Advanced Medical Life Support (AMLS)

A 72-year-old patient experiences lethargy and diminished respirations after medication confusion. Which toxicity is likely present?

1. Calcium channel blockers

2. Salicylate

3. Beta blocker

4. Anticoagulant

The correct answer is: Beta blocker

The likely toxicity present in this scenario is related to beta blockers. In older patients, beta blockers can lead to significant respiratory depression and lethargy, particularly if there has been an overdose or an interaction with other medications. This class of medication can impair the heart's ability to pump effectively, leading to a decrease in cardiac output and subsequent respiratory insufficiency. The symptoms described—lethargy and diminished respirations—are consistent with central nervous system effects and respiratory depression associated with beta blocker toxicity. In a case of confusion regarding medication, particularly with beta blockers, the risk of dosing errors can be significant, potentially leading to life-threatening outcomes. The respiratory depression can also actively hinder the patient’s ability to maintain adequate oxygenation and ventilation. Other options do have potential toxic effects but are less likely to present specifically with the combination of lethargy and diminished respirations as seen in this scenario. Calcium channel blockers can cause decreased heart rate and hypotension but do not typically result in the same level of respiratory compromise. Salicylate toxicity tends to lead to respiratory alkalosis initially and may present with hyperventilation. Anticoagulants primarily increase bleeding risk rather than respiratory issues. Thus, the presentation aligns most closely with beta blocker toxicity.