Toxicology- Antidotes Flashcards
Acetaminophen
N-acetylcysteine ( oral or Acetadote, IV)
MOA: Restores ntracellular glutathione (acts as
a glutathione substitute)
NAC should be administered immediately, even
before the results of APAP level are obtained; within 8 hours of ingestion.
Oral loading dose is 140 mg/kg PO, followed by 70 mg/kg Q4H x 1 doses, unless the APAP level is non-toxic.
Has an odor of rotten eggs and often causes nausea. IV form (Acetadote) can be used as an alternative, but is more costly; does not require oral ingestion.
Acetadote: IV, 150 mg/kg IV over 60 mins, followed by 50 mg/kg over 4 hrs, followed by 100 mg/Kg IV over 16 hrs
Organophosphates OPs (nerve agents, gases (sarin, others) Industrial insecticides (malathion)
Atropine and pralidoxime
Organophosphates, which inhibit acetylcholinesterase, leading to the accumulation of acetylcholine.
The symptoms of organophosphate poisoning are cholinergic and can be remembered by the mnemonic MUDDLES: miosis (pinpoint pupils), urination, diarrhea, diaphoresis, lacrimation, excitation (anxiety) and salivation.
Pralidoxime treats the muscle weakness and relieves paralysis of respiratory muscles secondary to toxicity
Benzodiazepines
Flumazenil (Romazicon)
also used off-label for non-benzos hypnotic overdose (e.g. zolpidem); can precipitate seizures if used in benzo dependent pts
Beta Blockers
supportive care, Glucagon (GIucaGen) and/or high dose insulin with glucose
treat bradycardia, hypotension, and seizures
Botulism
Botulism antitoxin, heptavalent
Black Widow spider bites
Antivenin (Lastrodectus mactans), supportive care
Carbon monoxide
Oxygen, possibly hyperbaric
Ethanol (alcoholic drinks)
Supportive care, correct hypoglycemia
if chronic user administer thiamine (vit B1) to prevent Wernicke syndrome (neurological damage)
Ethylene glycol, diethylene glycol, methanol (suspected with anion-gap metabolic acidosis along with osmolar gap)
Fomepizole (Antizol) or Ethanol (2nd line)- inhibit alcohol dehydrogenase (ADH)
Anticholinergic overdose (atropine, diphenhydramine, dimenhydrinate, atropa belladonna (deadly nightshade), jimson weed, scopolamine
symptoms: “red as beet, dry as bone, blind as bat, mad hatter and hot as hare”
- flushing, dry skin and mucous membrane, mydriasis with double or blurry vision, altered mental status and fever
severe: tachycardia, hypertension, psychosis, seizures, respiratory and cardiovascular collapse
supportive care, rarely Physostigmine (Antilirium)- inhibits acetylcholesterase. increases acetylcholine, used in severe cases of delirium
if seizures are present give benzodiazepines or anticonvulsants
Calcium channel blockers
supportive care, Calcium Chloride 10%, or gluconate
Glucagon (GIucaGen) and/or high dose insulin with glucose
Cyanide
due to high dose or long exposure or renal impairment treatment with nitroprusside, or ingestion of amygdalin (cancer remedy)
hydroxycobalamin (Cyanokit)
sodium thiosulfate + Sodium nitrite (Nithiodote)
Digoxin, oleander, foxglove
Digoxin Immune Fab (DigiFab)
Heavy metals (arsenic, copper, gold, lead, mercury
Dimercaprol or penicilliamine or calcium disodium edetate (EDTA)
Succimer (Dimercaptosuccinic acid, DMSA)
Heparin, LMWH
Protamine
1mg/ 100 units of heparin
Insulin or other hypoglycemics, severe low blood glucose
Dextrose
Glucagon if unconscious and outpatient
IV dextrose will result in hypokalemia. May require K+
Sulfonylureas: octreotide (SandoStatin)
lsoniazid
Pyridoxine (Vitamin B6)
oral 10-50 mg daily to prevent neuropathies, and higher doses treat toxicity
Iron
Deferoxamine (Desferal)
Deferiprone (Femprox) and Deferasirox (Exjade)- — for iron overload from blood transfusions
Methotrexate
leucovorin (folinic acid), levoleucovorin (Fusilev), Glucarpidase (Voraxaze)
Methemoglobinemia
Methylene Blue
antidote contraindicated in pts with G6PD deficiency
Amatoxin-containing mushrooms
hallucinations
supportive care, silibinin (Legalon SIL) +/- Atropine
Napthalene, from mothballs
Supportive care
Methylene Blue
Neostigmine, pyridostigmine
Pralidoxime
Pralidoxime treats the muscle weakness and relieves paralysis of respiratory muscles secondary to anticholinergic meds used to treat myasthenia gravis
Nicotine, including e-cigarettes in teenagers
Supportive care
Atropine is nicotine receptor antagonist (use to treat symptomatic bradycardia)
Use benzos to treat seizures
Opioids (legal or illicit (e.g, heroin)
Naloxone (Narcan, Evzio)
Evzio is auto injector for emergency treatment outside of the hospital
Petroleum distillates (gasoline, kerosene, mineral oil, paint thinners)
Oxygen supportive care
Do not use gastric emptying. Keep pt NPO
Plants: castor beans, jequirity beans, oleander and foxglove, hemlock
Supportive care
DigiFab if oleander, or foxglove
Salicylate
Sodium bicarbonate
salicylates are acidic; sodium bicarb is an alkalizing agent
Scorpion stings
Antivenin immune FAB Centruroides (Anascorp)
Snake bites
Antivenin Micrurus fulvius for coral snake bites;
Crofab for copperhead and rattlesnake bites
Stimulants amphetamines ADHD weight loss drugs cocaine, ephedrine, caffeine, theophylline, MDMA (ecstasy) alcohol withdrawal
Supportive care, possibly Benzodiazepines
symptoms of overdose include: tachycardia,hypertension, mydriasis, agitation, possible seizures, hyperthermia, and psychosis
Benzos (e.g. lorazepam) may be used for agitation and/or seizures
TCA’s
Supportive care
Sodium bicarbonate to decrease widening QRS complex
Benzos (e.g. lorazepam) may be used for seizures
Vasopressors may be used for hypotension
Valproate-induced hyperammonemia
L-carnitine (Levocarnitine)
treat if symptomatic (changes in mental status, elevated ammonia level)
Warfarin, rat poison (rodenticides)
Phytonadione (Vit K)
AquaMephyton, Mephyton
Vasopressors
Phentolamine
