Toxicity of β adrenergic ______ Most of the toxicity of β adrenergic antagonists is because of their ability to competitively antagonize the action of catecholamines at cardiac β-adrenergic receptors.

______ blockers are widely used for treatment of many disease states, including hypertension, arrhythmia, angina, glaucoma, & migraine prophylaxis.

Applications

Adrenergic

Treatment

Reactions

Side

Toxicity