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NAPLEX > Toxicology- Antidotes > Flashcards

Toxicology- Antidotes Flashcards

1
Q

Acetaminophen

A

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

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2
Q 
Organophosphates OPs  (nerve agents, gases (sarin, others) 
Industrial insecticides (malathion)
A

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

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3
Q

Benzodiazepines

A

Flumazenil (Romazicon)
also used off-label for non-benzos hypnotic overdose (e.g. zolpidem); can precipitate seizures if used in benzo dependent pts

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4
Q

Beta Blockers

A

supportive care, Glucagon (GIucaGen) and/or high dose insulin with glucose

treat bradycardia, hypotension, and seizures

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5
Q

Botulism

A

Botulism antitoxin, heptavalent

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6
Q

Black Widow spider bites

A

Antivenin (Lastrodectus mactans), supportive care

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7
Q

Carbon monoxide

A

Oxygen, possibly hyperbaric

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8
Q

Ethanol (alcoholic drinks)

A

Supportive care, correct hypoglycemia

if chronic user administer thiamine (vit B1) to prevent Wernicke syndrome (neurological damage)

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9
Q

Ethylene glycol, diethylene glycol, methanol (suspected with anion-gap metabolic acidosis along with osmolar gap)

A

Fomepizole (Antizol) or Ethanol (2nd line)- inhibit alcohol dehydrogenase (ADH)

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10
Q

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

A 
supportive care, 
rarely Physostigmine (Antilirium)- inhibits acetylcholesterase. increases acetylcholine, used in severe cases of delirium

if seizures are present give benzodiazepines or anticonvulsants

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11
Q

Calcium channel blockers

A

supportive care, Calcium Chloride 10%, or gluconate

Glucagon (GIucaGen) and/or high dose insulin with glucose

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12
Q

Cyanide
due to high dose or long exposure or renal impairment treatment with nitroprusside, or ingestion of amygdalin (cancer remedy)

A

hydroxycobalamin (Cyanokit)

sodium thiosulfate + Sodium nitrite (Nithiodote)

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13
Q

Digoxin, oleander, foxglove

A

Digoxin Immune Fab (DigiFab)

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14
Q

Heavy metals (arsenic, copper, gold, lead, mercury

A

Dimercaprol or penicilliamine or calcium disodium edetate (EDTA)

Succimer (Dimercaptosuccinic acid, DMSA)

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15
Q

Heparin, LMWH

A

Protamine

1mg/ 100 units of heparin

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16
Q

Insulin or other hypoglycemics, severe low blood glucose

A

Dextrose
Glucagon if unconscious and outpatient

IV dextrose will result in hypokalemia. May require K+
Sulfonylureas: octreotide (SandoStatin)

17
Q

lsoniazid

A

Pyridoxine (Vitamin B6)

oral 10-50 mg daily to prevent neuropathies, and higher doses treat toxicity

18
Q

Iron

A

Deferoxamine (Desferal)

Deferiprone (Femprox) and Deferasirox (Exjade)- — for iron overload from blood transfusions

19
Q

Methotrexate

A

leucovorin (folinic acid), levoleucovorin (Fusilev), Glucarpidase (Voraxaze)

20
Q

Methemoglobinemia

A

Methylene Blue

antidote contraindicated in pts with G6PD deficiency

21
Q

Amatoxin-containing mushrooms

hallucinations

A

supportive care, silibinin (Legalon SIL) +/- Atropine

22
Q

Napthalene, from mothballs

A

Supportive care

Methylene Blue

23
Q

Neostigmine, pyridostigmine

A

Pralidoxime

Pralidoxime treats the muscle weakness and relieves paralysis of respiratory muscles secondary to anticholinergic meds used to treat myasthenia gravis

24
Q

Nicotine, including e-cigarettes in teenagers

A

Supportive care
Atropine is nicotine receptor antagonist (use to treat symptomatic bradycardia)
Use benzos to treat seizures

25
Q

Opioids (legal or illicit (e.g, heroin)

A

Naloxone (Narcan, Evzio)

Evzio is auto injector for emergency treatment outside of the hospital

26
Q

Petroleum distillates (gasoline, kerosene, mineral oil, paint thinners)

A

Oxygen supportive care

Do not use gastric emptying. Keep pt NPO

27
Q

Plants: castor beans, jequirity beans, oleander and foxglove, hemlock

A

Supportive care

DigiFab if oleander, or foxglove

28
Q

Salicylate

A

Sodium bicarbonate

salicylates are acidic; sodium bicarb is an alkalizing agent

29
Q

Scorpion stings

A

Antivenin immune FAB Centruroides (Anascorp)

30
Q

Snake bites

A

Antivenin Micrurus fulvius for coral snake bites;

Crofab for copperhead and rattlesnake bites

31
Q 
Stimulants
amphetamines 
ADHD
weight loss drugs
cocaine, ephedrine, caffeine, theophylline, MDMA (ecstasy) alcohol withdrawal
A

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

32
Q

TCA’s

A

Supportive care
Sodium bicarbonate to decrease widening QRS complex
Benzos (e.g. lorazepam) may be used for seizures
Vasopressors may be used for hypotension

33
Q

Valproate-induced hyperammonemia

A

L-carnitine (Levocarnitine)

treat if symptomatic (changes in mental status, elevated ammonia level)

34
Q

Warfarin, rat poison (rodenticides)

A

Phytonadione (Vit K)

AquaMephyton, Mephyton

35
Q

Vasopressors

A

Phentolamine

NAPLEX (8 decks)

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