1. The document discusses a case study of a 41-year-old woman who was brought to the emergency room after ingesting 80 tablets of a sustained-release cardiovascular drug in a suicide attempt.
2. At the hospital, she developed hypotension, respiratory failure, bradycardic ventricular rhythm, and renal failure. Treatment with activated charcoal, calcium, bicarbonate, and hemodialysis were unsuccessful.
3. On the fourth day, continuous intravenous lipid emulsion therapy was initiated, which decreased her vasopressor requirements within hours and stabilized her hemodynamics within a day, allowing her to no longer require life support.
1. The document discusses a case study of a 41-year-old woman who was brought to the emergency room after ingesting 80 tablets of a sustained-release cardiovascular drug in a suicide attempt.
2. At the hospital, she developed hypotension, respiratory failure, bradycardic ventricular rhythm, and renal failure. Treatment with activated charcoal, calcium, bicarbonate, and hemodialysis were unsuccessful.
3. On the fourth day, continuous intravenous lipid emulsion therapy was initiated, which decreased her vasopressor requirements within hours and stabilized her hemodynamics within a day, allowing her to no longer require life support.
1. The document discusses a case study of a 41-year-old woman who was brought to the emergency room after ingesting 80 tablets of a sustained-release cardiovascular drug in a suicide attempt.
2. At the hospital, she developed hypotension, respiratory failure, bradycardic ventricular rhythm, and renal failure. Treatment with activated charcoal, calcium, bicarbonate, and hemodialysis were unsuccessful.
3. On the fourth day, continuous intravenous lipid emulsion therapy was initiated, which decreased her vasopressor requirements within hours and stabilized her hemodynamics within a day, allowing her to no longer require life support.
1. The document discusses a case study of a 41-year-old woman who was brought to the emergency room after ingesting 80 tablets of a sustained-release cardiovascular drug in a suicide attempt.
2. At the hospital, she developed hypotension, respiratory failure, bradycardic ventricular rhythm, and renal failure. Treatment with activated charcoal, calcium, bicarbonate, and hemodialysis were unsuccessful.
3. On the fourth day, continuous intravenous lipid emulsion therapy was initiated, which decreased her vasopressor requirements within hours and stabilized her hemodynamics within a day, allowing her to no longer require life support.
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St.
Paul University Philippines
Tuguegarao City, Cagayan 3500
SCHOOL OF NURSING AND ALLIED HEALTH SCIENCES
COLLEGE OF PHARMACY
PHR126 – CLINICAL TOXICOLOGY
EXERCISE NO. 12 Cardiovascular Drugs
I. Objectives: At the end of the exercise, the students should be able to: 1. Familiarize with the different types/classes of cardiovascular drugs 2. Learn the mechanism by which they cause toxicity 3. Determine the appropriate management, treatment, and prevention of the clinical manifestations resulting from intoxication with cardiovascular drugs
II. Discussion: Types of cardiovascular drugs
1. Cardiac Glycosides • are commonly used if the treatment of congestive heart failure a example is digoxin
2. Anti arrhythmic agents
• used in the treatment of arrhythmia or abnormal rhythms of the heart. It includes procainamide, phlecainide, acebutolol, propranolol, amiodarone and verapamil.
3. Antianginal Agents • nitroglycerin compounds were initially the only drugs capable of relieving symptoms of angina, but now other class of drugs like the Beta-blockers and Calcium-channel blockers are equally effective.
4. Antihypertensive Agents • antihypertensive drugs are used to maintain adequate control of the person ’s blood pressure. It includes the diuretics, Beta-blockers, Ace Inhibitors, Calcium blockers and Alpha adrenergic blockers. Intoxication from cardiovascular drugs usually results from overdose
1 III. Materials: Books Reference Materials Laboratory Manual
IV. Procedure: Case Analysis. Using the following cases, identify the suspected poisonous/toxic substance, describe its physicochemical properties, mechanism of toxicity, clinical signs and symptoms of toxicity and possible management or treatment procedures/antidotes
Case A 41 y.o woman with a history of depression presented to the ER of a refereeing hospital shortly after taking 80 tablets of a sustained release cardiovascular drug.
At the ER she was treated with multiple doses of activated charcoal, fluids and calcium, and was subsequently transferred to ICU 6 hours after ingestion. Her VS on admission were normal. An initial exam was unremarkable, the patient was easily aroused, alert and oriented, and appeared well. Serum chemistry, CBC and liver function tests were normal exempt for a mildly elated serum calcium of 10.8mg/dL and a Hct of 36.5%
The patient became hypotensive requiring 3 high-doses of vasopressors to maintain arterial
pressure. She also developed acute respiratory failure, bradycardic ventricular rhythm, necessitating continuous transvenous pacing and anuric renal failure. The patient was treated with intravenous calcium, bicarbonate, hyperinsulinemic euglycemic therapy and continuos venous hemodialysis without success
On the 4th day after hospital admission, continous IV lipid therapy was initiated. Within three hours, the patient’s vasopressors requirement decrease by half. Within 24 hours she was on minimal vasopressors support and regained an underlying junctional rhythm
After three days of lipid infusion, she no longer required inotropic agents to maintain blood pressure or pacing to maintain stale hemodynamics.
