NAPLEX Toxicology/Antidotes

Antidote for Alcohol

Thiamine (aka Vitamin B1)

Antidote for Anticholinergics

Supportive Care

Antidote for Dabigatran

Idarucizumab

Antidote for Warfarin (multiple options)

1. Phytondione (aka Vitamin K)

2. Prothrombin (aka KCentra)

Antidote for Heparin

Protamine

Antidote for Antipsychotics (specifically dystonia, seizures, and QRS widening)

Dystonia: Benztropine

Seizures: Benzodiazepines

QRS Widening: Sodium Bicarbonate

Antidote for Benzodiazepines

Flumazenil

Antidote for Beta Blockers (specifically hypotension, hypoglycemia, and lipophilics)

Hypotension: Fluids & Vasopressors

Hypoglycemia: Glucagon, insulin, & Dextrose

Lipophilic Beta Blockers: Lipid Emulsion

Antidote for Calcium Channel Blockers (hint: similar to another drug class, multiple options)

Same as Beta Blockers (fluids, pressors, glucagon, insulin, dextrose, lipid emulsion)

Plus calcium chloride or calcium gluconate

Antidote for Cyanide

Hydroxocobalamin

Antidote for Digoxin

Digoxin Immune Fab (aka DigiFab)

Antidote for Ethylene Glycol

Fomepizole

Antidote for 5-FU & Capecitabine

Uridine Triacetate

Antidote for Insulin (multiple options)

Glucose tablets, glucagon, IV dextrose

Antidote for Sulfonylureas (multiple options)

1. Octreotide

2. Glucose tablets, glucagon, or IV dextrose

Antidote for Isoniazid

Pyridoxine (aka Vitamin B6)

Antidote for Iron

Deferoxamine

Antidote for Local Anesthetics

Lipid Emulsion

Antidote for Mammal Bites

Rabies Vaccine + Immunoglobulin

**Tetanus Vaccine (if 10+ years since last dose)**

Antidote for Methotrexate (specifically to alkanize urine, replenish folate, kidney injury)

Urine: Sodium Bicarbonate

Folate: Folic Acid

Kidney Injury: Glucarpidase

Antidote for Neostigmine & Pyridostigmine (specifically reversal & bradycardia)

Reversal: Pralidoxime

Bradycardia: Atropine or Glycopyrrolate

Antidote for Nicotine (specifically bradycardia & seizures)

Bradycardia: Atropine

Seizures: Benzodiazepines

Antidote for Organophosphates (specifically cholinergic symptoms & muscle weakness/paralysis)

Cholinergic Symptoms: Atropine

Muscle Paralysis: Pralidoxime

Antidote for Paralytics (multiple options)

1. Neostigmine

2. Sugammadex

Antidote for Salicylates

Sodium Bicarbonate

Antidote for Snake Bites

Crotalidae Immune Fab

Antidote for Stimulants

Benzodiazepines

Antidote for Tricyclic Antidepressants (specifically for hypotension, seizures, QRS widening)

Hypotension: Vasopressors

Seizures: Benzodiazepines

QRS Widening: Sodium Bicarbonate

Antidote for Valproic Acid & Topiramate

Levocarnitine

What should you do initially for a topical poison exposure?

Wash skin with soap & water for 15 minutes

What should you do initially for an ocular (eye) poison exposure?

Remove contacts and rinse eyes with water for 15 minutes

Under what time frame is activated charcoal most effective after exposure to a toxin?

Within 1 hour of exposure

What is the dose & frequency for activated charcoal?

1 gram per kilogram once

What is the daily limit for tylenol dosing?

4000mg per day

Describe each of the 4 phases of tylenol overdose.

Phase 1: No symptoms or some Nausea/Vomiting

Phase 2: Elevated Liver Enzymes or INR

Phase 3: Liver Failure (jaundice, coagulopathy, renal failure)

Phase 4: Liver Transplant or Recovery

Antidote for Tylenol

N-Acetylcysteine (aka NAC)

What is the IV treatment for NAC in Tylenol Overdose?

Loading Dose + 1-2 additional infusions over 21 hours total

What is the oral treatment for NAC in Tylenol Overdose?

Loading Dose + 17 additional doses every 4 hours

**MUST REPEAT DOSE IF VOMITED**

Antidote for Opioids

Naloxone (aka Narcan)