]> 2026-07-31T07:27:55+00:00 WBR0367 0 en Cyproheptadine Glucagon Flumazenil Atropine Although atropine can be used to increase heart rate in sinus bradycardia and certain forms of atrioventricular block, it is not very effective in the treatment of patients with beta-blocker toxicity. In addition, patients with third degree block do not benefit from atropine. Sodium bicarbonate The classical treatment for patients with performance anxiety is a non-selective beta-blocker, most commonly propranolol. A key consideration in this question, other than the consistent clinical presentation, is the possibility of self-medication with a higher dose of propranolol given an upcoming stressful event. Beta-blocker toxicity manifests as bradycardia, hypotension, atrioventricular block, arrhythmias, and seizures. Given the non-selective nature of propranolol, bronchospasm is also a possible complication particularly in patients with pre-existing bronchospastic pulmonary disease. The ECG tracing may vary, showing anything from simple sinus bradycardia to third degree block (seen in this patient's tracing). The initial management for patients with propranolol toxicity includes activated charcoal; however, given the altered mental status of the patient, charcoal should be withheld. Along with initial fluid administration, glucagon is the treatment of choice for patients with beta-blocker toxicity. Glucagon increases heart rate and myocardial contractility, and improves atrioventricular conduction. These properties are unaffected by the presence of beta-blockers suggesting that glucagon's mechanism of action may bypass the beta-adrenergic receptor site. This may also explain why atropine and isoproterenol are not very effective in reversing the bradycardia and hypotension of beta-blocker overdose.<br/> '''Educational Objective:''' Glucagon is the treatment of choice for patients with suspected or confirmed beta-blocker toxicity.<br/> '''References:''' Peterson CD, Leeder JS, Sterner S. Glucagon therapy for beta-blocker overdose. Drug Intell Clin Pharm. 1984;18(5):394-8.<br> Kerr GW, Mcguffie AC, Wilkie S. Tricyclic antidepressant overdose: a review. Emerg Med J. 2001;18(4):236-41. Pharmacology B Cardiology General Principles 2020-10-28T00:19:06Z 2459150.5132639 WBR0367