Beta blockers + cocaine + MI?

[leviathan]

What's the official position on this nowadays? Is anyone giving it?

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[WilcoWorld]

I've seen some reports that beta blockers in cocaine may not be as bad as we previously thought, but COMMIT-II has also shown that betablockers in AMI aren't as good as we thought.

Specifically, with cocaine chest pain my 1st line antihypertensive is the benzodiazepine class. It's rare that I don't achieve a 20-30% reduction in MAP with that alone.

 

[BADMD]

What's the official position on this nowadays? Is anyone giving it?

The evidence for either side is pretty poor. The stuff that says it is fine relied on urine drug screens and assumed that + cocaine = acute intoxication. The stuff saying it was bad was based on small doses given during cardiac catheterization where they measured vessel diameter.

There is nothing resembling outcome based measures on the this subject.

 

[Jeff698]

While I agree that the science isn't all that strong, I'll admit to sticking with benzos.

Much like I still wear sterile gloves while suturing (they fit better) and don't use lido w/ epi on fingers. Not much science but the power of medical inertia is strong.

Take care,
Jeff

 

[diphenyl]

Was thinking about this recently when I saw a 25 YO w/ an AMI s/p 24 cocaine binge.

 

[BADMD]

While I agree that the science isn't all that strong, I'll admit to sticking with benzos.

Much like I still wear sterile gloves while suturing (they fit better) and don't use lido w/ epi on fingers. Not much science but the power of medical inertia is strong.

Take care,
Jeff

I'm with you on the benzos. They work great and reduce catecholamine release and myocardial sensitivity to them.

I do occasionally use lido with epi on healthy people with bloody finger wounds. Most of the time, I don't need it to get a good looking field, however.