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For cases of CCB poisoning where cardiotoxicity is evident, a combination of calcium and epinephrine should be used initially, reserving HDIDK for refractory cases. Good supportive care is important, in addition to the first line treatment for beta blocker overdose: high dose glucagon (see below). Because a glucagon bolus can be diagnostic and therapeutic, administer glucagon and check. For cases of beta-blocker poisoning where symptomatic bradycardia and hypotension are present, high-dose glucagon is considered the first-line antidote. Glucagon: Is losing favor as an antidote but can still be used safely. Poisoning by beta-blockers or CCBs usually produces hypotension and bradycardia, which may be refractory to standard resuscitation measures. Health-system pharmacists should be aware that when these drugs are used as antidotes, higher than normal dosing is needed. For cases of CCB poisoning where cardiotoxicity is evident, first-line therapy is a combination of calcium and epinephrine high-dose insulin with supplemental dextrose and potassium therapy (HDIDK) is reserved for refractory cases. consider administration of dobutamine, isoproterenol or glucagon.
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Traditionally, antidotes for CCB overdose have included calcium, glucagon, adrenergic drugs, and amrinone. Administration of beta-blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta-mediated vasodilatation in skeletal muscle. However, in beta-blocker poisoning where symptomatic bradycardia and hypotension are present, high-dose glucagon is considered the first-line antidote. Therapies include beta-agonists, glucagon, and phosphodiesterase inhibitors. Poisoning by CCBs is characterized by cardiovascular toxicity with hypotension and conduction disturbances, including sinus bradycardia and varying degrees of atrioventricular block. The second line of treatment is cardiac pacing if glucagon fails. It is especially useful in beta-blocker-induced cardiotoxicity. The common feature of beta-blocker toxicity is excessive blockade of the beta-receptors resulting in bradycardia and hypotension. The antidote for beta-blocker overdose is glucagon. Glucagon has become an accepted antidote to beta- blocker poisoning because it stimulates cAMP synthesis. In overdose, beta-blockers and CCBs have similar presentation and treatment overlaps and are often refractory to standard resuscitation measures.
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Beta-blockers and CCBs represent the most important classes of cardiovascular drugs. Overdoses with cardiovascular drugs are associated with significant morbidity and mortality. The toxic effects and treatment of beta-adrenergic blocker and calcium-channel blocker (CCB) overdose are reviewed.