Toxicology/ Antidotes
4 phases of tylenol overdose
1. < 24 hours: common asymptomatic or non-specific n/v 2. 24-48: lab (increased INR, ALT/AST) 3. 48-96: hepatic failure (jaundice, encephalopathy, coagulopathy, hepatorenal syndrome) 4. > 96: recovery, death, transplant
CC, a 5 year-old child, has accidentally ingested approximately eight tablets of acetaminophen twenty minutes ago. She is conscious with no apparent symptoms. Her mother has contacted poison control and has been instructed the best course of action would be to:
Activated charcoal; Activated charcoal is effective if administered within one hour of ingestion of a toxic substance
Scorpion bite?
Anascorp; Antivenin immune FAB
Black widow spider bite?
Antivenin
Organophosphates (OPs) including industrial insecticides
Atropine and pralidoxime or combo Because OPs block acetylcholinesterase which increases acetylcholine; so atropine anticholinergic blocks SLUDGE symptoms (salivation, lacrimation, urination, diarrhea, GI, emesis)
The antidote for methanol and ethylene glycol overdose is: A Naloxone B Fomepizole C N-acetylcysteine D Flumazenil E Cyanocobalamin
B - Fomepizole is a competitive inhibitor of alcohol dehydrogenase
Which of the following is contraindicated in a patient with G6PD deficiency? A N-acteylcysteine B Leucovorin C Methylene blue D Deferoxamine E Pyridoxine
C
Acetaminophen overdose is dose dependent adverse effect, with increased metabolism of tylenol by ________ leads to increased production of ________ which is toxic
CYP2E1 NAPQI (n-acetyl-p-benzoquinone-imine) --> binds to cell proteins and causes injury
Diltiazem overdose give?
Calcium chloride or calcium glucagon
Ethanol antidote?
Chronic alcohol user: administer Vit B1 to prevent wernicke encephalopathy
Snake bite?
CroFAB: copperhead, rattle snakes bites Antivenin: coral snake bites
Iron antidote
Deferoxamine (desferal)
Heavy metal antidote?
Dimercaprol (arsenic, gold, mercury) Penicillamine (copper) Succimer (lead) Prussian blue (thallium)
Antidote benzodiazepines?
Flumazenil But can precipitate seizures in benzo dependent patients
Activated charcoal works by preventing ___________. Dose is? Contraindicated when?
GI absorption 1 mg/kg Airway is unprotected
Beta blocker antidote?
Glucagon
Common symptomatic treatment: hypotension
IV fluids, vasopressors
Common symptomatic treatment: hypertension
IV vasodilator
He consumed over 15 alcoholic beverages and now presents to the Emergency Department with presumed alcohol poisoning. What laboratory abnormality would likely be present?
Increased anion gap
Methyl salicylate antidote?
It is a salicylate... sodium bicarbonate
Antidote for prothrombin complex (warfarin sometimes, Xa inhibitors)
Kcentra
Antidote for Tylenol? How?
NAC (n-acetylcysteine) -increases GSH which convers NAPQI to mercapturic acid which can be safely excreted out of the body *note: if NAQI has bonded to hepatocytes, damage is irreversible*
Opioid overdose antidote?
Naloxone
Dabigatran reversal?
Praxibind (Idarucizumab)
Isoniazid antidote
Pyridoxine (vitamin B6) Neurotoxicity (coma, seizure) administer IV, oral pyridoxine is given daily to prevent neuropathies
Animal bite antidote?
Rabies vaccine + human rabies immune globulin
Anticholinergic overdose s/s
Red as a beet: flushing dry as a bone: dry skin/mucous blind as a bat: blurry vision mad as a hatter: AMS hot as a hare: fever
Salicyclates antidote?
Sodium bicarbonate Because makes urine alkaline, which decreases drug absorption and increases excretion
Cyanide toxicity antidote? From nitroprusside
Sodium thiosulfate + sodium nitrite Hydroxocobalamin
Nicotine overdose management?
Supportive care Atropine if bradycardic
Antidote anticholinergics? (atropine, benadryl, scopolamine, etc)
Supportive care Rarely physostigmine
Kcentra is used for warfarin in emergent situations (t/f)
TRUE
Common symptomatic treatment: bradycardia
atropine, inotropes
Common symptomatic treatment: seizure
benzo
Common symptomatic treatment: hypoglycemia
dextrose
Common symptomatic treatment: sedation
protect airway (intubation)
S/S opioid overdose?
sedation, respiratory depression
Common symptomatic treatment: agitation
sedatives (benzo)
Common symptomatic treatment: QRS widening
sodium bicarbonate