Chelation Flashcards
Deferoxamine (Desferal) MISC
Can only treat for 24 hours before acute lung injury manifests
British Anti-Lewisite (Dimercaprol) Class
Dithiol
2,3-dimercaptosuccinic acid (Succimer) Class
Dithiol
British Anti-Lewisite (Dimercaprol) MOA
Forms stable chelate via electron pair donation and coordination with metal ion; solubilized in peanut oil
2,3-dimercaptosuccinic acid (Succimer) MOA
Coordinate bonding to sulfur (arsenic and mercury) or sulfur and oxygen (lead and cadmium)
Edetate calcium disodium (EDTA) MOA
Displacement of calcium by lead
Ferric hexacyanoferrate /Prussian Blue (Radiogardase) MOA
Stays in gut and not absorbed until it grabs metal; goes into gut and is excreted that way
Deferoxamine (Desferal) MOA
Chelates free iron and iron transported between transferrin and ferritin
British Anti-Lewisite (Dimercaprol) Therapies
Arsenic, lead, inorganic mercury poisoning
2,3-dimercaptosuccinic acid (Succimer) Therapies
Arsenic, lead, mercury, cadmium poisoning
Edetate calcium disodium (EDTA) Therapies
Lead poisoning
Ferric hexacyanoferrate /Prussian Blue (Radiogardase) Therapies
Thallium and radioactive cesium poisoning
Deferoxamine (Desferal) Therapies
Acute iron poisoning; chronic iron overload
British Anti-Lewisite (Dimercaprol) SE
Renal toxicity (unless urine is alkalinized, due to dissociation), Pain at injection site (IM); nausea, vomiting; increases in BP and HR
2,3-dimercaptosuccinic acid (Succimer) Se
Mild ALT/AST elevation (usually only 2 - 3 times upper limit normal, and transient, Well tolerated; nausea, vomiting, flatuus, diarrhea
Edetate calcium disodium (EDTA) SE
Malaise, fever, Renal toxicity (proximal tubules, distal tubules, glomeruli); ALT/AST increase
Ferric hexacyanoferrate /Prussian Blue (Radiogardase) SE
Well tolerated; not absorbed after oral dosing into systemic circulation (this is pretty unique)
Deferoxamine (Desferal) SE
Rate-related hypotension; anaphylactoid reactions; yersinia enterocolitis; acute lung injury/ARDS
British Anti-Lewisite (Dimercaprol) MISC
Given IV or IM; allergic implications (peanut oil); need to start using ASAP
2,3-dimercaptosuccinic acid (Succimer) MISC
Given orally onlu in US;given IV in other countries with more severe adverse events secondary to IV administration
Edetate calcium disodium (EDTA) MISC
Given IV; DO NOT CONFUSE WITH Na2EDTA (can lead to life-threatening hypocalcemia); if given in lead encephalopathy, there is a potential to cause lead redistribution into the brain; BAL must be given before this in that scenario
Ferric hexacyanoferrate /Prussian Blue (Radiogardase) MISC
Some concern that cyanide is liberated from Prussian Blue, however the amount released appears to be quantitatively minimal & not clinically significant
Deferoxamine (Desferal) MISC
Can only treat for 24 hours before acute lung injury manifests
