Pharmacotherapy Management of Beta Blocker Toxicity in the Emergency Department

TEST INSTRUCTIONS Read the article. The test for this nursing continuing professional development (NCPD) activity is to be taken online at www.nursingcenter.com/CE/AENJ. Tests can no longer be mailed or faxed. You’ll need to create an account (it’s free!) and log in to access My Planner before taking online tests. Your planner will keep track of all your Lippincott Professional Development online NCPD activities for you. There’s only one correct answer for each question. A passing score for this test is 8 correct answers. If you pass, you can print your certificate of earned contact hours and access the answer key. If you fail, you have the option of taking the test again at no additional cost. For questions, contact Lippincott Professional Development: 1-800-787-8985 Registration deadline is March 3, 2028. PROVIDER ACCREDITATION Lippincott Professional Development will award 2.0 contact hours and 1.5 pharmacology contact hours for this nursing continuing professional development activity. Lippincott Professional Development is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 2.0 contact hours. Lippincott Professional Development is also an approved provider of continuing nursing education by the District of Columbia, Georgia, West Virginia, New Mexico, South Carolina, and Florida, CE Broker #50-1223. Your certificate is valid in all states. Payment: The registration fee for this test is $ 21.95. Disclosure statement: All authors and planners have no relevant financial relationships with any ineligible organizations regarding this educational activity. The author discusses the off-label use of methylene blue, intralipid, insulin for the treatment of beta blocker toxicity. CE TEST QUESTIONS Learning Outcome: By the conclusion of this activity, a majority of the participants will demonstrate knowledge of the pharmacologic management of beta blocker toxicity by achieving a passing score on the posttest. Learning Objectives: After completing this continuing professional development activity, the participant will apply knowledge gained to: Explain the pathophysiologic and clinical manifestations of beta-blocker toxicity. Select evidence-based pharmacotherapeutic interventions to manage beta-blocker toxicity. Identify key diagnostic tests necessary in the management of beta-blocker toxicity. JP is a 54-year-old man with a history of hypertension; he was brought to the emergency department after being found confused and extremely lethargic at home, with an empty bottle of propranolol nearby. Overdose is presumed. On arrival, JP is bradycardic, hypotensive, and cool to the touch with slow respirations and signs of impending cardiogenic shock. JP’s bradycardia and hypotension are most likely due to increased myocardial contractility. suppressed sinoatrial node activity. excessive agonist of β-adrenergic receptors. Given the agent that JP ingested, you should monitor him closely for seizures. atrial fibrillation. deep vein thrombosis. Considering the symptoms that JP is exhibiting, you suspect that the ingestion took place 24 hours ago. within 1 to 2 hours. within 15 to 30 minutes. Initial laboratory evaluation for JR should include serum lactate. ammonia. triglycerides. In exploring treatment options, the team is considering gastric lavage or activated charcoal. The most important factor in determining if this is an appropriate therapy for JR is timing of ingestion. the number of pills ingested. a prior history of gastric lavage. JR is in cardiogenic shock. He received 30 ml/kg of intravenous crystalloid and his mean arterial pressure is 58. An appropriate next step in his resuscitation should be to administer an additional crystalloid bolus. initiate a dopamine infusion at 1 mcg/kg/min to the target heart rate (HR) goal. initiate norepinephrine at 2 mcg/min and titrate to the target blood pressure (BP) goal. JR’s BP is improving however, his HR remains in the 40s. When you check on him again, you note that his HR is in the 20s and he is losing consciousness. Which drug should be administered immediately? insulin atropine glucagon A glucagon infusion is started for JR. To pretreat him for the most common adverse event of this therapy, you administer analgesia. an antiemetic. an antipyretic. After an initial improvement in BP and HR with glucagon infusion; JR’s HR and BP are now trending downward. Hyperinsulinemic euglycemic therapy is ordered. Prior to initiation, hypokalemia should be corrected. vasopressors should be weaned off. the patient should be intubated and placed on mechanical ventilation. JR is not responding to treatments and hemodynamics are deteriorating. A potential option for JR’s refractory beta-blocker toxicity is hemodialysis. IV lipid-emulsion. dopamine infusion.