Antidotes

Antidodes

An antidote is a substance that can counteract a form of poisoning. The term antidote is a Greek word meaning “given against”. This post will help you familiarize with the common antidotes that are used in the hospital setting. The following are antidotes that should be familiarized by the nurse to respond to this emergency situation quickly.

Mechanism of Action of Antidotes

Antidotes act by different mechanism. The mechanisms of action of antidotes are given below:

  1. Complex formation.
  2. Metabolic conversion.
  3. Prevention of toxic metabolite formation.
  4. By changing the physio-chemical nature of toxicant.
  5. Promotes return to normal function by repairing a defect or enhancing a function that corrects the effects of poison.

Classification of Antidotes

Depending on their action, antidotes are classified as:

  1. Chemical Antidotes: Chemical antidotes are the agents which change the chemical nature of poison. For example, sodium thiosulphate which changes toxic cyanide to the non-toxic thiocyanate; sodium calcium edetate chelates agents used for heavy metal poison.
  2. Physiological Antidotes: Physiological antidotes acs by producing the effect opposite to that of poison. For example, sodium nitrite converts hemoglobin into methemoglobin in order to bind cyanide.
  3. Mechanical Antidotes: Mechanical antidotes which prevent the absorption of poison into the body. For example, activated charcoal absorbs the poison prior to absorption across intestinal wall. Copper sulphate, magnesium sulphate and sodium monohydrogen phosphate inactivate and precipitate the toxic material as insoluble salts by chelation.

 

  1.   Antidote Toxin/Drug/Agent Note
    1 Atropine or pralidoxime Organophosphate/ carbamate insecticide poisoning and other cholinesterase inhibitors (eg, warfare agents); bradycardia induced by a variety of toxins May require large amounts in severe cholinesterase inhibitor poisoning. Also stocked in the Strategic National Stockpile but will need supplies for first 48 hours. Coordinate with local Homeland Security office.
    2 Antivenom, Crotalidae Polyvalent ImmuneFAB(ovine)/ Cro-Fab® Rattlesnake envenomation Rattlesnake envenomation CROFAB was shown in clinical studies to be effective when given within 6 hours of snakebite.
    3 Antivenom, Black Widow

    Spider/ Antivenom

    (Latrodectus Mactans)®

    Black Widow Spider envenomation Equine base risk of allergic hypersensitivity
    4 BAL(Dimercaprol)/ BAL in oil 10% Heavy metal poisoning IM administration only
    5 Calcium Chloride injection Calcium channel blocker poisoning; hypocalcemia induced by various agents Can cause tissue necrosis if extravasation occurs – use large vein for infusion OR use calcium gluconate (see below)
    6 Calcium Gluconate Powder Hydrofluoric acid For manufacture of topical gel
    7 Calcium Gluconate injection Hydrofluoric acid skin exposure or poisoning; hypocalcemia induced by various agents it is contraindicated if the patient have Hypersensitivity; IM/SC administration; ventricular fibrillation during CPR; hypercalcemia; Digoxin poisonings;Sarcoidosis.
    8 Calcium Gluconate

    gel/Calgonate 2.5% gel®

    Hydrofluoric acid dermal burns For topical burns
    9 Leucoverin Calcium Fluorouracil/Methotrexate
    10 Carnitine (L-Carnitine)/ Carnitor® Hyperammonemia from valproic acid toxicity
    11 Cyanide Antidote Kit (from Akorn)/Amyl nitrate, Sodium Nitrate, Sodium thiosulfate Cyanide; Sodium nitroprusside toxicity Conventional cyanide antidote kit: contains 2-10mL (3%) amps of sodium nitrite, 2-50 mL (25%) vials of sodium thiosulfate, 12 amyl nitrite inhalant ampules
    12 Cyanokit®/ Hydroxycobalamin Cyanide poisoning Newer, safer and easier to use than the conventional cyanide antidote kit
    13 Sodium Nitrite Cyanide Risk of methemoglobinemia with use
    14 Sodium Thiosulfate Cyanide; Sodium nitroprusside toxicity
    15 Dimercapol, edetate Calcium, Disodium Lead poison .
    16 Deferoxamine/ Desferal Iron poisoning IV use only
    17 Digoxin Immune FAB (ovine)/ DigibindÒ or DigiFab® Digoxin poisoning; other cardiac glycosides (eg, oleander, foxglove) Consult with poison center regarding dosing, especially for cardiac glycosides than digoxin.
    18 Phentolamine(Regitine) Dopamine
    19 Diphenhyldramine(Benadryl) Extrapyramydal symptoms(EPS)
    20 DMSA (Succimer)/ ChemetÒ Heavy metal poisoning
    21 DTPA-Calcium (Diethylenetriamine pentaacetate)/ Pentetate Calcium Trisodium injection) Dirty bomb agents: radioactive plutonium, americium and curium Stocked in the Strategic National Stockpile but will need supplies for first 48 hours. Coordinate with local Homeland Security office.
    22 DTPA-Zinc (Diethylenetriamine pentaacetate)/ Pentetate Zinc Trisodium injection) Dirty bomb agents: radioactive plutonium, americium and curium Stocked in the Strategic National Stockpile but will need supplies for first 48 hours. Coordinate with local Homeland Security office.
    23 EDTA-Calcium/ Versenate Heavy metal poisoning
    24 Ethanol IV 10% with 5% Dextrose Ethylene glycol or methanol poisoning Note: IV 10% ethanol product no longer manufactured. Fomepizole easier to dose and monitor than ethanol.
    25 Ethanol (oral) / Vodka Ethylene glycol or methanol poisoning Fomepizole easier to dose and monitor than ethanol. Oral ethanol can be used in an emergency situation.
    26 Flumazenil/ RomaziconÒ Benzodiazepine poisoning Use small initial dose to avoid abrupt awakening/ delirium. Do not use in patients on chronic benzodiazepine therapy as withdrawal seizures may occur. Also use with caution in mixed drug overdoses.
    27 Fomepizole (4-MP)/ AntizolÒ Preferred antidote for ethylene glycol or methanol poisoning Manufacturer will replace expired stocks.
    28 Glucagon Beta blocker/calcium channel blocker poisoning Anticipate nausea and vomiting
    29 Glucose (Dextrose 50%) Insulin Reaction
    30 Methylene Blue Methemoglobinemia
    31 Mesna Cyclophosphamide
    32 N-Acetylcysteine (NAC) MucomystÒ or generic Acetaminophen poisoning (oral preparation) Use orally. Dilute at least by a 3:1 ratio.
    33 N-Acetylcysteine (NAC) Acetadote Acetaminophen poisoning (IV preparation) Loading dose should be infused slowly over 45-60 minutes. Generic N-acetylcysteine can be used if Acetadote® is not available (consult with poison center and administer via a micropore filter).
    34 Naloxone/ NarcanÒ or Nalmefene Opioid overdose/Narcotics Use small initial dose to avoid abrupt awakening/withdrawal
    35 Octreotide acetate/ SandostatinÒ Oral sulfonylurea poisoning Avoid long-acting depot products.
    36 Physostigmine/ Antilirium Anticholinergic poisoning, especially antimuscarinic delirium. Administer at low dose (0.5 mg) and slowly, over 2-5 minutes to avoid severe adverse reactions including bradycardia, asystole and seizures. (Contraindicated in TCA or similar poisoning with widened QRS intervals.)
    37 NaHCO3:Bicarbonate Tricyclic antidepressant
    38 Pralidoxime(2-PAM)/ Protopam Cholinesterase Inhibitor poisoning (organophosphate or “nerve gas”) Also stocked in the Strategic National Stockpile but will need supplies for first 48 hours. Coordinate with local Homeland Security office
    39 Prussian Blue/ Radiogardase® Dirty bomb agents: radioactive cesium and thallium and non-radioactive thallium Stocked in the Strategic National Stockpile but will need supplies for first 48 hours. Coordinate with local Homeland Security office.
    40 Pyridoxine (Vitamin B6) Isoniazid (INH) poisoning Large amounts needed for poisoning: 5 grams is the minimum antidotal dose used in an ingestion of an unknown amount. Note: the 100 mg in 1 mL vials contain the preservative chlorobutanol. A 5 gram dose requires 50 of these vials and will deliver a toxic dose of the preservative.
    41 Albuterol inhaler,Insulin & glycose,NaHCO3,Kayexalate Potassium
    42 Protamine Sulfate Heparin
    43 VitaminK1 (Phytonadione)/ MephytonÒ or AquaMephytonÒ Warfarin, warfarin-based anticoagulants and superwarfarin based rodenticide poisoning If patient is actively bleeding use fresh frozen plasma or Factor VII concentrate.
© Copyright 2017, All Rights Reserved | Terms and Conditions