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TERMS TO LEARN

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Neutropenia Decrease in number of neutrophils in the blood.
Paresthesias An abnormal touch sensation (such as burning or prickling) often without external stimulus.
Systemic Lupus Erythematous Autoimmune disorder typically seen in women; characterized by fever, polyarthritis, serositis, endocarditis, and skin rash.
Wilson's Disease Defect in copper metabolism; leads to hepatic failure, tremor, and psychosis.

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I. MANAGING POISONINGS

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TREATING SPECIFIC POISONS

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Drug Poison(s) Mechanism of Action
N-Acetylcysteine/NAC (Mucomyst, Acetadote)
  • Acetaminophen

  • Glutathione analog that acts as a glutathione surrogate preventing the formation and accumulation of a toxic metabolite

Flumazenil (Romazicon)
  • Benzodiazepines

  • Direct benzodiazepine antagonist

Oxygen
  • Carbon monoxide

  • Competitive inhibitor with carbon monoxide for binding sites on hemoglobin

Amyl nitrite and sodium nitrite
  • Cyanide

  • Induce methemoglobinemia which competes with cyochrome oxidase for cyanide

Sodium thiosulfate (All packaged as cyanide)
  • Enhances the conversion of cyanide to thiocyanate which is less toxic

Digoxin-specific antibodies (Digibind)
  • Digoxin

  • Digitoxin

  • Antibodies that bind excess digoxin/digitoxin creating a complex that is excreted by the kidneys

Fomepizole (Antizol)
  • Methanol

  • Ethylene glycol

  • Competitive inhibitor of alcohol dehydrogenase

Ethanol
Physostigmine (Antilirium, Eserine)
  • Muscarinic antagonists

  • Reversible inhibitor of acetylcholinesterase

  • Results in increased Ach to counteract muscarinic antagonism

Naloxone (Narcan)
  • Opiates

  • Opiate antagonist

Atropine
  • Organophosphates

  • Carbamates

  • Anticholinesterases

  • Muscarinic antagonist

  • Prevents muscarinic overactivity caused by inhibition of acetylcholinesterase

Pralidoxime (2-PAM, Protopan)
  • Organophosphates

  • Reactivates acetylcholinesterase by cleaving the bond between the enzyme and the organophosphate

  • Reverses Ach overstimulation at both nicotinic and muscarinic receptors

Hydroxocobalamin (Cyanokit)
  • Cyanide

  • Combines with cyanide to form cyanocobalamin (Vitamin B12)

Protamine sulfate
  • Heparin

  • Neutralizes heparin by formation of a heparin-protamine complex

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II. CHELATORS

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CHELATORS: DRUG FACTS

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Drug Pharmacokinetics Clinical Uses Side Effects
Dimercaprol (BAL)
  • A: IM

  • M: Hepatic

  • E: Metabolites excreted in urine

  • Arsenic

  • Gold

  • Lead

  • Mercury

  • Sulfhydryl (–SH) group (good chelators of heavy metals)

  • Transient hypertension

  • Tachycardia

  • Headache

  • Abdominal pain, nausea, and vomiting

  • Paresthesias

  • Fevers, especially in children

Succimer/DMSA (Chemet)
  • A: PO; variable absorption

  • E: Absorbed portion excreted unchanged in urine

  • Lead

  • Arsenic

  • Mercury

  • CNS effects

  • Elevation of liver enzymes

  • GI distress (nausea, vomiting, diarrhea)

  • Neutropenia

  • Skin rash

Edetate calcium disodium (EDTA, Endrate, Versenate)
  • A: IM and IV

  • E: Unchanged in urine

  • All heavy metals, especially lead

  • Calcium disodium salt form prevents hypocalcemia

  • Hypotension

  • Nausea and vomiting

  • Nephrotoxicity

  • Systemic febrile reactions

Penicillamine (Cuprimine, Depen)
  • A: PO

  • E: Unchanged in urine

  • Arsenic

  • Gold

  • Lead

  • Copper

  • Treatment of Wilson's disease

  • Nephrotoxicity with proteinuria

  • Pancytopenia

  • Autoimmune dysfunction, including systemic lupus erythematosus and hemolytic anemia

  • Allergic reactions in patients with penicillin allergy

Deferoxamine (Desferel)
  • A: IM or IV

  • E: Unchanged in urine

  • Iron

  • Skin reactions

  • Rapid IV administration may cause histamine release and hypotensive shock

  • LTU associated with retinal degeneration, hepatic and renal dysfunction, and coagulopathies

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