Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Methylene blue is an emerging therapy for calcium channel blocker poisoning. Although traditionally used as a reducing agent for the treatment of methemoglobinemia, methylene blue is also a vasoconstrictor.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
In calcium channel blocker poisoning, the endocrine system is affected. As calcium influx triggers the release of insulin, patients poisoned with calcium channel blockers are often hyperglycemic.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
A unique feature of calcium channel blocker poisoning is endocrine dysfunction. Like many drugs, calcium channel blockers lose specificity in overdose and thus interfere with other calcium channels within the body.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Dihydropyridine calcium channel blocker (such as amlodipine) toxicity often causes reflex sinus tachycardia from peripheral vasodilation. Calcium channel blockade has little effect on ventricular conduction.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Severe calcium antagonism eventually affects multiple organ systems. Hypotension and bradycardia occur early, and other rhythm disturbances which include AV block of all degrees, sinus arrest, AV dissociation, junctional rhythm and asystole.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
In calcium channel antagonist overdoses, there are negative effects on heart rate, contractility, conduction and vascular tone, with the exception of dihydropyridine calcium channel blockers, which tend to result in tachycardia even in toxicity.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
In cases of calcium channel antagonists overdose, verapamil has the deadliest profile, combining severe myocardial depression and peripheral vasodilation. Both verapamil and diltiazem act on the heart and blood vessels.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Calcium channel antagonists block the slow calcium channels in the myocardium and vascular smooth muscle, leading to coronary and peripheral vasodilation. They also reduce cardiac contractility, depress SA nodal activity and slow AV conduction.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
High-dose insulin improves cardiac output significantly in beta-blocker toxicity from an increase in stroke volume more than heart rate. Dosing of high-dose insulin in humans successfully treated ranges from 0.5 to 22 U/kg/hr.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Despite glucagon's longer history for treatment of beta-blocker toxicity, high-dose insulin is a superior therapy. High-dose insulin is not a vasopressor. It is a profound inotrope with vasodilating properties.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Vomiting is a common complication of glucagon, particularly if administered too rapidly, so the airway should be monitored closely to prevent aspiration. With cumulative large doses, glucagon should be diluted in 5% glucose in water.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Glucagon is recommend for beta-blocker overdose for patients with bradycardia or hypotension not responsive to crystalloid fluids, atropine and calcium. Glucagon has a very short (20-minute) half-life, and its effect is often transient.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Glucagon has both inotropic and chronotropic effects and does not depend on beta-adrenergic receptors for its action. Therefore, it is used for beta-blocker toxicity. It stimulates the production of intracellular cyclic adenosine monophosphate.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
When treating beta-blocker overdose, indications for calcium include hypotension unresponsive to crystalloid fluids and/or bradycardia. Typically, the heart rate should be less than 60 beats per minute.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
When treating beta-blocker overdose, IV administration of calcium can be used for treatment of hypotension. One gram of calcium gluconate contains 4.5 mEq of elemental calcium, whereas one gram of calcium chloride contains 13.6 mEq.