Management of β‎-blocker and calcium channel blocker poisoning

2016 ◽  
Author(s):  
Geoffrey Isbister ◽  
Colin Page
Keyword(s):  
Calcium Channel ◽  
Calcium Channel Blocker ◽  
Calcium Channel Blockers ◽  
Channel Blocker ◽  
Phosphodiesterase Inhibitors ◽  
Blood Glucose Measurement ◽  
Response To Treatment ◽  
Glucose Measurement ◽  
High Dose ◽  
Channel Blockers

β‎-blocker and calcium channel-blockers can cause life-threatening toxicity due to cardiogenic shock. Both β‎-blockers and calcium channel-blockers are heterogenous groups of drugs and particular drugs, such as propranolol, diltiazem, and verapamil are far more toxic than the others in their class. The most important investigations in β‎-blocker and calcium channel-blocker overdose are an electrocardiogram, blood glucose measurement, and electrolytes. Like most overdoses, supportive treatment is the most important, with emphasis on the primary pathophysiology. Early decontamination should be considered based on the severity of the poisoning. Treatment of β‎-blockers and calcium channel-blockers poisoning, using absolute blood pressure as an endpoint can be misleading and measuring cardiac output can be more informative in gauging response to treatment. There are no specific antidotes, although β‎-agonists may be effective in β‎-blocker overdose and calcium has been shown to be effective in calcium channel-blocker overdose. The choice of inotropes and/or vasopressors will differ for β‎-blockers and calcium channel-blockers. These include isoprenaline, high dose insulin euglycaemia, phosphodiesterase inhibitors, and other catecholaminergic inotropes for β‎-blocker poisoning and adrenaline, high dose insulin euglycaemia and vasopressors for calcium channel-blocker poisoning.

scholarly journals Densitas tulang mandibula pengguna obat anti hipertensi calcium channel blocker (CCB) melalui radiograf panoramik

2020 ◽  
Vol 4 (2) ◽  
pp. 1
Author(s):  
Gunawan Gunawan ◽  
Suhardjo Sitam ◽  
Lusi Epsilawati
Keyword(s):  
Bone Density ◽  
Calcium Channel ◽  
Calcium Channel Blocker ◽  
Calcium Channel Blockers ◽  
Drug Users ◽  
Channel Blocker ◽  
Antihypertensive Drugs ◽  
Panoramic Radiograph ◽  
Channel Blockers ◽  
Hypertensive Drug

Objectives: The purpose of this research was to describe radiographic density of mandibular bone in calcium channel blocker anti-hypertensive drug users. Bone density in the mandible is assessed from the trabecular. Panoramic radiograph is a routine examination that is often done in dentistry that can be used to assess changes in quality in the form of changes in bone density in users of anti-hypertensive calcium channel blockers Material and Methods: This research is a descriptive study of 21 panoramic radiographs of calcium channel blocker anti-hypertensive drug users aged 40-75 years. Panoramic radiograph archive density checks in the distal region of the foramen mentale and the mandibular angular region using software image j, with the final result was the percentage between bone and marrow. Results: This research showed the average radiographic density in male using calcium channel blocker antihypertensive drugs was 18.81% and the average radiographic density in female was 20.92%. Conclusion: Based on the results of the study found that the average radiographic density of female patients taking antihypertensive drugs calcium channel blockers was higher than male.

Treatment of calcium channel blocker-induced gingival overgrowth without modifying medication

2021 ◽  
Vol 14 (1) ◽  
pp. e238872 ◽  
Author(s):  
Satoru Morikawa ◽  
Mana Nasu ◽  
Yoko Miyashita ◽  
Taneaki Nakagawa
Keyword(s):  
Calcium Channel ◽  
Calcium Channel Blocker ◽  
Calcium Channel Blockers ◽  
Channel Blocker ◽  
Periodontal Treatment ◽  
Common Side Effect ◽  
Channel Blockers ◽  
Gingival Overgrowth ◽  
Old Japanese ◽  
Almost All

Gingival overgrowth is a common side effect of calcium channel blockers used in the treatment of cardiovascular diseases. While controversial, management includes discontinuing the calcium channel blocker. We report the case of a 66-year-old Japanese man with hypertension and type 2 diabetes mellitus who was diagnosed with severe periodontitis covering almost all the teeth. The patient had been on nifedipine (40 mg/day) and amlodipine (10 mg/day) medication for 5 years. With his physician’s consent, nifedipine was discontinued during his treatment for periodontitis, which consisted of oral hygiene instructions and scaling and root planing on all areas. Gingivectomy was performed on the areas of hard fibrous swelling. Nifedipine was resumed during periodontal treatment when the patient’s hypertension worsened. His periodontal scores improved when he resumed treatment. We report that significant improvement in gingival overgrowth can occur with basic periodontal treatment, surgery and sustained intensive follow-up without adjusting calcium channel blockers.

Nifedipine in the Treatment of Hypertensive Episodes in the Coronary Care Unit

DICP ◽  
1989 ◽  
Vol 23 (11) ◽  
pp. 855-858 ◽  
Author(s):  
Mark A. Malesker ◽  
Karen S. Rovang ◽  
Syed M. Mohiuddin ◽  
Aryan N. Mooss ◽  
Daniel E. Hilleman ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Calcium Channel ◽  
Calcium Channel Blocker ◽  
Calcium Channel Blockers ◽  
Channel Blocker ◽  
Coronary Care Unit ◽  
Channel Blockers ◽  
Blocker Therapy ◽  
Coronary Care ◽  
Percent Response

The effectiveness of nifedipine for the treatment of acute hypertensive episodes in patients already taking chronic calcium-channel blocker therapy is unknown. We report our experience with 43 consecutive patients who received nifedipine for acute hypertensive episodes in the coronary care unit. Of the 43 patients (24 men, 19 women), 23 (53 percent) were taking chronic (>2 mo) calcium-channel blocker therapy. Nifedipine 10 mg capsules were chewed and swallowed with repeat doses given at hourly intervals if necessary. Target BP was 140/90 mm Hg, which was achieved in 31 of 43 patients (72 percent). In patients already taking calcium-channel blockers, target BP was achieved in 18 of 23 patients (78 percent). Response in patients not taking chronic calcium-channel blockers was observed in 13 of 20 patients (65 percent). Overall, adverse effects occurred in 16 of 43 patients (37 percent): 11 of 23 patients (48 percent) taking calcium-channel blockers, and 5 of 20 patients (25 percent) not taking calcium-channel blockers. Nifedipine is equally effective in lowering BP in patients taking calcium-channel blockers as it is in patients not taking them. Although associated with a higher incidence of adverse effects in patients already taking calcium-channel blockers, these effects were not considered serious. Nifedipine is an effective agent in acute hypertensive episodes, even in patients receiving chronic calcium-channel blocker therapy.

Successful use of calcium channel blocker for management of arterio-venous malformations following Fontan procedure

2018 ◽  
Vol 28 (12) ◽  
pp. 1468-1470
Author(s):  
Ramzi Hamzeh ◽  
Ziad Bulbul ◽  
Jana Assy
Keyword(s):  
Nitric Oxide ◽  
Arteriovenous Malformation ◽  
Calcium Channel ◽  
Calcium Channel Blocker ◽  
Calcium Channel Blockers ◽  
Pulmonary Circulation ◽  
Channel Blocker ◽  
Fontan Procedure ◽  
Channel Blockers ◽  
Venous Malformations

AbstractIn diffuse forms of arteriovenous malformation following Fontan procedure, “classical” medical therapy, inhaled nitric oxide and sildenafil, may play a role, until re-direction of hepatic flow to pulmonary circulation cures it. However, in refractory cases, as reported in our 2-year-old patient, unusual medications such as calcium channel blockers can be tried and continued if patients respond adequately.

Calcium Channel Blocker Toxicology

2005 ◽  
Vol 18 (3) ◽  
pp. 169-174 ◽  
Author(s):  
Matthew Hedge
Keyword(s):  
United States ◽  
Calcium Channel ◽  
Calcium Channel Blocker ◽  
Mechanism Of Action ◽  
Calcium Channel Blockers ◽  
Channel Blocker ◽  
Clinical Presentation ◽  
The United States ◽  
Channel Blockers ◽  
Antihypertensive Medications

Calcium channel blockers are commonly prescribed antihypertensive medications in the United States and as such are a common presenting ingestion. The pharmacology and mechanism of action of this class of drugs will be discussed. The clinical presentation and therapeutic options will be reviewed.

Abstract 1716: Calcium Channel Blockers Reduce the Antiplatelet Effect of Clopidogrel

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jolanta Siller-Matula ◽  
Irene Lang ◽  
Guenter Christ ◽  
Bernd Jilma
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Platelet Aggregation ◽  
Calcium Channel ◽  
Calcium Channel Blocker ◽  
Calcium Channel Blockers ◽  
Channel Blocker ◽  
Platelet Reactivity ◽  
Channel Blockers ◽  
Artery Disease

Due to the known CYP3A4 inhibition by calcium channel blockers, we hypothesized that there might be a pharmacodynamic interaction between clopidogrel and dihydropyridines in patients with coronary artery disease (CAD). Clopidogrel is activated by CYP3A4 which also metabolizes calcium channel blockers of the dihydropyridine class. Methods: Responsiveness to clopidogrel was assessed by the vasodilator stimulated phosphoprotein (VASP) phosphorylation assay and aggregometry in 200 patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). The platelet reactivity index (PRI in the VASP assay, normal range 69–100%) was higher in patients on both clopidogrel and calcium channel blockers (61%) as compared to patients on clopidogrel without calcium channel blockers (48%). The absolute difference was 13% (95%CI: 6 –20%; p = 0.001) and the relative difference approached 21%. A high post-treatment platelet reactivity (PRI > 69%) was seen in 40% of patients with concomitant calcium channel blocker treatment compared to 20% without (X2-test: p = 0.008). Intake of calcium channel blocker remained an independent predictor of high platelet reactivity after adjustment for cardiovascular risk factors. This corresponded to an increased platelet aggregation of similar magnitude (p < 0.05). In vitro incubation with calcium channel blockers (nimodipine, verapamil, amlodipine and diltiazem) did not alter the PRI or the ADP-induced platelet aggregation of patients on clopidogrel, indicating that the interaction occurs in vivo, conceivably at the level of the CYP3A4 cytochrome. Co-administration of calcium channel blockers is associated with a decreased platelet inhibition by clopidogrel.

Calcium channel blockers modulate airway constriction in the canine lung periphery

1991 ◽  
Vol 70 (2) ◽  
pp. 624-630 ◽  
Author(s):  
K. S. Lindeman ◽  
C. A. Hirshman ◽  
A. N. Freed
Keyword(s):  
Calcium Channel ◽  
Calcium Channel Blocker ◽  
Calcium Channel Blockers ◽  
Channel Blocker ◽  
Calcium Influx ◽  
Channel Blockers ◽  
Dry Air ◽  
Before And After ◽  
Dihydropyridine Calcium Channel Blocker ◽  
Lung Periphery

We studied the effect of two voltage-sensitive calcium channel blockers on Na2EDTA-induced bronchoconstriction in the canine lung periphery. A wedged bronchoscope technique was used to measure collateral system resistance before and after challenges with aerosolized Na2EDTA, hypocapnia, aerosolized acetylcholine, and increased flow of dry air in anesthetized mongrel dogs. Nifedipine, a dihydropyridine calcium channel blocker, reduced hypocapnia-induced bronchoconstriction by 88 +/- 6% (SE) but did not alter Na2EDTA-induced constriction. Verapamil, a phenylalkylamine calcium channel blocker, attenuated hypocapnia- and Na2EDTA-induced bronchoconstriction by 69 +/- 6 and 44 +/- 7%, respectively, but did not significantly alter responses to either acetylcholine or dry air challenge. We conclude that calcium influx through voltage-sensitive calcium channels, perhaps of the T subtype, has a limited role in the initiation of Na2EDTA-induced bronchoconstriction in the canine lung periphery.

Effects of Long- and Intermediate-Acting Dihydropyridine Calcium Channel Blockers in Hypertension

2018 ◽  
Vol 23 (5) ◽  
pp. 433-445 ◽  
Author(s):  
Sandip Chaugai ◽  
Lhamo Yangchen Sherpa ◽  
Amir Ali Sepehry ◽  
Scott Reza Jafarian Kerman ◽  
Hisatomi Arima
Keyword(s):  
Heart Failure ◽  
Calcium Channel ◽  
Calcium Channel Blocker ◽  
Calcium Channel Blockers ◽  
Lower Risk ◽  
Randomized Clinical Trials ◽  
Channel Blocker ◽  
Channel Blockers ◽  
Dihydropyridine Calcium Channel Blocker ◽  
Long Acting

Background: Dihydropyridine calcium channel blockers are a heterogeneous group of antihypertensive drugs. Long-acting dihydropyridine agent amlodipine is widely used for monotherapy and combination therapy for hypertension in clinical practice, while intermediate-acting dihydropyridine agents have shown inconsistent results in randomized clinical trials (RCTs). Methods and Results: A meta-analysis of 18 RCTs enrolling a total of 80,483 patients with hypertension followed for a mean of 51.4 months was performed. Amlodipine therapy was associated with 25% higher risk of heart failure (relative risk [RR]: 1.25, 95% confidence interval [CI], 1.05-1.49, P = .019) but 17% lower risk of stroke (RR: 0.83, [95% CI, 0.72-0.97], P = .009) without statistically significant effect on acute myocardial infarction (AMI) compared to major alternative antihypertensive therapy (MAAT), including β-blocker, diuretic, angiotensin-converting enzyme inhibitor, or angiotensin-receptor blocker. Intermediate-acting dihydropyridine calcium channel blocker therapy was associated with 25% higher risk of heart failure (RR: 1.25, [95% CI, 1.06-1.47], 0.005, P = .005) and 26% higher risk of AMI (RR: 1.26, [95% CI, 1.05-1.51], 0.019, P = .019) compared to MAAT. Results of the subgroup analysis suggested that the intermediate-acting dihydropyridine calcium channel blocker was associated with higher risk of heart failure (RR: 1.30, [95% CI, 1.08-1.56], P = .005) and AMI (RR: 1.50, [95% CI, 1.01-2.22], P = .043) compared to renin–angiotensin system blockers and a trend toward higher risk of AMI (RR: 1.17, [95% CI, 0.99-1.38], P = .064) compared to conventional therapy, including β-blockers and diuretics. Meta-regression analyses suggested that long-acting dihydropyridine calcium channel blocker is associated with lower risk of AMI ( B: −0.327, [95% CI, −0.530 to −0.123], P = .002) with a trend toward lower risk of stroke ( B: −0.203, [95% CI, −0.410 to 0.003] P = .054). Conclusions: This study suggests that Amlodipine offers greater protection against major complications of hypertension compared to intermediate-acting dihydropyridine calcium channel blockers.

Electroanalytical Methods for Determination of Calcium Channel Blockers

2019 ◽  
Vol 15 (3) ◽  
pp. 207-218 ◽  
Author(s):  
Fatma Ağın
Keyword(s):  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Channel Blocker ◽  
Heart Diseases ◽  
Dosage Forms ◽  
Channel Blockers ◽  
Electroanalytical Methods ◽  
Pharmaceutical Dosage Forms ◽  
Ischemic Heart Diseases

Background:Calcium Channel Blockers (CCBs) are widely used in the treatment of cardiovascular and ischemic heart diseases in recent years. They treat arrhythmias by reducing cardiac cycle contraction and also benefit ischemic heart diseases. Electroanalytical methods are very powerful analytical methods used in the pharmaceutical industry because of the determination of therapeutic agents and/or their metabolites in clinical samples at extremely low concentrations (10-50 ng/ml). The purpose of this review is to gather electroanalytical methods used for the determination of calcium channel blocker drugs in pharmaceutical dosage forms and biological media selected mainly from current articles.Methods:This review mainly includes recent determination studies of calcium channel blockers by electroanalytical methods from pharmaceutical dosage forms and biological samples. The studies of calcium channel blockers electroanalytical determination in the literature were reviewed and interpreted.Results:There are a lot of studies on amlodipine and nifedipine, but the number of studies on benidipine, cilnidipine, felodipine, isradipine, lercanidipine, lacidipine, levamlodipine, manidipine, nicardipine, nilvadipine, nimodipine, nisoldipine, nitrendipine, diltiazem, and verapamil are limited in the literature. In these studies, DPV and SWV are the most used methods. The other methods were used less for the determination of calcium channel blocker drugs.Conclusion:Electroanalytical methods especially voltammetric methods supply reproducible and reliable results for the analysis of the analyte. These methods are simple, more sensitive, rapid and inexpensive compared to the usually used spectroscopic and chromatographic methods.

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