CBRNE - Ricin Medication
- Author: Ferdinando L Mirarchi; Chief Editor: Robert G Darling, MD, FACEP more...
Medication Summary
Update tetanus status if unknown. If exposure is via parenteral route, antibiotics may be helpful in preventing secondary bacterial infection.
Antibiotics
Class Summary
With regard to ricin toxicity, the only possible indication for antibiotics is for the parenteral mechanism of exposure. Direct the choice of antibiotic to cover skin flora.
Cefazolin (Ancef)
First-generation semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth.
Vasopressor agents
Class Summary
Perform adequate volume resuscitation of patients with isotonic fluids and packed red blood cells prior to using or in conjunction with these agents; do not use in place of volume resuscitation. Choice of agent usually is determined by physician preference.
Dopamine (Intropin)
Probably most well-known and used pressor agent. Standard mixture of 200 mg in 250 cm3 produces a concentration of 800 mcg/cm3; administer IV.
Norepinephrine (Levophed)
Often a second-line agent but can be used as a first-line agent; can be used with dopamine. Standard mixture of 4 mg in 250 cm3 produces a concentration of 16 mcg/cm3; administer IV.
Toxoids
Class Summary
These agents are used to induce active immunity. Update tetanus status if unknown.
Diphtheria and tetanus toxoid (Decavac)
Used to induce active immunity against tetanus in selected patients.
H2 blockers
Class Summary
Reversible competitive blockers of histamine at H2 receptors, particularly those in the gastric parietal cells where they inhibit acid secretion. The H2 antagonists are highly selective, do not affect H1 receptors, and are not anticholinergic agents.
Famotidine (Pepcid)
Competitively inhibits histamine at H2 receptor of gastric parietal cells, resulting in reduced gastric acid secretion, gastric volume, and reduced hydrogen concentrations.
Antidotes
Class Summary
Used to inhibit or reduce absorption of the toxin.
Activated charcoal (Liqui-Char, Actidose Aqua)
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 after ingesting poison.
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