Sections

Medication

Medication Summary

The goals of pharmacotherapy are to reduce the toxic effects of the drug, reduce morbidity, and prevent complications. Treatment measures may include gastrointestinal decontamination, sedation, seizure control, and control of catecholamine-induced hypertension and tachycardia.

Class Summary

Empirically used to minimize systemic absorption of the toxin.

Polyethylene glycol (PEG) solution

Laxative with strong electrolyte and osmotic effects. Cathartic actions in GI tract. May be indicated in treatment of methamphetamine ingestion in people who carry methamphetamine packages in their body. Must administer after activated charcoal. Liquid reconstituted per package instructions.

Activated charcoal (Liqui-Char)

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A form of carbon processed to be riddled with small, low-volume pores that increase the surface area available for adsorption or chemical reactions. Due to its high degree of microporosity, one gram of activated charcoal has a surface area in excess of 500 square meters, and further chemical treatment often enhances adsorption properties.

Class Summary

Neuroleptic agents are CNS dopamine antagonists that are useful for control of agitated patients. By increasing the action of GABA, which is a major inhibitory neurotransmitter in the brain, benzodiazepines depress all levels of CNS, including limbic and reticular formation. Haloperidol and droperidol are D2 receptor antagonists that interfere with dopaminergic neurotransmission in the limbic system and the cerebral cortex.

Lorazepam (Ativan)

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Benzodiazepine. GABA receptor agonist.

Diazepam (Valium)

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Benzodiazepine. GABA receptor agonist.

Midazolam (Versed)

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Benzodiazepine. GABA receptor agonist.

Haloperidol (Haldol)

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CNS dopamine D2 receptor antagonist.

Droperidol (Inapsine)

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CNS dopamine D2 receptor antagonist.

Olanzapine (Zyprexa, Zydis)

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The exact mechanism of action of olanzapine is not known. It binds to alpha-1, dopamine, histamine H-1, muscarinic, and serotonin type 2 (5-HT2) receptors.

Ziprasidone (Geodon)

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Dopamine and serotonin receptor antagonist. It also inhibits the re-uptake of serotonin and norepinephrine in the CNS.

Class Summary

Used to control catecholamine-induced hypertension and tachycardia.

Labetalol (Normodyne, Trandate)

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Blocks beta1-, alpha-, and beta2-adrenergic receptor sites, decreasing blood pressure. When given IV, acts primarily as a beta-receptor antagonist.

Metoprolol (Lopressor, Toprol)

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Blocks beta1-adrenergic receptor sites, decreasing heart rate.

Questions

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Author

John R Richards, MD, FAAEM Professor, Department of Emergency Medicine, University of California, Davis, Medical Center

John R Richards, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Robert W Derlet, MD Professor of Emergency Medicine, University of California at Davis School of Medicine; Chief Emeritus, Emergency Department, University of California at Davis Health System

Robert W Derlet, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Association for the Advancement of Science, Infectious Diseases Society of America, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Timothy E Albertson, MD, PhD, MPH Distinguished Professor of Pharmacology and Toxicology, Distinguished Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Chair, Department of Internal Medicine, University of California, Davis, School of Medicine; Distinguished Professor of Anesthesiology, Professor of Emergency Medicine and Clinical Toxicology, Davis Medical Center; Medical Director of Poison Control System, University of California, San Francisco, School of Pharmacy

Timothy E Albertson, MD, PhD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP Attending Physician in Emergency Medicine and Medical Toxicology, Excela Health System

Fred Harchelroad, MD, FACMT, FAAEM, FACEP is a member of the following medical societies: American College of Medical Toxicology

Disclosure: Nothing to disclose.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician / Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Prisma Health Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Columbia Medical Society, Society for Academic Emergency Medicine, South Carolina College of Emergency Physicians, South Carolina Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor - Chief Editor for Medscape.

Additional Contributors

Edward A Michelson, MD Associate Professor, Program Director, Department of Emergency Medicine, University Hospital Health Systems of Cleveland

Edward A Michelson, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Methamphetamine Toxicity Medication

Medication Summary

GI decontaminant

Class Summary

Polyethylene glycol (PEG) solution

Activated charcoal (Liqui-Char)

Activated charcoal (Liqui-Char)

Sedatives

Class Summary

Lorazepam (Ativan)

Lorazepam (Ativan)

Diazepam (Valium)

Diazepam (Valium)

Midazolam (Versed)

Midazolam (Versed)

Haloperidol (Haldol)

Haloperidol (Haldol)

Droperidol (Inapsine)

Droperidol (Inapsine)

Olanzapine (Zyprexa, Zydis)

Olanzapine (Zyprexa, Zydis)

Ziprasidone (Geodon)

Ziprasidone (Geodon)

Cardiovascular Agents

Class Summary

Labetalol (Normodyne, Trandate)

Labetalol (Normodyne, Trandate)

Metoprolol (Lopressor, Toprol)

Metoprolol (Lopressor, Toprol)

Methamphetamine Toxicity Medication

Medication Summary

GI decontaminant

Class Summary

Polyethylene glycol (PEG) solution

Activated charcoal (Liqui-Char)

Sedatives

Class Summary

Lorazepam (Ativan)

Diazepam (Valium)

Midazolam (Versed)

Haloperidol (Haldol)

Droperidol (Inapsine)

Olanzapine (Zyprexa, Zydis)

Ziprasidone (Geodon)

Cardiovascular Agents

Class Summary

Labetalol (Normodyne, Trandate)

Metoprolol (Lopressor, Toprol)

References

Tables

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