Antidotes

Question 1

Acetylcysteine Indication

Answer 1

APAP intoxication, potentially other hepatotoxic ingestion or indeterminate causes of acute hepatic failure

Question 2

Acetylcysteine IV dose

Answer 2

Use if NPO or in acute liver failure; 150 mg/kg over 60 min, then 50 mg/kg over 4 h then 6.35 mg/kg/h for 16 h. Total 24 h dose: 300 mg/kg; caution in pts w/ h/o asthma

Question 3

Acetylcysteine Enteral Dose

Answer 3

140 mg/kg followed in 4 h by 70 mg/kg q4h x 17 add’n doses. Repeat any dose if pt vomits w/in 1 h or admin

Question 4

DigiFab Indication

Answer 4

Digoxin level greater than 10 ng/mL, ingestion of at least 10 mg, K greater than 5 2/2 digoxin

Question 5

DigiFab Dose

Answer 5

Over 30 min; round to nearest vial; (conc x bw in kg)/100; mg of dig/0.5; acute ingestion - start w/ 10 vials then 10 vials prn, chronic ingestion - 6 vials

Question 6

Flumazenil Indication

Answer 6

benzo, z-drugs; CNS depression w/ norm vitals and ECG

Question 7

Flumazenil Caution

Answer 7

avoid: seizure hx, chronic benzos, concomintant TCA OD, arrhythmogenic or epileptogenic; caution: known EtOH dependence or panic attacks

Question 8

Flumazenil Dose

Answer 8

0.2-0.5 mg q30-60 sec, total max of 3-5 mg, cont IV of 0.1-1 mg/h

Question 9

Glucagon Indication

Answer 9

beta-blocker, CCB intoxication

Question 10

Glucagon Dose

Answer 10

2-10 mg IV bolus then 3-10 mg/h

Question 11

Naloxone Indication

Answer 11

opiate intoxication, caution: CV dz or acute pulmonary edema

Question 12

Naloxone Dose

Answer 12

0.1-0.4 mg IV over 30s q2-3min prn to max of 10 mg, cont IV: at 2/3 reversal dose in rebound toxicity

Question 13

Octreotide Indication

Answer 13

Indication: sulfonylurea and quinine intoxication (2nd after glucose)

Question 14

Octreotide Dose

Answer 14

50 mcg IV/SQ q6h

Question 15

Protamine Indication

Answer 15

Reversal of UFH (100%) and LMWH/fondaparinux (60%) intoxication

Question 16

Protamine Dose

Answer 16

UFH: amount of UFH in circulation (1 hr half-life), 1 mg protamine/100 units of UFH may repeat half dose; Enoxaparin/dalteparin: 1 mg of protamine/1 mg; max dose 50 mg over 10 min

Question 17

Pyridoxine Indication

Answer 17

isoniazid toxicity

Question 18

Pyridoxine Dose

Answer 18

1 g pyridoxine/ 1 gm of isoniazid to a max of 5 gm or 70 mg/kg

Question 19

Hydoroxocobalamine Dose

Answer 19

Cyanide poisoning: 5 g iv over 15 min may repeat once over 15 min to 2 h

Question 20

Sodium Nitrite Dose

Answer 20

Cyanide poisoning: 300 mg or 4-6 mg/kg over 2 min, may repeat 50% dose

Question 21

Sodium Thiosulfate Dose

Answer 21

12.5 gm or 150-200 mg/kg IV over 2 min, may repeat 50% dose

Question 22

Vitamin K Indication

Answer 22

Warfarin reversal

Question 23

Vitamin K Dose

Answer 23

INR 4.5-10 and rapid reversal needed: 2.5-5 mg enterally
INR 10 more w/o bleeding: 10 mg, add’n prn
Serious bleeding: 10 mg IV over 30-60 min, may repeat in 12 h