Sunday, January 1, 2017

cocaine toxicity

Q: All of the following can be used in cardiac complications of cocaine toxicity except?

A) nitroglycerin
B) benzodiazepines
C) aspirin  
D) phentolamine
E) beta-blocker 


Answer: E

The objective of the above question is to reinforce the contraindication of beta-blockers in acute cocaine ingestion, as well as to highlight the benefit of phentolamine. Phentolamine is an alpha-adrenergic antagonist and is very effective as a second agent in reversing cocaine-induced coronary artery vasoconstriction in unresponsive benzodiazepines. It is given as an IV bolus in a dose of 1 to 2.5 mg every 5 to 10 minutes on a PRN basis.

#toxicology


References: 

1. Lange RA, Hillis LD. Cardiovascular complications of cocaine use. N Engl J Med 2001; 345:351.

2. Hollander JE. The management of cocaine-associated myocardial ischemia. N Engl J Med 1995; 333:1267. 

3. Albertson TE, Dawson A, de Latorre F, et al. TOX-ACLS: toxicologic-oriented advanced cardiac life support. Ann Emerg Med 2001; 37:S78.

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