Poisoning by cardiovascular drugs

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Poisoning by cardiovascular drugs

  1. 1. POISONING BYCARDIOVASCULAR DRUGS Ayman Zaaqoq Lecturer Department of Forensic Medicine and Clinical Toxicology, ASU 2012-2013
  2. 2. CV TOXICITY CV toxicity Bradycardia Tachycardia CalciumDigoxin Beta-blockers channel Theophylline blockers
  3. 3. CV TOXICITY INVESTIGATIONS Investigation Laboratory ECGS. drug level Glucose S.K+ KFTs ABG
  4. 4. TOXICITY TREATMENT GENERAL GUIDELINES TreatmentStabilization Decontamination Elimination Antidote Supportive MDAC: dig., Bradycardia, GL theo Very high level AVB Ventricular AC Dialysis: theo Serious C/P dysrhythmias Huge dose Hyperkalemia
  5. 5. TREATMENT OF SERIOUS DYSRHYTHMIAS TdP V-tach MgSO4 IV  Cardioversion Overdrive pacing  NaHCO3 IV Cardioversion  Lignocaine Phenytoin  Phenytoin  Esmolol
  6. 6. DIGOXIN TOXICITY
  7. 7. DIGOXIN TOXICITY SOURCES Pharmaceutical preparations:Lanoxin®, Cardixin® Plants: oleander Animals: cane toad
  8. 8. DIGOXIN TOXICITY FORMS Acute Chronic Accidental  Therapeutic error Intentional  Decreased elimination
  9. 9. DIGOXIN TOXICITY MECHANISM Digoxin Changes Θ Na+/K+- Vagotonic refractory ATPase period↑ intracellular ↑ extracellular ↓ in atria and Na+ K+ ↑ in AV node ventricles
  10. 10. DIGOXIN TOXICITY ACTIONS Digoxin ↓ ↑↑ inotropy ↑ potassium chronotropy automaticity
  11. 11. DIGOXIN TOXICITY CLINICAL PICTURE C/P PotassiumCV GI Visual imbalance
  12. 12. DIGOXIN TOXICITY INVESTIGATIONS Investigation Laboratory ECGS.K+ SDC KFTs ABG Glucose
  13. 13. DIGOXIN TOXICITY INVESTIGATIONS ECG changes • Due to digoxin intake • Due to digoxin toxicity • Due to potassium disturbances • Due to pre-existing cardiac condition
  14. 14. DIGOXIN TOXICITY TREATMENT TreatmentStabilization Antidote Supportive Decontamination Elimination (antidote) Ventricular GL (?) MDAC Bradycardia, AVB dysrhythmias AC Hyperkalemia
  15. 15. DIGOXIN TOXICITYANTIDOTE: DIGIBIND Indications Laboratory Clinical History S.K+ SDC High Unavailable
  16. 16. BETA-BLOCKER TOXICITY
  17. 17. BETA-BLOCKER TOXICITY MECHANISM BBβ-receptor Na channel Lipid blockade blockade solubility
  18. 18. BETA-BLOCKER TOXICITY ACTIONS BB ↓↓ inotropy chronotropy Wide QRS Θ CNS
  19. 19. BETA-BLOCKER TOXICITY CLINICAL PICTURE C/PCVs CNS Metabolic
  20. 20. BETA-BLOCKER TOXICITY INVESTIGATIONS Investigation Laboratory ECG Glucose S.K+ KFTs
  21. 21. DIGOXIN TOXICITY TREATMENT Treatment AntidoteStabilization Decontamination Supportive (Glucagon) Bradycardia, GL Wide QRS hypotension AC Seizures Hypoglycemia
  22. 22. CALCIUM CHANNEL BLOCKERS
  23. 23. CALCIUM CHANNEL BLOCKERS They block slow Ca channels of vascular smooth muscles andcardiac muscles. Acute toxicity is similar to B-blockers Treatment is as in B-blockers. In addition, CaCl2 10% 10ml IVover 10 min for hypotension and myocardial depression.
  24. 24. THEOPHYLLINE TOXICITY
  25. 25. THEOPHYLLINE TOXICITY MODE Mode of poisoning Intentional Dosing errors Change in the ReducedParent error Miscalculation frequency clearance
  26. 26. THEOPHYLLINE TOXICITY MECHANISM Theophylline↓cGMP & Adenosine cAMP receptor block ↑catecholamines
  27. 27. THEOPHYLLINE TOXICITY C/P Nausea and GIT vomiting Hematemesis Hypovolemic shock Irritability, Seizures, CNS Anxiety tremors coma Sinus Ventricular Cardiogenic CVS tachycardia tachycardia shock Metabolic Metabolic Hypokalemia acidosis
  28. 28. THEOPHYLLINE TOXICITY INVESTIGATIONS Investigation Laboratory ECG S. Glucose S.K+ KFTs ABGTheophylline
  29. 29. THEOPHYLLINE TOXICITY TREATMENT TreatmentStabilization Decontamination Elimination Antidote Supportive GL MDAC Hemodialysis Hemoperfusion Emesis (?)
  30. 30. THEOPHYLLINE TOXICITY TREATMENT Supportive treatment Tachycardia Hypokalemia Hypotension Seizures VomitingSupraventricluar Ventricular

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