Toxaphene Toxicity Medication

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

Class Summary

These agents are empirically used to minimize systemic absorption of the toxin and are only beneficial if administered within 1-2 h of ingestion.

Activated charcoal (Liqui-Char)

Emergency treatment in poisoning caused by drugs and chemicals. Network of pores present in activated charcoal adsorbs 100-1000 mg of drug per gram of charcoal. Does not dissolve in water.

For maximum effect, administer within 30 min of ingesting poison.

MDAC may be useful to intercept enterohepatically-recirculated toxicants. Can be administered as multiple individual doses.

Class Summary

Theoretically, cholestyramine enhances rate of fecal excretion of stored toxin. This may be true because toxaphene and other related chlorinated hydrocarbons are normally recirculated through the biliary-enterohepatic and enteroenteric system.

Binding resin binds secreted insecticide and metabolites, reducing reabsorption and retaining the bound agent in the lumen of the intestinal tract. Also, by binding bile salts and, therefore, reducing formation of emulsions, binding resin minimizes uptake of these highly lipid-soluble agents.

Cholestyramine (Questran)

Nonabsorbable bile acid binding anion exchange resin. Administer 1 h before or 4 h after a drug.

Class Summary

Ventricular dysrhythmias may respond to beta-adrenergic blockade therapy. In contrast, if mixed adrenergic stimulation is highly suspected acutely, do not use beta-blockers because of the possibility of developing deleterious unopposed alpha-adrenergic stimulation.

This category of drugs has the potential to suppress ventricular ectopy due to ischemia or excess catecholamines. In the setting of myocardial ischemia, beta-blockers have antiarrhythmic properties and reduce myocardial oxygen demand secondary to elevations in heart rate and inotropy.

Consider an alpha-agonist, such as phenylephrine, for the treatment of hypotension that does not respond to fluid replacement.

Propranolol (Inderal)

A nonselective beta-adrenergic blocker with membrane depressant activity.

Maximum beta-blockade achieved with approximately 0.2 mg/kg.

Esmolol (Brevibloc)

Short-acting IV cardioselective beta-adrenergic blocker with no membrane-depressant activity.

Class Summary

These agents decrease portal circulation pressure by diminishing blood flow due to vasoconstriction. The major indication for these agents is variceal bleeding.

Phenylephrine (Neo-Synephrine)

Strong postsynaptic alpha-receptor stimulant with little beta-adrenergic activity that produces vasoconstriction of arterioles in the body. Increases peripheral venous return.

Useful in treating hypotension. Theoretically, using pure alpha-agonists for hypotension is better because of sensitized myocardium.

Class Summary

These agents are used to treat acute seizure activity.

Diazepam (Valium)

Potentiates inhibitory effect of GABA neuronal activity in CNS.

If convulsions persist, administer an alternative anticonvulsant.

Lorazepam (Ativan)

DOC for treatment of status epilepticus because it persists in the CNS longer than diazepam. Rate of injection should not exceed 2 mg/min. May be administered IM if unable to obtain vascular access.

Midazolam (Versed)

Used as alternative in termination of refractory status epilepticus. Because water soluble, takes approximately 3 times longer than diazepam to peak EEG effects. Thus, clinician must wait 2-3 min to fully evaluate sedative effects before initiating procedure or repeating dose. Has twice the affinity for benzodiazepine receptors than diazepam. May be administered IM if unable to obtain vascular access.

Class Summary

These agents prevent seizure recurrence and terminate clinical and electrical seizure activity.

Pentobarbital (Nembutal)

Second-line drug category for treatment of drug-induced seizures. Short-acting barbiturate with anticonvulsant properties. Interferes with transmission of impulses from thalamus to cortex of brain.