Medication Summary
The goals of pharmacotherapy are to reduce morbidity, prevent complications, and neutralize the effects of the toxin.
GI decontaminants
Class Summary
Empirically used to minimize systemic adsorption of toxin. May benefit only if administered within 1-2 hours 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.
Pharmacologic antidotes
Class Summary
Prevents seizure recurrence and terminates clinical and electrical seizure activity. May be used in conjunction with benzodiazepines.
Pyridoxine (Nestrex)
Involved in synthesis of GABA within CNS. Administer with benzodiazepines.
Benzodiazepines
Class Summary
Prevents seizure recurrence and terminates clinical and electrical seizure activity. May be used in conjunction with pyridoxine (vitamin B-6).
Diazepam (Valium)
Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.
Lorazepam (Ativan)
Sedative hypnotic with short onset of effects and relatively long half-life. May depress all levels of CNS, including limbic and reticular formation, by increasing action of GABA, which is a major inhibitory neurotransmitter in the brain. Monitoring patient's blood pressure after administering dose is important. Adjust prn.
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.
Methemoglobin treatments
Class Summary
In reduced form, leukomethylene blue is an electron donor to reduce methemoglobin. Reduction of methylene blue is by NADPH generated by G-6-PD.
Methylene blue (Urolene blue)
Used to convert ferrous iron of reduced hemoglobin to ferric form that is the basis for antidotal action.
