Metoprolol and cocaine

Discussion in 'Prescription Online' started by Zaratustra, 08-Sep-2019.

  1. phpin XenForo Moderator

    Metoprolol and cocaine


    The following is a hypothetical example of a classic exam question that one might come across as a medical student: A 50-year-old male presents to the emergency department with severe chest pain. His past medical history is significant for congestive heart failure and stent placement. His vitals are significant for a blood pressure of 220/110 and a heart rate of 170. All of the above are acceptable to use in the setting of cocaine-related chest pain If you said D, you would most likely receive full credit, for the classic teaching is that beta-blockers are contraindicated in the setting of chest pain related to cocaine use. On physical exam he appears to be profusely sweating, and his pupils are markedly dilated. Beta-blockers are also frequently withheld from patients with significant heart disease who happen to be active users of cocaine. Troponin I is within normal limits and EKG shows normal sinus rhythm. As medical students we learn not to use beta-blockers in such a setting on many occasions, from test questions like the one above, to mannequin simulations, to interactions with patients on the hospital wards. When prompted, the patient admits to snorting cocaine just a few hours prior to presentation. However, one should question the reasoning behind the practice of not giving beta-blockers to patients who use cocaine. Which of the following should NOT be used in the management of this patient’s symptoms? After all, if as clinicians we choose not to prescribe cocaine users a drug that has a significant mortality benefit in the setting of coronary artery disease [1,2], one might presume that there would be some good evidence to support this practice. Years ago I treated a university student who presented to the emergency department (ED) after drinking several cans of a popular caffeinated energy drink to “pull an all-nighter” during final exam week. He was tremulous, agitated, and pale, with sinus tachycardia ranging from 140 to 160 bpm and normal blood pressure (BP). The house officer (registrar) working with me that night proposed treating him with a benzodiazepine, but I pointed out he had an important exam to take in a few hours and had driven himself to the ED. Rather than snow him with benzos, I suggested metoprolol, a lipophilic beta-1 blocker with both peripheral and central nervous system effects. Her response to this was, “Oh no, you can’t do that – what about unopposed-alpha stimulation? ” I told them I had never experienced or heard of a case of this at our hospital in my 20 plus years of emergency medicine, but I had always been looking for it. ” It was at this point I realized the level of misinformation regarding this dogma had become so pervasive, that newly-minted physicians were applying it as an absolute contraindication to beta-blocker treatment for stimulants. ” She replied, “It’s where you give a beta-blocker and their BP immediately skyrockets.” I asked some other house officers nearby: “It’s when they get an arrhythmia after beta-blockers,” and, “They get chest pain and MI right after beta-blockers, but only with cocaine.” “It puts methamphetamine and cocaine patients at high-risk for aortic and coronary artery dissection.” I then asked, “Have you ever seen it or heard of a case? It was kind of like the emergency medicine equivalent of a snipe hunt. Within minutes his tachycardia resolved, and he felt back to baseline. We watched him for another hour then discharged him.

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    Metoprolol answers are found in the Davis's Drug Guide powered by Unbound. Concurrent use with amphetamines, cocaine, ephedrine, epinephrine. Cocaine is the leading cause for drug–abuse-related visits to emergency departments, most of which. with metoprolol after consuming 1,000 mg of cocaine. Administration in patients with cocaine associated chest pain and myocardial. metoprolol from 4.9% to 4.3%.9 These trials form the basis of the. ACC/AHA.

    Metoprolol belongs to the class of medications called beta-blockers. Metoprolol is used to treat high blood pressure and prevent the symptoms of certain types of angina (chest pain). It is also used to help reduce the risk of death right after a heart attack. Metoprolol is also taken by people who have had a heart attack to reduce the risk of having another one. Metoprolol is often used in combination with other high blood pressure medications such as diuretics (water pills) when the use of one medication by itself is not enough to control blood pressure. This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here. What are the potential interactions and history between cocaine and beta blockers? The following provides information about what beta blockers are, and the relationship between cocaine and beta blockers, including interactions and history. Before looking at the interactions and history of cocaine and beta blockers, what are beta blockers? Beta blockers are also referred to as beta-adrenergic blocking agents, and they can treat many different conditions ranging from migraines to high blood pressure. Beta-blockers stop the impact of epinephrine, which is a hormone more commonly known as adrenaline, and in doing so, they reduce blood pressure. When you take a beta blocker, it slows your heartbeat and makes it less forceful, which ultimately lowers blood pressure. When you take beta blockers, it also helps improve blood flow by opening vessels.

    Metoprolol and cocaine

    Death temporally related to the use of a beta. - Springer Link, The Cardiovascular Effects of Cocaine - JACC

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  5. Cocaine abuse remains a significant worldwide health problem. Patients with cardiovascular toxicity from cocaine abuse frequently present to the emergency.

    • Blockers, Cocaine, and the Unopposed α-Stimulation Phenomenon..
    • A Review of Beta-blockers in the Setting of Cocaine Associated..
    • Cocaine Acute intoxication - UpToDate.

    Beta-Blockers for Cocaine and other Stimulant Toxicity. Rather than snow him with benzos, I suggested metoprolol, a lipophilic beta-1 blocker. May 24, 2010. Cocaine is an illegal substance used by millions of Americans. for that first dose was intravenous metoprolol in 113 74%, oral metoprolol in. Ava-Metoprolol Metoprolol belongs to the class of medications called. cobicistat; cocaine; cyproterone; darifenacin; delavirdine; dextromethorphan; digoxin.

     
  6. deniskin1 XenForo Moderator

    Many people with depression are prescribed antidepressant medications by a health care provider. Antidepressant medications not only affect biochemicals in the brain to help alleviate symptoms of depression, they may be impacting other organs in the body. The liver is one such organ that may be affected by antidepressant medications, according to the July 2007 issue of the “Annals of Pharmacology.” Antidepressants are medications used to treat major depression, dysthymia or chronic low-grade depression, and anxiety disorders such as obsessive compulsive disorder and social anxiety disorder. The type most people are familiar with is the selective serotonin reuptake inhibitors, or SSRIs, which includes the drugs Prozac, Zoloft and Celexa. Other classes of antidepressants are the tricyclic antidepressants; monoamine oxidase inhibitors, or MAOIs; serotonin-norepinephrine reuptake inhibitors, or SNRIs; and norepinephrine-dopamine reuptake inhibitors. Antidepressants may affect liver enzymes, as noted by the “Annals of Pharmacology” article. After starting antidepressants, the liver enzyme count in the bloodstream may rise. In many instances this rise is not concerning and the enzyme levels return to normal in a little over a week. Depression and Elevated Liver Enzymes Zoloft Disease Interactions - Psychotropic drugs and liver disease A critical review of.
     
  7. vox XenForo Moderator

    If you subscribe to any of our print newsletters and have never activated your online account, please activate your account below for online access. By activating your account, you will create a login and password. Valtrex for warts - What Doctors Want You to Know HPV infection - Diagnosis and treatment - Mayo Clinic Valtrex and warts - MedHelp
     
  8. soycle Guest

    Metoprolol Lopressor - Side Effects, Dosage, Interactions - Drugs Metoprolol Lopressor is a beta blocker, prescribed for treating high. too much of the drug, symptoms of a metoprolol overdose may include.

    Fatal metoprolol overdose.