A Review of Beta-Blocker Toxicity and Management Strategies.

In 2017, a total of 26,431 beta-blocker exposures were reported to United States poison centers, with 21% of adult exposures attributed to patients 60 years of age and older. Beta-blockers are a major component of therapy in numerous cardiovascular diseases, which have a higher incidence in older people. Along with polypharmacy and neurocognitive decline, potentially limiting reliable medication adherence, older patients may be more sensitive to the hypotensive and bradycardic effects of beta-blockers. Additionally, because of a lack of success of traditional management methods, evidence of newer therapies such as highdose insulin euglycemia therapy and intravenous lipid emulsion has shown success in various patient cases. This review seeks to summarize the mechanisms and effects of beta-blocker toxicity and review management strategies in older people.

Management of overdoses of salvia, kratom, and psilocybin mushrooms: a literature review.

INTRODUCTION: Despite the relative reduction in opioid and other illicit substance overdoses in the past few years, clinicians must remain vigilant in keeping up to date on emerging trends with regard to potential substances of abuse. As overdoses of traditional drugs of abuse decrease in light of legislative and de-prescribing initiatives, it stands to reason that alternative agents, including natural products, have increased. Toxicities associated with these agents have been contributing to emergency department visits across the globe. AREAS COVERED: This evaluation covers salvia, kratom, and psilocybin mushrooms, and was accomplished through a comprehensive review of PubMed, SCOPUS, ProQuest Central, ProQuest Dissertations, and CINAHL. Thirty-one pieces of literature are included in this evaluation. The objective of this review is to provide clinicians with the information necessary to provide bedside care for overdoses of salvia, kratom, and psilocybin mushrooms. EXPERT OPINION: Salvia, kratom, and psilocybin mushrooms may not be an initial consideration when healthcare practitioners are triaging an overdose scenario; however, data from around the world demonstrate an increased use of these agents. While not typically fatal, clinicians must be prepared to assess these as a potential etiology of overdoses and provide appropriate supportive care.