Antidotes

Question 1

Anticholinergics

Answer 1

Agents: atropine, diphenhydramine, dimenhydrinate, scopolamine

Sx: flushing, dry skin, mydriasis w/ blurred vision, AMS, fever
(red as a beet, dry as a bone…)

Tx: physostigmine

Question 2

Warfarin

Answer 2

Sx: bleeding

Tx: phytonadione (vitamin k), PCC (kcentra)

Question 3

Factor Xa inhibitors

Answer 3

Sx: bleeding

Tx:
Andexxa -apixaban, rivaroxaban
PCC (kcentra) - factor Xa inhibitors

Question 4

Dabigatran

Answer 4

Sx: bleeding

Tx: Idarucizumab (Praxbind)

Question 5

Heparin, LMWH

Answer 5

Sx: bleeding

Tx: Protamine

Question 6

Antipsychotics

Answer 6

Tx: benztropine for dystonias

Question 7

BZD

Answer 7

Agents: Valium, Xanax, Ativan, Klonopin

Tx: Flumazenil

can cause seizures in patients on BZD chronically

Question 8

Beta-blockers

Answer 8

Tx: Glucagon if unresponsive to symptomatic treatment

Question 9

CCB

Answer 9

Tx: IV Calcium (chloride or gluconate)

Question 10

Cyanide

Answer 10

Agents: Nitroprusside (in high doses/long durations/renal impairment)

Tx: Hydroxocobalamin (Cyanokit)

Question 11

Lanoxin

Answer 11

Digoxin Immune Fab (DigiFab)

Question 12

Ethanol

Answer 12

Sx: can cause an ↑anion gap

Tx: thiamine (vitamin B1) to prevent Wernicke’s encephalopathy

Question 13

Heavy metals

Answer 13

Tx:
arsenic, gold, mercury - Dimercaprol
lead - Succimer + DMSA
copper - Penicillamine

Question 14

Hydrocarbons (petroleum products)

Answer 14

Do not induce vomiting
NPO due to aspiration risk

Question 15

Insulin

Answer 15

Dextrose (do not admin if patient unconscious)
Glucagon

Question 16

Isoniazid

Answer 16

Pyridoxine (vitamin B6)

Question 17

Iron

Answer 17

Deferoxamine (Desferal)

Question 18

Organophosphates
(industrial insecticides)

Answer 18

MOA: OPs block acetylcholinesterase (↑ACh levels)

↑ACh = SLUDD symptoms

Tx:
Atropine - anticholinergic
Pralidoxime - relieves paralysis by reactivating cholinesterase

Atropine & Pralidoxime combo

Question 19

Neostigmine, pyridostigmine

Answer 19

pralidoxime

Question 20

Nicotine

Answer 20

Sx: abdominal pain, nausea

Tx:
supportive care
atropine - for symptomatic bradycardia
BZD for seizures

Question 21

Paralytics

Answer 21

Neostigmine - rocuronium, vecuronium, pancronium
Sugammadex - rocuronium & vecuronium

Question 22

Salicylates

Answer 22

General concept: ↑ excretion
weak base: acidify the urine
weak acid: alkaline the urine

Tx:
Nabicarb (alkalinizing agent) -
↓ drug reabsorption and ↑ excretion

Question 23

Stimulant overdose

Answer 23

Agents: amphetamines, ADHD & weight loss drug

Tx: BZD

Question 24

Toxic alcohols

Answer 24

Agents: ethylene glycol (antifreeze), methanol

can cause an ↑ anion gap

Tx: Fomepizole

Question 25

TCA

Answer 25

can cause fatal arrhythmias

Tx:
Na-Bicarb: to ↓ wide QRS complex

Question 26

VPA or topiramate-induced hyperammonemia

Answer 26

Levocarnitine (Carnitor)