8.9 A) Antiarrhythmics Toxicology

Front 1

In regards to High-dose Insulin Euglycaemic

therapy {HIET}, which is incorrect?
A. It can be used in CCB and BB overdose
B. Early consideration for initiation is being advocated in severe

CCB toxicity

C. It is positively chronotropic
D. It is best used with inotropes in severe toxicity.

Back 1

C. Positively inotropic

Front 2

Which is incorrect regarding HIET - high dose

insulin euglycaemic therapy?
A. It overcomes the metabolic derangement

{ metabolic starvation state} affecting the myocardium

B. It enhances myocardial contractility
C. Side effects may include hypoglycaemia and hypokalaemia
D. It should be started once other measures

{atropine / inotropes/vasopressors} show a poor response.

Back 2

D. It should be started as soon as

haemodynamic compromise manifests.

Front 3

Which overdoses is High-dose insulin

euglycaemic therapy used?

Back 3

1. CCB
2. BB { recommended-but clinical data lacking}

Front 4

Which Drug in toxicology does not give rise to bradycardia and Hypotension- with a narrow QRS?

A. Propranolol
B. Calcium channel blockers (Verapamil ; diltiazem )

C. Organophosphates
D. A2 agonists ( clonidine )

Back 4

A. Propranolol has sodium blocking

actions- widens QRS

Front 5

List the sequential treatment options for severe Calcium Channel Blocker Overdose.

Back 5

1. IV fluids NaCl
2. Euglycaemic insulin therapy
3. Calcium boluses + infusion
4. Atropine
5. Vasopressor support

(Noradrenaline / adrenaline )
6. NaHCO3 (acidosis)
7. Transcutaneous cardiac pacing
8. ECMO
9. IABP
10. **Whole Bowel irrigation ONLY if cooperative patient + < 4/24 post ingestion SR tablets + no established toxicity

Front 6

List the sequential treatment options for severe B Blocker overdose.

Back 6

1. IV fluids NaCl
2. Euglycaemic insulin therapy
3. Atropine
4. Vasopressor support ( noradrenaline / adrenaline )
6. NaHCO3 (acidosis)
7. Transcutaneous cardiac pacing
8. ECMO
9. IABP
10. Propranolol overdose ==> Intubate/ ventilate / NaHOC3
11. Sotalol ==> Long QT / Torsades : Magnesium / Isoprenaline / Overdrive pacing.

Front 7

What 3 factors will guide DigiFab dosing in

digoxin poisoning?

Back 7

1. Whether patient is Critically ill.
2. The amount of digoxin ingested is known
3. The steady state digoxin level is known

Front 8

Which is incorrect regarding acute digoxin

poisoning ?
A. 2 Ampoules are given for haemodynamically stable toxicity.
B. Patients often develop GIT symptoms - nausea and vomiting
C. The most common cardiac effects are Bradycardia and heart block
D. Hyperkalaemia > 5 mmol/L is associated with a high mortality.

Back 8

A. 5 Ampoules

Front 9

Which is incorrect regarding Chronic digoxin

poisoning?
A. The serum potassium is typically elevated.
B. It is usually due to change in the dose, or clearance of digoxin in those receiving digoxin therapy.
C. Patients may develop ventricular or atrial premature contractions.
D. The Digifab dosing for unstable and symptomatic patients is

2 Ampoules.

Back 9

A. Not typically. It can be normal , or even low- unless there is severe acute renal

impairment .