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TCAs

Pharmacologic Effects of TCAs

K+ Channel BlockadeQTC Prolongation
NE & Serotonin Reuptake InhibitionInitial hypertension quickly followed by hypotension
Na+ Channel BlockadeQRS Prolongation
Hypotension — depresses myocardial contractility
Ventricular dysrhythmias
Brugada-like findings on EKG
Muscarinic Anticholinergic Receptor AntagonismAnticholinergic Toxidrome
AntihistaminergicCNS stimulation or sedation
alpha1 Adrenergic AntagonismHypotension
GABA-A Receptor BlockadeSeizures
Source: http://resusreview.com/2013/toxicology-board-review

Treatment

Sodium bicarbonate slow push (1-2 min)
Goals:
QRS duration <100
hemodynamically stable
Na ~150
pH ~7.5
Monitor for hypokalemia and hypocalcemia
Alternatives: hypertonic saline, sodium acetate, lidocaine, intralipid

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  463k v. 1 May 24, 2013, 12:51 PM Kit Tainter
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