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Cardiac Drugs Poisoning
By Sadia Saeed (PMC)

Different cardiac drugs:
1. Amiodarone
2. B-blockers
3. Calcium channel blockers
4. Digoxin and Digitoxin
 
AMIODARONE:
The drug cause poisoning effect when taken in access . acute overdose of Amiodarone causes:
· Nausea and vomiting
· Headache
· Flushing
· Ataxia
· Tremor
· Vertigo
· Hypotention

TREATMENT:
Gastric lavage and oral activated charcoal, 25-100 g, together with symptomatic and supportive measures.

BETA- BLOCKERS:
Beta-blockers are the drugs which cause poisoning effect even on small overdose, sinus bradicardia may be the only feature, but if substantial overdose has been ingested, coma, convultions, profound bradycardia and hypotension may occur.
There is increasing evidence that central respiratory depression may precede respiratory and cardiac arrest.

TREATMENT:
A delay in treatment may be fatal to the patients who are severely poisoned with Beta-blockers. The fisrt line treatment is to mentain the blood pressure, cardiac rhythm and respiratory rate.
Gastric lavage should be carried out in adults who have ingested more than 10 tablets.
Atropine 0.6-1.2 mg i.v will prevent vagal-induced cardiovascular collapse during the procedure.
Activated charcoal 50-100 g may be administered if presentation is early.

CALCIUM CHANNEL BLOCKERS:
The drugs which come under the category of calcium channel blockers are
· Diltiazem
· Nicardipine
· Nifedipine
· Verapamil
These drugs produce following features when taken in overdose
· Nausea and vomiting
· Dizziness
· Bradycardia
· Prolonged atrioventricular(AV) conduction
· AV dissociation
· Hypotension
· Hyperglycemia
· Metabolic acidosis
· Convulsions

TREATMENT:
Includes measures to prvent absorption, if appropriate, together with supportive care.
Calcium Gluconate 10-20 ml of 10% solution i.v, may reverse prolonged intracardiac conduction times.

DIGOXIN AND DIGITOXIN:
Acute poisoning with cardiac glycosides is uncommon but mortality may be high as 20% after a substantial dose.
The clinical features include:
· Nausea and vomiting
· Drowsiness
· Cardiac conduction abnormalities and arrhythmias
 
TREATMENT:
Gastric lavage should be performed if the patient is available within 4 hours of taking the overdose .
Activated charcoal, 50g. should be left in stomach after lavage if less than I hour has elapsed since the overdose.
Heamoperfusion may be effective in Digitoxin poisoning .