Differential Diagnosis Drug Induced Bradycardia

Hypertension: P1-selective > nonselectives, which also block bronchodilation and peripheral vasodilation and could exacerbate bron-chospasm in obstructive pulmonary disease and lower extremity claudication in peripheral vascular disease.

Angina: Reduce anginal attacks and decrease post-myocardial infarction mortality. Tachydysrhythmias: Used in theophylline overdose, butadenosine preferred over P-blockers. Tremor: Propanolol over prescribed agitation, stage fright, and panic attacks ("shakes"). Migraine headaches.

Hyperthyroidism: P-blockers moderate the sympathetic, hyperdynamic effects of thyroid storm.

Side Effects

Bronchospasm: Nonselectives prevent bron-chodilation and promote bronchospasm in chronic obstructive pulmonary disease (COPD) patients.

High anaphylaxis risk: Nonselectives block cat-echol's ability to reduce mast cell degranulation in patients with atopic allergies. Hypoglycemia: All ß-blockers mask sympathetic response to hypoglycemia and interfere with gluconeogenesis/glycogenolysis. Withdrawal: Rebound increased heart rate and elevated blood pressure on abrupt withdrawal can precipitate MI and CVA.

P-Blockers: Hypotension, depressed mental status, slightly elevated K, ECG — prolonged PR interval and widened QRS. CCBs: Hypotension, preserved mental status, ECG — PR prolonged interval and widened QRS complex.

Digoxin: Nausea and vomiting, hyperkalemia, hypertension, and mental status preserved; ECG — prolonged PR, ST changes, atrial then ventricular dysrhythmias.

Na-channel blockers: Seizures, hypotension, depressed mental status, ECG — widened QRS complex.

Cholinergics: SLUDE, DUMBBELS, ECG — sinus tachycardia or paradoxical bradycardia. a-agonists: a1 = phenylpropanolamine (PPA): Severe hypertension, intracranial hemorrhage (ICH), sinus bradycardia; a2 = clonidine, imid-azolines: cause an opioid toxidrome, with pinpoint miosis and sinus bradycardia.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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