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Antidotes for Arkansas

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by

Howell Foster

on 25 February 2016

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Transcript of Antidotes for Arkansas

Howell Foster PharmD, DABAT
Antidotes
Five Antidotes Every Arkansas Hospital Should Stock
Conclusions
N-Acetylcysteine
Crotalidae Polyvalent Immune Fab
Digoxin Immune Fab
Hydroxocobalamin
Fomepizole

Sodium bicarbonate, Calcium salts, Naloxone, Atropine, Lipids, Folic acid, Glucagon, & Insulin
Antidotes that have multiple other uses.
Sodium bicarbonate, Calcium salts, Naloxone, Atropine, Lipids, Folic acid, Glucagon, & Insulin
Availability
Sufficient quantities
Over reliability
Stocked but out of date.
Pitfalls with antidotes
N-Acetylcysteine
Acetaminophen overdose
IV and oral
Oral:LD 140 mg/kg then 70 mg/kg every 4 hours for 17 doses
IV: LD 150 mg/kg over 1 hour, then 50 mg/kg over 4 hours, then 100 mg kg over 16 hours
NAC IV Dosing per Me
Loading Dose: 150 mg/kg over 1 hour
4HR Bag: 12.5 mg/kg over 4 hours
16HR Bag: 6.25 mg/kg over 16 hours

I think this is logical.
CroFab
Polyvalent Crotalidae Fab
Need at least 6 vials
Works for Rattlesnakes, Cottonmouths, and Copperheads
PC consults on about 65-75 pit viper bites each year.
Digoxin Immune Fab
2 brands available both bind at equivocal levels so stock the cheapest one.
10 vials on hand
Acute dose is very different from chronic.
Pediatric dose empirically is the same as the adult dose in acute patients. Chronic is different.
Hydroxocobalamin HCl
Turns serum red so labs should be drawn before giving it.
Binds cyanide resulting in formation of B12.
Fire victims think CO first then CN
Fomepizole
Inhibits Alcohol Dehydrogenase
Inhibits the metabolism of EG and methanol
Safer than using ethanol
Recombinant enzyme cleaves MTX into DAMPA & glutamate.

Indicated for the treatment of elevated levels of methotrexate (defined as 1 micromol/L) during treatment of cancer patients who have impaired kidney function.
Glucarpidase
Full transcript