MOA/Pharmacokinetics
Clinical Manifestations
Treatment
Treatment II
100

What receptors do beta blockers work on? (specific)

B1- heart (heart rate, contractility, AV conducttion)

B2- bronchial and peripheral SM/uterus

B3- adipose (lipolysis/thermogenesis)

100

General signs/symptoms of overdose?

bradycardia, hypotension, AMS, delirium, lethargy, resp depression, bronchospasm, hypothermia, hypoglycemia (esp propranolol)

- most evident before 2 hours but before 6 hours

100

What labs/tests should be done?

EKG - BC, QRS/QTc prolongation

POCT gluc - hypoglycemia

CXR - acute decomp HF?

BMP- Hyperkalemia 

Lactate - elevated in bradycardia > worse outcomes

Digoxin level

100

When is calcium useful for BB overdose?

undifferentiated bradycardia - might have taken CCB as coingestant 

CaCl 1g

CaGluconate 3g q 10min; 9g

200

Antagonism of B receptors on heart causes what effect?

blunting of the chronotropic and ionotropic response (B1)

200

EKG manifestations of overdose?

sinus bradycardia, sinus pauses, or sinus arrest

prolonged PR interval or high-grade AV block

Prolonged QRS and QT intervals may occur and severe poisonings may result in asystole

200

Quick, patient not protecting airway and is bradycardic!

Intubate

Atropine & IVF prior

200

MOA of insulin in BB toxicity?

increases intropy and contractility

1u/kg bolus followed by 1u/kg/hr with 0.5 g/kg/hr dextrose

monitor gluc every 15-30 min 

cardiac function still depressed > inc up to 10u/kg/hr

300

patients taking nonselective β-adrenergic antagonists typically have increased plasma concentrations of

triglycerides

- altered lipid metabolism, release of FFA inhibited

300

Manifestations in BB agents with K channel blockade?

Acebutolol and Sotalol

QT with significant lengthening

Risk of Ventricular dysrhythmias highest between 4-20 hours

300

Recent large ingestion/significant toxic effects we should proceed with ___!

OG lavage - if pills could still be in stomach

- may cause vagal response (can pre-treat w atropine)

- AC with minor effects and water soluble BB

- sustained release > whole bowel irrigation

300

how long does it take for response to insulin?

15-60 mins 

may need to start catecholamine infusion before insulin effects apparent

*monitor K*

400

β2-Adrenergic antagonists impair the ability to recover from ____ and may mask the sympathetic discharge that serves to warn of ______

hypoglycemia

400

Manifestations in membrane-stabilizing agents?

Coma, seizures, hypotension, bradycardia, impaired AV conduction, wide QRS, Ventricular tachydysrhythmias

carvedilol, propranolol


400

Dosing of Atropine in BB overdose?

Increase HR

0.5-1mg  every 3-5 min

Max 3mg

400

treatment consideration if BB lipophilic (propranolol)?

lipid emulsion therapy

1.5mL/kg of 20% bolus over 2-3 min q3-5 min

0.25 mL/kg/min infusion for 30-60 mins 

until recovery or max 10ml/kg

500

Most lipophilic BB?

Most hydrophilic BB?

Lipophilic - propranolol (25% bioavailable) > hepatic elimination

Hydrophilic - atenolol (near 100% bioavailable) > renal 

highly lipid soluble - cross membranes and concentrate in adipose tissue/CNS penetration

highly water soluble - distribute in TBW/less CNS toxicity

500

Isolated β-adrenergic antagonist overdose is most likely to cause symptoms in persons with congestive heart failure, sick sinus syndrome, or impaired AV conduction who rely on _______ to maintain heart rate or cardiac output

sympathetic stimulation

500

MOA of glucagon in BB overdose?

Increase AC activation > increase HR, inotropy, AVN conduction 

3-5 mg IV over 1-2 min, every 5 min (max 10mg)

+ response --> start @response dose per hour

no response -->start @10mg/hr regardless

500

Which BB indication for ECMO?

NASA

nadalol, acebutolol, sotalol, atenolol

(water soluble renally excreted B antagonists)