Antidotes Flashcards
AChE inhibitors, organophosphates
Atropine followed by pralidoxime
Amphetamines overdose
NH4CL (acidfies urine)
Antimuscarininc, anticholinergic agent overdose (Atropine)
Physostigmine salicylate (works both peripherally and centrally), control hyperthermia Common in elderly
Benzodiazepines overdose
Flumazenil
B-Blockers overdose
Glucagon (acts on Gs and increases intracellular cAMP)
Carbon Monoxide poisoning
100% O2, hyperbarid O2
Blocks complex 4 in ETC
Decreasing proton gradient
Copper poisoning
Penicillamine or trientine
Arsenic poisoining
pencillamine
Dimercaprol depletes aresenic from sulfhydryl groups of enzymes (low therapeutic index can lead to nephrotoxicity and hypertension)
Succimer
Aresenic inhibits lipoic acid (cofactor for a ketodehydrogenase and pyruvate dehydrogenase)-vomiting, rice water stools and garlic breath
Causes 0 net ATP in glycolysis
Gold poisoning
Pencillamine
Dimercaprol (low therapeutic index can lead to nephrotoxicity and hypertension)
succimer
Cyanide poisoining
Can be due to nitroprusside overdose
Nitrite+thiosulfate,
hydroxocobalamin (directly binds to cyanide)
Cyanide inhibits cytochrome a-a3 complex in ETC inhibiting aerobic metabolism-decreases proton gradient
Cyanide normally broken down by rhodanese a sulfur donor that converts cyanide to thiocyanate which can be excreted in the urine
Nitrite increase methemoglobin which cannot bind oxygen but has an increased affinity for cyanide therefore cyanide is sequestered in blood away from mitochondria
Digitalis overdose
Anti-dig Fab fragments
Heparin overdose
Protamine sulfate
Iron toxicity
Deferoxamine, deferasirox
Lead poisoining
EDTA, dimercaprol, succimer, pencillamine
Mercury poisoning
Dimercaprol (low therapeutic index can lead to nephrotoxicity and hypertension)
Succimer
Methanol, ethylene glycol (antifreeze) poisoning
Fomepizole>ethanol, dialysis
Fomepizole inhibits alcohol dehydrogenase
Methemoglobin toxicity
Methylene blue, vitamin C
Opioids overdose
Naloxone
Salicylates overdose
NaHCO3 (alkalinize urine), dialysis
TCAs overdose
NaHCO3 (plasma alkalinization)
tPA, streptokinase, urokinase overdose
Aminocaproic acid
Warfarin overdose
Vitamin K, plasma (if active bleeding)
Rodenticides (brodifarium)
decrease Vitamin K therefore give IV fresh frozen plasma and Vitamin K
Acetaminophen overdose
N-acetylcystein (replenishes glutathione)
Also provides sulfylhydryl groups to enhance the non toxic sulfation elimination of acetaminophen
Serotonin syndrome
Cryproheptadine
5HT receptor antagonist
Dexrazoxane
Prevents doxorubicin dilated cardiomyopathy by chelating iron decreasing formation of O2 free radicals
Amifostone
Prevents cisplatin induced nephrotoxicity
Free radical scavenger
Leucorvin
“Folinic acid”
Reverses methotrexate myelosuppression because it does not require DHF reductase to be converted to THF
Mesna
Partially prevents Hemorrhagic cystitis induced by cyclophosphamide by binding to acrolein which is toxic to uroepithelial cells
NE extravasation
Causes a1 receptor vasoconstriction
Treat with phentolamine mesylate an a receptor blocker
Rotenone
Blocks Complex 1 in ETC (NADH to NAD+)
Decreased proton gradient
Antimycin A
Blocks Complex 3 in ETC
Decreased proton gradient
Oligomycin
Inhibits ATP synthase
increased proton gradient
2,4 Dinitrophenol
Used illicilty for weight loss
Increases permeability of membrane causing decreased proton gradient and increased O2 consumption
ETC produces heat not ATP
Calcium channel blocker toxicity
Glucagon