antidote.docx

October 19, 2017 | Author: netradeep | Category: Pharmacology, Drugs, Medicine, Clinical Medicine, Wellness
Share Embed Donate


Short Description

for various drugs, doses of antidote and comments....

Description

Substance

Antidote

Acetaminophen

N-acetylcysteine

Anticholinergic agents (eg, atropine)

Physostigmine

Benzodiazepines

Flumazenil

β-Adrenergic antagonists

Glucagon

Insulin and dextrose

Amrinone

Carbon monoxide

Calcium-channel blockers

Dose



IV: 150 mg/kg over 15 min, then 50 mg/kg over 4 hr, then 100 mg/kg over 16 hr

Comments



AE: vomiting (PO); anaphylactoid reaction (IV).



IV protocol requires large volumes of free water, which may cause hyponatremia and seizures in children.



PO: 140 mg/kg load, then 70 mg/kg/dose every 4 hr for 17 doses



P: 0.5 mg IV slowly



May repeat dose after 15 min.



A: 2 mg IV slowly



AE: cholinergic symptoms occur with excessive dosing.



P: 0.01 mg/kg IV slowly every min (max 1 mg)





A: 0.1–0.2 mg IV slowly every min (max 1 mg)

Titrate to effect or maximal dose. May not reverse respiratory depression. If positive response is of short duration, may be administered as a continuous infusion.



AE: withdrawal symptoms in dependent or chronic use; seizures or dysrhythmias in cyclic antidepressant overdose.



If positive response is of short duration, may be administered as a continuous infusion.



AE: vomiting, hyperglycemia, hypocalcemia.



P: 0.1 mg/kg IV slowly



A: 3–5 mg IV slowly



Insulin 0.5 U/kg/hr IV, with



Dextrose 1 g/kg/hr

750 mcg/kg over 3–5 min slowly (max 3 mg/kg)

AE: hypo- or hyperglycemia, hypokalemia.



May use other phosphodiesterase inhibitors with equal efficacy (eg, milrinone).



AE: hypotension.

Oxygen (100%)

100% oxygen by nonrebreather

Treat until normal CO level or until hyperbaric oxygen initiated.

Oxygen (hyperbaric)

100% oxygen at 23 atmosphere for 20 min

AE: pneumothorax, perforated tympanic membrane.

Calcium chloride (10%)



P: 20 mg/kg (0.2 mL/kg)



May use glucagon, insulin, and dextrose as adjunctive

IV slowly, via central line



Calcium gluconate (10%)

Cyanide

Amyl nitrate

Sodium nitrite (3%)

Sodium thiosulfate (25%)

Digoxin

Ethylene glycol and methanol

Digoxin-specific antibody fragments (Digibind)

Ethanol (10%)

A: 1–2 g (10–20 mL) IV slowly



P: 60 mg/kg (0.6 mL/kg)



A: 3–6 g (30–60 mL) IV

One ampule by inhalation for 30 seconds every 3 min until IV access



P: 0.33 mL (10 mg) IV (for Hb at 12)



A: 10 mL IV over 10 min



P: 1.6 mL/kg IV (for Hb at 12)



A: 50 mL IV over 3 min



For known ingested dose: number of vials = mg ingested × 1.5



For known serum digoxin concentration (SDC, ng/mL): number of vials = SDC × weight (kg)/100



For unknown SDC or dose acute overdose: 10–20 vials



For chronic overdose: P: 2 vials; A: 5 vials

800 mg/kg (8 mL/kg) IV over 20-60 min, then 80-130 mg/kg/hr (0.8-1.3 mL/kg/hr) IV

treatment in CCB as in BB toxicity.



AE: hypercalcemia, phlebitis, nausea, vomiting, flushing, confusion, angina.

AE: methemoglobinemia (see caution for sodium nitrite below).



Dose varies according to weight and Hb level. See package insert.



AE: methemoglobinemia.



Use with caution in unconfirmed or unlikely cyanide poisoning (eg, in the setting of smoke inhalation), because induced methemoglobinemia may exacerbate hypoxemia from other causes.



Dose varies according to weight and Hb count. See package insert.



AE: hypotension, CNS toxicity.



Each 40-mg vial binds 0.6 mg digoxin.



AE: hypokalemia, worsening CHF.

Titrate to serum ethanol 100 mg/dL. Increase dose during dialysis and in chronic alcoholics. Oral dosing may be used in select cases.

Fomepizole (4methylpyrazole)

15 mg/kg over 30 min IV, then 10 mg/kg/dose every 12 hr × 4 doses, then 15 mg/kg/dose every 12 hr

Heparin

Protamine sulfate

Use 1 mg protamine for every 100 units of heparin to be neutralized.

Iron

Deferoxamine

5–15 mg/kg/hr IV (max 6 g/24 hr)



Continue therapy until serum methanol or ethylene glycol level < 20 mg/dL. Increase dose during dialysis.



AE: headache, nausea, dizziness bradycardia, eosinophilia, transient increase of liver enzyme levels

AE: hypotension, bradycardia, hemorrhage. Use with caution with known fish allergy.





Isoniazid

Lead

Pyridoxine (vitamin B6)

Succimer (DMSA)

Dimercaprol (BAL)



Known INH dose: 1g per g of INH ingested IV slowly



Unknown INH dose: 5 g IV over 10 min

10 mg/kg/dose PO every 8 hr × 5 days, then 10 mg/kg/dose twice daily × 14 days

 

CaNa2 EDTA

Methanol

See Ethylene glycol

75 mg/m2/dose IM every 4 hr Max: 450 mg/m2/dose/24 hr

1–1.5 g/m2/day continuous IV infusion × 5 days

Titrate dose slowly to avoid hypotension. Continue therapy until vin rose urine color clears, symptoms clinically resolve, or maximal dose attained. Deferoxamine challenge no longer suggested.



AE: flushing, hypotension, acute respiratory distress syndrome.



Administer 1 g every 23 min.



AE: CNS toxicity—headache, seizure, peripheral neurotoxicity.

AE: rash, neutropenia, increased LFTs, GI upset.



Pretreatment with diphenhydramine suggested. Contraindicated with peanut allergy, hepatic insufficiency.



AE: G6PD hemolytic crisis, nausea, vomiting, histamine release.



In cases of encephalopathy, administer after dimercaprol to prevent increased CNS lead levels.



AE: phlebitis.

Methemoglobinemia Methylene blue (1%)

Opioids

Cholinergic agents (eg, malathion)

Naloxone

Atropine

Pralidoxime

Oral antidiabetic agents

Octreotide

Dextrose

1–2 mg/kg IV over 5 min

0.5–2 mg IV/IM/SC/ET (max 10 mg)



P: 0.02 mg/kg IV initial dose (minimum 0.1 mg)



A: 0.5–1 mg IV initial dose



P: 25–50 mg/kg over 30– 60 min, then 20 mg/kg/hr



A: 1–2 g IV over 15–30 min, then 0.5 g/hr



P: 1–2 mcg/kg SC/IV every 6–12 hr



A: 50–100 mcg SC/IV, then 50 mcg every 12 hr



Neonate: 0.2 g/kg IV (use D10W, 2 mL/kg)



P: 0.5–1 g/kg IV (use D25W, 2–4 mL/kg)



A: 25–50 g IV (use D50W)



Repeat doses as needed.



AE: dyspnea, chest pain, and hemolysis.



Higher dose may be required for certain agents. Can repeat dose every 2–3 min until response or max dose. If no response to total 10-mg dose, unlikely opioid intoxication. If positive response is of short duration, may be administered as a continuous infusion. In setting of possible opioid dependence, consider initial dose of 0.05 mg to avoid withdrawal.



AE: opioid withdrawal (piloerection, agitation, vomiting).



Double dose every 3–5 min. Titrate to reduced bronchorrhea or improved oxygen saturation. May require total doses 5 or 10 times the initial dose or higher.



AE: anticholinergic toxicity.

Pralidoxime should be administered in addition to atropine. Continue therapy for 24–72 hr.



Continue therapy until euglycemic. May require several days of therapy.



AE: bradycardia, dysrhythmias, GI upset, hyperglycemia.

AE: hyperglycemia, extravasation may cause local tissue reaction.

Tricyclic antidepressants

Sodium bicarbonate

Warfarin

Vitamin K

1–2 mEq/kg IV bolus, then titrate to pH ~7.5 with additional doses or with continuous infusion



P: 1–5 mg SC/IM/IV/PO, every 6–8 hr PRN



A: 10 mg SC/IM/IV/PO, every 6–8 hr PRN

AE: volume overload, hypernatremia, metabolic alkalosis.

Much larger doses may be required. Continue therapy until INR within normal limits.

Abbreviations: AE, adverse effects; BB, β-adrenergic blocker; CCB, calcium-channel blocker; CHF, congestive heart failure; CNS, central nervous system; CO, carbon monoxide; D10W, 10% dextrose and water; ET, endotracheally; G6PD, glucose-6-phosphate dehydrogenase; GI, gastrointestinal; Hb, hemoglobin; INH, isoniaizid; IM, intramuscular; INR, international normalized ratio of prothrombin time; IV, intravenous; LFT, liver function tests; max, maximum; PO, oral; PRN, as needed; SC, subcutaneous; SDC, serum digoxin concentration. *Pediatric (P) and adult (A) doses are the same unless specifically noted.

View more...

Comments

Copyright ©2017 KUPDF Inc.
SUPPORT KUPDF