beta blockers (bb) - austin health: home blockers guideline_sg...beta blockers (bb) version 1:...

Propranolol and sotalol overdose can produce life-threatening cardiovascular toxicity. Toxicity / Risk Assessment Management - Treat ↓BP in graduated, but aggressive manner. Early echocardiogram may guide Rx Onset of effects occur within 1-2 hours Bradycardia Onset of effects for Metoprolol MR may be delayed Atropine: 0.6 mg IV boluses q5 minutely up to 3 doses (child 0.02 mg/kg boluses) Ingestion > 1 g Propranolol may cause significant toxicity, Isoprenaline: 20 mcg IV, repeat to clinical response (up to 100 mcg, via peripheral line) OR usually within 6 hours epinephrine infusion titrated to response. Electrical pacing is the definitive treatment Lone ingestion of other BB: significant toxicity unlikely Hypotension Likelihood of toxicity increases with: underlying CVS Fluid: Initially load with 10-20 mL/kg IV crystalloid. Further IV fluid may lead to pulmonary oedema disease, elderly, co-ingestion of other –ve inotropes (CCBs) High Dose Insulin-Euglycaemia Therapy (HIET): HIET is most effective if commenced early No medical treatment required if patient is well AND has - 50 mL of 50% dextrose as slow IV bolus FOLLOWED BY 1 unit/kg IV actrapid bolus normal ECG 6 hours post ingestion - Commence 1 unit/kg/hour actrapid infusion. Titrate to effect up to 10 units/kg/hour over first hour Clinical features: - Closely monitor serum glucose and K⁺ - CVS: ↓HR and ↓BP. Norepinephrine infusion ↑PR may be first sign of CVS toxicity. Mechanical: consider early IABP or Extra-Corporeal Life Support (ECLS) interventions in severe cases Increasing AV block progressing to complete heart block, Wide QRS and Na channel blockade (propranolol OD is managed as a TCA antidepressant OD) CVS collapse, pulmonary oedema. - Bolus dose – 1 mL/kg 8.4% NaHCO3 solution as slow (2 minutes) IV push - Other: ↓glucose, ↑K⁺ - Repeat bolus doses q5minute to rapidly acquire pH in 7.50-7.55 range. Maintain with hyperventilation - Sotalol: ↑QT, ↓HR, TdP Management of ↑ QT Interval – CVS monitor +maintain normal serum Ca 2+ ,K + , Mg 2+ concentrations - Propranolol: ↑QRS, ventricular arrhythmias, delirium, Management of TdP coma, seizures - MgSO4 10 mmol (2 grams) as IV push (if pulseless: electrical defibrillation) - Maintain HR > 80 bpm with isoprenaline/epinephrine or with electrical pacing AUSTIN CLINICAL TOXICOLOGY SERVICE GUIDELINE POISONS INFORMATION CENTRE: 13 11 26 Beta Blockers (BB) Version 1: Published 7/2017. Review 7/2020

Upload: ngotu

Post on 10-Jun-2018

213 views

Category:

Documents

0 download

Report

Download

Embed Size (px):

TRANSCRIPT

Page 1: Beta Blockers (BB) - Austin Health: Home Blockers guideline_SG...Beta Blockers (BB) Version 1: Published 7/2017. Review 7/2020 Title Microsoft Word - Beta Blockers guideline_SG.docx

Propranololandsotaloloverdosecanproducelife-threateningcardiovasculartoxicity.

Toxicity/RiskAssessment Management-Treat↓BPingraduated,butaggressivemanner.EarlyechocardiogrammayguideRx

Onsetofeffectsoccurwithin1-2hours Bradycardia

OnsetofeffectsforMetoprololMRmaybedelayed Atropine:0.6mgIVbolusesq5minutelyupto3doses(child0.02mg/kgboluses)

Ingestion>1gPropranololmaycausesignificanttoxicity, Isoprenaline:20mcgIV,repeattoclinicalresponse(upto100mcg,viaperipheralline)OR

usuallywithin6hours epinephrineinfusiontitratedtoresponse.Electricalpacingisthedefinitivetreatment

LoneingestionofotherBB:significanttoxicityunlikely Hypotension

Likelihoodoftoxicityincreaseswith:underlyingCVS Fluid:Initiallyloadwith10-20mL/kgIVcrystalloid.FurtherIVfluidmayleadtopulmonaryoedema

disease,elderly,co-ingestionofother–veinotropes(CCBs) HighDoseInsulin-EuglycaemiaTherapy(HIET):HIETismosteffectiveifcommencedearly

NomedicaltreatmentrequiredifpatientiswellANDhas -50mLof50%dextroseasslowIVbolusFOLLOWEDBY1unit/kgIVactrapidbolus

normalECG6hourspostingestion -Commence1unit/kg/houractrapidinfusion.Titratetoeffectupto10units/kg/houroverfirsthour

Clinicalfeatures: -CloselymonitorserumglucoseandK⁺

-CVS:↓HRand↓BP. Norepinephrineinfusion

↑PRmaybefirstsignofCVStoxicity. Mechanical:considerearlyIABPorExtra-CorporealLifeSupport(ECLS)interventionsinseverecases

IncreasingAVblockprogressingtocompleteheartblock, WideQRSandNachannelblockade(propranololODismanagedasaTCAantidepressantOD)

CVScollapse,pulmonaryoedema. -Bolusdose–1mL/kg8.4%NaHCO3solutionasslow(2minutes)IVpush

-Other:↓glucose,↑K⁺ -Repeatbolusdosesq5minutetorapidlyacquirepHin7.50-7.55range.Maintainwithhyperventilation

-Sotalol:↑QT,↓HR,TdP Managementof↑QTInterval–CVSmonitor+maintainnormalserumCa2+,K+,Mg2+concentrations

-Propranolol:↑QRS,ventriculararrhythmias,delirium, ManagementofTdP

coma,seizures -MgSO410mmol(2grams)asIVpush(ifpulseless:electricaldefibrillation)

-MaintainHR>80bpmwithisoprenaline/epinephrineorwithelectricalpacing

AUSTINCLINICALTOXICOLOGYSERVICEGUIDELINEPOISONSINFORMATIONCENTRE:131126

BetaBlockers(BB)

Version1:Published7/2017.Review7/2020

Beta blockers in hypertension

4 ACE-Inhibitors, Beta( )-Blockers

Beta Blockers in HF

Beta blockers

Neuropsychiatric Consequences of Lipophilic Beta-Blockers

Beta blockers: Role in Hypertension

Beta blockers in brain injuries

Sujay iyer beta blockers

Beta-blockers in cardiovascular diseases

Beta blockers for heart failure

Beta blockers dr wan azizi

Beta blockers in sihd

Beta blockers in STEMI

Beta blockers in primary hypertensionbsmedicine.org/congress/2007/Dr._Billal.pdf · 2018. 3. 6. · Beta blockers 1958 - The first beta-blocker, dichloroisoproterenol, was originated

Beta blockers Pharmacology

Established uses of beta blockers

Beta blockers in cardiology

Non-selective Beta blockers

Beta adrenergic blockers

13 Beta Adrenoceptor Blockers

Beta Blockers in HTN

Pharmacotherapy for hypertension in the elderly · beta adrenergic blockers, combined alpha and beta blockers, calcium-channel blockers, diuretics, alpha adrenergic blockers, cen-

Asmah Nasser, M.D.. Alpha blockers Beta blockers Alpha plus beta blockers

Beta Blockers In Anesthesia. Introduction Introduction

Alpha & beta- adrenergic receptor blockers Adrenoceptor Blockers Adrenolytics Adrenergic Neuron Blockers Sympatholytics Form False Transmitters Deplete

Cocaine & Beta-Blockers

Toxicity of CCl4, CO, Beta-blockers

Beta Blockers In Anesthesia

Adrenolytics. Adrenoceptor Blockers Adrenolytics Adrenergic Neuron Blockers Sympatholytics Alpha & beta- adrenergic receptor blockers

Beta-blockers in cirrhosis: Cons

Beta blockers in Acute MI

Beta blockers and calcium channel blockers

Comprehensive Study of Beta Blockers

Beta Blockers and CV Disease 2013 · Beta Blockers and Hypertension • In early versions of JNC, beta-blockers were considered first-line therapy. • But in JNC 7, beta-blockers

Beta blockers in cardiology practice