====== Hypotension and Bradycardia ======

**There are a relatively small number of toxins that commonly lead to hypotension and bradycardia. It is important to make a correct diagnosis, as these drugs are among the most lethal and have specific antidotes.**

   * [[:wikitox:2.1.6.1.1_calcium_channel_blockers|Calcium channel blocking drugs (CCBs)]]
  * [[:wikitox:3.4.3.4.2_beta_blockers|Beta adrenoceptor blocking drugs]]
  * [[:wikitox:2.1.6.1.2_cardiac_glycosides|Digoxin]]

In addition there are a number of toxins that will occasionally lead to bradycardia and hypotension in very severe poisoning but which usually cause either tachycardia or no change to heart rate.

  * [[:wikitox:2.1.11.9.4_mood_stabilizers|Lithium]]
  * [[:wikitox:2.1.11.9.2.1_tricyclic_antidepressants|Tricyclic antidepressants (TCAs)]]
  * [[:wikitox:2.1.11.9.3_antipsychotics|Neuroleptics]]
  * [[:wikitox:2.1.11.2_anticonvulsants|Anticonvulsants]]
  * [[:wikitox:barbiturates|Barbiturates]]
  * [[:wikitox:chloroquine|Chloroquine]]
  * [[:wikitox:quinine|Quinine]]
  * [[:wikitox:2.1.1.3_opioids|Opioids]]
  * [[:wikitox:2.1.11.5.1_acute_management_of_alcohol_problems|Alcohol]]
  * [[:wikitox:2.2.7.4.5_organophosphates|Organophosphates]]

Features that help to differentiate between these drugs are:

  * [[:wikitox:response_to_painful_stimuli|RESPONSE TO PAINFUL STIMULI]]
  * [[:wikitox:pupil_size_and_reaction|PUPIL SIZE & REACTION]]
  * [[:wikitox:myoclonic_jerking_or_hyperreflexia|MYOCLONIC JERKING or HYPERREFLEXIA]]
  * [[:wikitox:bowel_sounds|BOWEL SOUNDS]]
  * [[:concept_ecg_changes|ECG CHANGES]]
  * [[:wikitox:response_to_antagonists|RESPONSE TO ANTAGONISTS]]
  * [[:wikitox:electrolytes_and_blood_glucose|ELECTROLYTES/BLOOD GLUCOSE]]
  * [[:wikitox:blood_concentrations|BLOOD CONCENTRATIONS]]