However, using the ACLS protocol for wide-complex tachycardia or possible ventricular tachycardia might lead the treating physician to administer procainamide, a class IA antiarrhythmic agent with cardiodepressant effects that are additive to those of the tricyclic antidepressants. A patient with multiple premature ventricular contractions or runs of ventricular tachycardia after intoxication with chloral hydrate or inhalation of a chlorinated solvent would respond more readily to a beta blocker than to lidocaine, the drug recommended by the ACLS protocols. Although hypertension is not commonly recognized as a serious pharmacological effect of drug intoxication, it may have life-threatening consequences and requires aggressive treatment. Severe hypertension can lead to intracranial hemorrhage, aortic dissection, or other catastrophic complications. Hypertension may be accompanied by tachycardia, as commonly occurs in cases of intoxication with generalized stimulants such as cocaine and amphetamine derivatives.
Treatment is directed at the cause of the hypertension.
In patients who have taken cocaine, amphetamines, or other generalized stimulants, mild or moderate increases in blood pressure may be reduced simply by the clinician's providing a quiet environment and administering a sedative agent such as diazepam. Prolonged or repeated convulsions can lead to serious complications, including hyperthermia, rhabdomyolysis, brain damage, and death. In addition, seizure activity causes metabolic acidosis, which may worsen cardiotoxicity in patients who have taken an overdose of a tricyclic antidepressant. Treatment of seizures includes taking immediate steps to protect the airway and provide oxygen while administering anticonvulsant drugs. If seizure activity persists, consult with a neurologist and consider administering pentobarbital or another short-acting barbiturate.