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Common Drugs And Antidotes Every Nurse Should Know

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An antidote is a substance that can counteract a form of poisoning. The term antidote is a Greek word meaning “given against”. It is therefore necessary for every nurse to familiarize with common antidotes in in the hospital setting in case of emergency.

AntidoteIndicationMode of Action
acetylcysteine (Mucomyst)Acetaminophen/ Tylenol/ ParacetamolRestores depleted glutathione stores and protects against renal and hepatic failure.
Activated charcoalNon-specific poisons except cyanide, iron,  lithium, caustics and alcohol.Absorption of drug in the gastric and intestinal tracts. Interrupts the entero-hepatic cycle with multiple dose.
albuterol inhaler, insulin & glucose, NaHCO3, kayexalatePotassium 
anticholinesterase agentsNeuromuscular blockade (paralytics) 
atropine sulfate or pralidoximeAnticholinesteraseCompetitive inhibition of muscarinic receptors.
BenzylpenicillinAmanita phalloides (Death cap mushroom)Not known; partial protection against acute hepatic failure; may displace amatoxin from protein-binding sites allowing increased renal excretion; may also inhibit penetration of amatoxin to hepatocytes.
Calcium saltsFluoride ingestionRapidly complexes with fluoride ion.
deferoxamineIronDeferoxamine acts by binding free iron in the bloodstream and enhancing its elimination in the urine.
digoxine immune fab
DigoxinBinds molecules of digoxin, making them unavailable for binding at their site of action on cells in the body.
dimercapol, edetate calcium, disodium,LeadChelation of lead ions and endogenous metals (e.g., zinc, manganese, iron, copper).
diphenhydramine (Benadryl)Extrapyramidal symptoms (EPS)A potent antagonist to acetylcholine in muscarinic receptors.
flumazenilBenzodiazepinesReverses the effects of benzodiazepines by competitive inhibition at the benzodiazepine binding site on the GABAA receptor.
fomepizoleEthylene glycolA competitive inhibitor of the enzyme alcohol dehydrogenase found in the liver. This enzyme plays a key role in the metabolism of ethylene glycol and methanol.
glucagonBeta blockers and calcium channel blockersStimulates the formation of adenyl cyclase causing intracellular increase in cycling AMP and enhanced glycogenolysis and elevated serum glucose concentration.
Glucose (Dextrose 50%)Insulin reactionDextrose (the monosaccharide glucose) is used, distributed and stored by body tissues and is metabolized to carbon dioxide and water with the release of energy.
HeparinErgotamineReverses hypercoagulable state by interacting with antithrombin III. Used in combination with vasodilator phentolamine or nitroprusside to prevent local thrombosis and ischemia.
HydroxocobalaminCyanideForms cyanocobalamin, a non-toxic metabolite that is easily excreted through the kidneys.
leucovorin calciumFluorouracil 
MethotrexateProtects the healthy cells from the effects of methotrexate while allowing methotrexate to enter and kill cancer cells.
Magnesium sulfatecalcium gluconate 
mesnaCyclophosphamideA “chemoprotectant” drug that reduces the undesired effects of certain chemotherapy drugs.
Methylene blueChemical producing severe methemoglobinemia. Ifosamide-induced encephalopathy.Reduces methemoglobin to hemoglobin.
nalmefene or naloxoneOpioid analgesicsPrevents or reverses the effects of opioids including respiratory depression, sedation and hypotension.
naloxone (Narcan)NarcoticsNaloxone is believed to antagonize opioid effects by competing for the µ, κ and σ opiate receptor sites in the CNS, with the greatest affinity for the µ receptor.
NeostigmineAnticholinergicsAnticholinesterase which causes accumulation of acetylcholine at cholinergic receptor sites.
Nitrite, sodium and glycerytrinitrateCyanideOxidizes hemoglobin to methemoglobin which binds the free cyanide and can enhance endothelial cyanide detoxification by producing vasodilation.
PenicillamineCopper, gold, lead, mercury, zinc, arsenicChelation of metal ions.
phentolamine (Regitine)DopamineRegitine produces an alpha-adrenergic block of relatively short duration. It also has direct, but less marked, positive inotropic and chronotropic effects on cardiac muscle and vasodilator effects on vascular smooth muscle.
phyostigmine or NaHCO3Tricyclic antidepressantsA reversible anticholinesterase which effectively increases the concentration of acetylcholine at the sites of cholinergic transmission.
Phytomenadione (Vitamin K.)Coumadin/WarfarinBypasses inhibition of Vitamin K epoxide reductase enzyme.
protamine sulfateHeparinProtamine that is strongly basic combines with acidic heparin forming a stable complex and neutralizes the anticoagulant activity of both drugs.
PyridoxineIsoniazid, theophylline, monomethyl hydrazine. Adjunctive therapy in ethylene glycol poisoning.Reverses acute pyridoxine deficiency by promoting GABA synthesis. Promotes the conversion of toxic metabolite glycolic acid to glycine.
Snake anti-veninCobra biteNeutralizes venom by binding with circulating venom components and with locally deposited venom by accumulating at the bite site.
Sodium BicarbonateIronPrevents convertion of ferrous to ferric.
Cardiotoxic drug affecting fast sodium channel (TCA, cocaine)Decreases affinity of cardiotoxic drugs to the fast sodium channel.
Weak acidsPromotes ionization of weak acids.
Chlorine gas inhalational poisoningNeutralization of hydrochloric acid formed when chlorine gas reacts with water in the airways.
Sodium thiosulphateCyanideReplenishes depleted thiosulphate stores by acting as sulfur donor necessary for the conversion of CN-O to thiocyanate through the action of sulfur transferase enzyme rhodanese.
ThiamineAlcohol, Wernicke-Korsakoff SyndromeReverses acute thiamine deficiency
Adjunctive in ethylene glycolEnhances detoxification of glyoxylic acid.
Vitamin CChemicals causing methemoglobinemia in patients with G6PD deficiencyReduces methemoglobin to hemoglobin.

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