medical common antidotes
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8/18/2019 medical common antidotes
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PPIYs
Nurci
Drug
Guide
--
s table consists of
the
readily available agents used as antidotes. Data have been reviewed and updated
=--ed
on
the clinical
experience and
researches
conducted by the toxicology staff of the
National Poison
-:ntrol
and
lnformation
Service.
irrg,
)no
-Edton
zD8-2009
.t:tivated
:harcoal
.-acetylcysteine
3romocriptine
3alcium
folinate
-eucovorin
calcium
(Folinic
acid
or citrovorum
factor)
Calcium
salts
Glucagon**
Non-specific adsorbent of
poisons
Except
cyanide,
iron, lithium,
|
-^--Fr
vJsr
rrvvr rr
vr
caustics and alcohol
Paracetamol,
"watusi"
(dancing
fire cracker),
zinc
phosphide,
carbon tetra-
chloride, chloroform,
penny
Neuroleptic malignant
syndrome
caused
by
neuroleptic drugs
or
levodopa
withdrawal
Folic
acid antagonists:
Methotrexate
Trimethoprim
Methanol
(formate)
Adjunct:
Ethylene glycol
poisoning
Fluoride ingestion
Black widow
spider
envenomation
Hypocalcemia from oxalate
ingestion or citrate
l.V.
(anticoagulant
of
fresh frozen
plasma/whole
blood)
Absorption
of drug
in
gastric
and
intestinal
tracts and
interruption
of
entero-hepatic
cycle
with multiple
dose
MDAC)
Restores depleted
glutathione
stores
Protects against
renal
and
hepatic
failure
acute
hepatic failure; may
displace
amatoxin
from
protein-binding
sites
allowing
increased renal
excretion;
may
also
inhibit
penetration
of ama-
toxin to
hepatocytes.
Dopamine agonist
Bypasses
blocked
folate metabolism
Rapidly
complexes
with
fluoride ion
Directly antagonistic to the cardiotoxic
effects of
hyperkalemia
Maintains adequate amount of ionized
calcium
to
prevent
hypocalcemia
Stimulates
formation of
adenyl cyclase
causing
intracellular increase in
cyclic
AMP
and enhanced
glycoge-
nolysis
and elevated
serum
glucose
concentration.
Calcium channel
blocker or
B-receptor blocker
toxicity;
Cardiac depression caused
by
la
and
lc
antiarrhythmic
drugs;
Empiric
use
in
patients
with
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Table
of
Antidotes
myocardial
depression
(bradycardia,
hypotension,
low
cardiac
output)
Ergotamine
Reverses hypercoagulable
state
by
interacting with antithrombin
lll
to
produce
a
heparin-antithrombin-
thrombin complex.
Used
in
combination
with
vasodilator
phentolamine
or
nitroprusside to
preve':
local thrombosis
and
ischemia
Hydroxo-
cobalamin**
(followed
by
sodium
thiosulfate)
Methylene blue
Cyanide and cyanide
derivatives
Cyanogenic compounds
(e.9.
acetonitrile)
Prevention
of
nitroprusside-
induced
cyanide
toxicity
Forms
cyanocobalamin, a
non-toxic
metabolite that
is
easily excreted
through
the kidneys
Chemicals
producing
severe
methemoglobinemia;
lfosfamide-induced
encephalopathy
Narcotics,
opioids
Opioids
with long duration of
action
Reduces methemoglobin to hemoglobir
at therapeutic doses,
methylene
blue
is reduced by
nicotinamide
adenine
dinucleotide
phosphate
dependent
enzymes system
to leucomethylene
blue
which rapidly converts methemo-
globin
back to
hemoglobin
Pure
antagonist, act
as
competitive
inhibitor
at opiate
receptor
sites
(p,
x,
a
receptors)
within
the central
nervous
system
Neostigmine
Anticholinergic
drugs
with
tachycardia
Competitive
neuromuscular
blockers
(non-depolarizing)
Anticholinesterase which
causes
accumulation
of acetylcholine at
cholinergic
receptor
sites
Nitrite, sodium
(intravenous)
and
glyceryl-
trinitrate/nitro-
gylcerin (oint-
ment or
patch)
Penicillamine
Propranolol
(oral)
Esmolol
(lV)
(NOT
compati-
ble
with
sodium
bicarbonate
solution)
Cyanide, cyanogenic
compounds
N itroprusside-induced
cyanide toxicity
Hydrogen
sulfide
Copper,
gold,
lead, mercury,
zinc,
arsenic
B-ad
renoreceptor
sti
mu
lants
Ephedrine,
cocaine
Theophylline,
caffeine
Thyroxine
Excessive
myocardial
sensitivity
(freons,
chloral
hydrate,
chlorinated
hydrocarbons)
Oxidizes hemoglobin
to
methemoglobir'
which
binds
with free
cyanide
and
car^
enhance endothelial cyanide
detoxi-
fication by
producing
vasodilatation
Chelation of
metal ions
Propranolol,
a
non-selective
B-adreno
receptor
drug and
Esmolol,
a cardio-
selective agent, suppress sympathebc
overactivity and
rate-related myocaro;a
ischemia
Organophosphates and some
carbamates
with nicotinic
effects including organo-
phosphate
nerve warfare
agents
Reactivates
phosphorylated
cholines-
terase enzymes and
protects
enzyme
from
further
inhibition when given
belore acetylcholinesterase
has
been irreversibly bound; must always
be used
in combination with atropine
620
|
**
Not
available
in the
Philimr=
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8/18/2019 medical common antidotes
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Table
of
Antidotes
=yridoxine
soniazid,
theophylline
Monomethyl hydrazine,
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
notamine
sulfate
Heparin
Neutralizes heparin
by combining with
heparin
and
forming
an
inactive
salt
Sodium
bicarbonate
ron
Cardiotoxic drugs affecting
fast
sodium channel
(tricyclic
anti-
depressant, cocaine,
Type a
and
lc
anti-arrythmic agents,
diphenydramine)
Weak acids
Chlorine
gas
inhalational
poisoning
Prevents
conversion of
ferrous
to ferric
Decreases affinity
of cardiotoxic drug
to the
fast
sodium channel
Promotes ionization of weak acids
(salicylates,
phenobarbital,
chlorpro-
pamide,
chlorophenoxy-herbicides,
methotrexate, lNH,
etc.)
Neutralization
of
hydrochloric
acid
formed when
chlorine
gas
reacts with
water
in the
airways
Sodium
calcium
edetate**
Lead
Chelation
of
lead ions
and endo-
genous
metals
(zinc,
manganese,
iron, copper)
Snake
anti-venin
Cobra bite Neutralizes
venom
by
binding
with
circulating
venom
components and
with locally
deposited
venom
by
accumulating at
the
bite site
Sodium
thiosulphate
Cyanide and cyanide
derivatives
Cisplatin
Replenishes
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
Thiamine Alcohol
Wernicke-Korsakoff
Synd
rome
in
alcoholic and
malnourished
patients
Adjunctive in
ethylene
glycol
Reverses
acute
thiamine deficiency
Enhances detoxification
of
glyoxylic
acid
Vitamin
C
(Ascorbic
acid)
Chemicals causing
methemoglobinemia
in
patients
with G6PD deficiency
Reduces methemoglobin to
hemoglobin
Vitamin Kr
(Phytome-
nadione)
Anticoagulant
drugs
(coumarin,
indanedione
derivatives)
Anticoagu
lant rodenticides
Vitamin K
deficiency
(hemorrhagic
disease
of the
newborn) with coagulopathy
Hypoprothrombinemia
from
salicylate/white or
yellow
phosphorus
i ntoxication
Bypasses inhibition
of
Vitamin
K
epoxide
reductase
enzyme
As replacement
for
Vitamin K,
orepared
by: Maramba, NPC and Panganiban LR:
University of the Philippines Nationa Poison Management
and
Control
Center
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PPIIs
(a'troe-peen)
Philippine
brand/s;
Euro-Med
Atropine
Sulfate,
Hizon
Atropine
Sulfate,
lsopto Atropine
Australia
brand/s:
Atropt,
Ptizer
Atropine lnj.,
Astra-
zeneca
Atropine,
Fawns
&
Mcallan
Atropine,
Minims
Atropine,
RPS Atropine, Min-l-Jet
Atropine
Canada brand/s:
Akorn Atropine
AK, Alveda
Atropine,
Alcon Atropine, Atropinum,
Dioptic's Atropine Solution,
Hospira Atropine, lsopto Atropine, lsopto
Homatro-
pine,
Minim Atropine, Sandoz
Atropine
UK
brand/s;
lnternational Medication System
Atropine
lnj., Minims
Atropine Wockhardt
Atropine
US brandls;
Atropen
Action:
lnhibits acetylcholine
at
parasympathetic
neuro
effector
junction,
blocking
vagal
effect
on
the
heart
(SA
node), exocrine
glands,
smooth
muscles
and
urinary bladder.
Drug increases
heart rate, dries
secretions,
decreases sweating and
salivation
in
low
doses.
Mydriasis
(dilatation
of
the
pupil)
and
cyclople-
gia (failure
to accommodate
for close
vision) occur at
moderate
doses.
Motility
of Gl and GU
systems are
affected at
high
doses.
Pharmacokinetics
Absorption
Well absorbed
(PO,
lM),
unknown
(SC)
Distribution
Throughout
body
including
CNS
Metabolism
Liver
Excretion
Kidneys,
unchanged
(70%-90%)
Half-life
13-40 hrs
Pharmacodynamics
PO
IM/SC lV Ophth
Onset
Yz
hr
15
mins
2-4 mins lz
hr
Peak
Vz-1
hr
30
mins
2-4 mins
30-60
mins
Duration
4-6 hrs 4-6 hrs 4-6
hrs
1-2 wks
lndication: Administration
prior
to
anesthesia
to
reduce
or
prevent
secretions
of
respiratory
tract;
to
control
rhinorrhea; treatment
of
parkinsonism;
res-
toration of cardiac
rate
and
arterial
pressure
in
some
situations;
treatment of
peptic
ulcers;
management
of
hypersecretion, irritation or inflammation of stomach,
intestines or
pancreas;
treatment of diarrhea;
relief
of
infant
colic;
management
of spasms
of bile
tract;
treatment
of
hypertonicity
of small
intestine and uterus;
management of
hypermotility
of colon;
prevention
of
spasm of
pylorus,
biliary
tree,
ureters,
and
bronchi;
treatment of
frequent
urination
and bedwetting;
therapy
for
certain bradycardias
and
heart
blocks;
treatment
of closed
head
injury with
acetylcholine
release;
re-
duction of
laughing and crying associated
with
brain
lesions;
treatment
of alcohol
withdrawal
symptoms;
relief
of
motion
sickness.
Antidote
for
cardiovascular
collapse
in
certain
overdoses or
poisonings.
Short-
term treatment and
prevention
of
bronchospasm
associated
with
chronic bronchial
asthma,
bronchitis
2rrt
and COPD. Ophthalmic
Preparations:
Prc---,:
-
cycloplegia
and
mydriasis.
Dosage:
For lV administration.
Adult 0.4-0
6
-rl
1",;r'
4-6 hrs. Pedia 0.1-0.6
mg depending
on
l,*'f
antidote:
1-2 mg every
20-30 mins until
:-e .r
"
flushed and dry,
the
pupils
dilated
and
tar.-
1:i,
has
developed.
Adult:
By
subcutaneous
-
+-
(SC)
0.5
mg
4-6 hrly. Pedia
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calcium lolinate
t
2.4
to
0.6
mg, for
paradoxical
bradycardia
(effect
r CNS).
lt usually disappears
within
2
mins.
,
t*cnilor
cardiac
rate, rhythm
and character.
Watch
cr
tachycardia,
it
may
cause
ventricular fibrilla-
lL'r.
-
ulonitor
ECG
for
ectopic
ventricular
beats,
PVC,
arycardia
in cardiac
patients
-
lbnitor
respiratory
status: rate,
rhythm, cyanosis,
rneezing,
dyspnea,
engorged neck veins
-
tlonitor
allergic/hypersensitivity
reaction:
rash,
-rraria
-
tbnitor
input-output
ratio;
check
for
urinary
reten-
:on
and daily
output in
elderly or
postoperative
=bents
-
tlonitor
for
bowel
sounds; check for
constipation;
odominal distention
and constipation
may
occur
-
$cnitor
for increased
intraocular
pressure:
eye
pain,
rausea, vomiting, blurred vision, increased tearing;
jscontinue
use
if
pain
occurs
(optic)
thnsnc
Dracnosrs
.
lecreased
cardiac output
.
]sturbed
visual sensory
perception
-
lonstipation
.
(rowledge-deficit
on drug therapy
r-lttuNG
Y
route
.
Give
V undiluted or diluted
with
10
mL
sterile
Hr0:
give at
a
rate of
0.06
mg/min; give through Y-tube
or 3
way
stopcock;
do
not
add
to
lV
solution;
may
cause
paradoxic
bradycardia
lasting 2 mins
\ri
n
ge
com
pati
b
i I
itie
s:
Be nzq u
i
nam i de, b uto
rp
h
a-
'c,1.
chlorpromazine,
droperidol, cimetidine, dimenhy-
rnate, diphenhydramine,
fentanyl,
glycopyrrolate,
'eoarin,
hydromorphone, hydroxyzine, meperidine,
-etoclopramide,
midazolam, milrinone, morphine,
nal-
:uphine,
pentazocine,
perphenazine, propiomazine,
=nitidine,
scopolamine,
sutentanil,
vit
B
with
C
Y-site
compatibilities:
Amrinone,
etomidate, famo-
:dine, heparin,
hydrocortisone,
sodium succinate,
leropenem,
nafcillin,
potassium
chloride, sufentanil,
,1
B
with
c
Additive
compatibilities:
dobutamine,
furosem-
ce,
meropenem,
netilmicin, sodium
bicarbonate,
rerapamil
PO route
.
Oral
administration
30
mins
before
meals
.
Give
increased
bulk,
water
in
diet
if
constipation
occurs (anticholinergic effect)
lM
route
.
Expect atropine
flush 15-20
mins after
inj;
it
may
occur
in children
and
is not harmful
upleuentATroN
P
atie
ntlf
a
m
i
ly
ed
u cati
on
.
Advise
patient
not to
perform
strenuous
activity
in
high
temperatures
due
to danger
of heat stroke
.
lnstruct
patient
to
take as
prescribed
and
not to skip
doses
.
lnstruct
patient
to
report blurring of vision, loss
of
sight;
troubled breathing, sweating,
flushing, chest
pain,
allergic
reactions, constipation
and
urinary
retention
.
Advice
patient
perform
other
not
to
drive, operate
machines, or
hazardous activities,
atropine
may
cause dizziness,
drowsiness, or
blurred
vision.
Alcohol may
also
increase
the
dizziness and drowsi-
ness.
.
Advise
patient
not
to take
OTC
products
without
approval of
physician
Ophthalmic
route
.
Teach
patient
method of instillation:
pressure
on
lacrimal
sac
for
1
min;
do
not
touch
dropper
to
eye
.
lnstruct
patient
that
blurred
vision will
decrease with
repeated
use of drug and to omit next instillation if
side effects
are
present
.
Advise
patient
to
wait
5 mins
after atropine before
using other
drops and
not
to
blink
more
than
usual.
.
lnstruct
patients
not to
do
hazardous
task until
able
to
see. Use sunglasses to
protect
eyes
Everuerroru
Positive therapeutic outcome
.
Decreased
dysrhythmias
.
lncreased heart rate
.
Decreased
secretions, Gl and
GU spasms
.
Bronchodilatation
.
Decrease in inflammation
(iritis)
or cycloplegic
ref raction
(ophthal
mic)
(kal'see-uhm
fole'ih-nate)
See
Antineoplastics Drugs
Section
(dees'fe
r-ox-ah-mee n)
Philippine brandls.' Desfera
Australia
brandls:
Desferal, DBL
Desferrioxamine,
Hospi
ra Desferrioxamine
UK
brand/s:
Desteral, Hospira Desterrioxamine
Action:
A
chelate which has high affinity
to
ferric
iron. Removes both
free
iron and bound
iron from
hemosiderin and
ferritin, but
not
from
hemoglobin,
transferrin,
or
cytochromes.
Pharmacokinetics
Absorption
Poorlyabsorbed(oral),
rapidly
absorbed
(lM,lV)
Distribution
10% bound
to
plasma
protein
Metabolism
Unknown
Excretion
Urine, bile
Half-life
1-2.4
hrs,5.6-4.6
hrs (lM),
20 mins
(lV)
Pharmacodynamics
Ora
Onset
rapid
Peak 30
mins-1
hr
t
hr
t
hr
Duration 6
hrs
6
hrs hrs
lndication:
Monotherapy
iron
chelation
treatment
for
chronic
overload
(e.9.
transfusional
hemosiderosis,
as seen
in thalassaemia
major
and other chronic
anemias; idiopathic hemochromatosis in patients
in
whom concomitant disorders
preclude phlebotomy;
porphyria
cutanea
tarda
in
patients
unable
to tolerate
phlebotomy).
Acute iron
poisoning.
Chronic
aluminum
overload
in renal
patients
on
maintenance dialysis
(e.9.
with aluminum-related
bone
disease
and/or
encephalopathy.
Test for
iron
or aluminum overload.
V IM
rapid rapid
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8/18/2019 medical common antidotes
6/7
naloxone
Dosage:
Should be determined individually,
depend-
ing
on
the
indication
and
severity
of condition.
Chronic
iron
overload: 20-60 mg/kg
body weight
per
day. Acute
iron
poisoning:
Up
to
80 mg/kglday.
Chronic aluminum
overload:
5
mg/kg
body
weight
once
weekly.
Desfer-
rioxamine
test
for
iron
overload:
500 mg. Desferriox-
amine
infusion
test for
aluminum
overload:
5
mg/kg
body weight.
Contrai
nd
ication
: Hypersensitivity.
Precaution:
Pregnancy (Category
C).
Renal
dysfunc-
tion. May
exacerbate
aluminum-related
encephalopa-
thy
and
precipitate
seizures. An increased
susceptibil-
ity to infection,
particularly
with Yersinia
species, has
been
reported in
patients
with
iron
overload treated
with
desferrioxamine.
Severe fungal infections
have
also been reported,
predominantly
in
patients
undergo-
ing
dialysis.
lf
infection
is
suspected, treatment with
desferrioxamine
should
be stopped and
appropriate
antimicrobial treatment
given.
Monitoring
of urinary
excretion
and
periodic
ophthalmological
and audio-
logical
examinations
are
recommended
for
patients
on
long-term therapy.
lnappropriately
high
dosage
in
children
with
low ferritin levels
may retard
growth,
therefore regular
checks on height
and
weight
are
recommended.
Adverse Reactions:
Rapid intravenous
injection may
cause
flushing,
urticaria, hypotension,
and shock.
Lo-
cal
pain
may
occurwith
subcutaneous
or
intramuscular
injections
and
pruritus,
erythema, and swelling
have
occu
rred
after
prolon
ged
subcutaneous
ad
m i nistration.
Gastro-intestinal
disorders,
dysuria, fever,
allergic skin
rashes,
tachycardia,
cardiac
arrhythm
ias,
convu lsions,
and
leg
cramps have
been
reported.
Visual
distur-
bances, including
retinal
changes, and hearing
loss
may
occur
and
may
be reversible
if
desferrioxamine is
withdrawn.
Cataract
formation
has
also been
reported.
May retard
groMh
in
very
young
children.
Drug lnteraction:
Prochlorperazine,
vitamin
C,
Gal-
lium-67-imaging.
Treatment
of Overdose: Acute
overdosage of desfer-
rioxamine
may
be
remove
by
haemodialysis.
NURSING
CONSIDERATIONS
Assessuerur
.
Obtain
patient
history
and
hypersensitivity
to
other
drugs
.
Monitor
patient
for
ocular effects
during
the
therapy
.
Monitor
if
patient
experience
diarrhea
and abdomi-
nal
pain
during therapy,
appropriate
stool samples,
blood testing
and/or
serologic testing is required.
.
Monitor for
abrupt increase
and decrease
of blood
pressure
of
patient.
.
Monitor visual
acuity test, funduscopic
examina-
tion
and
audiometry
periodically
during
chronic
therapy.
Nunsnc
Dracruoses
.
lron toxicity
.
Aluminum
toxicity
PuaNnrnc
.
Given
by
lM injection, by
slow lV
infusion
.
Powder
should be
stored at temperature
less than
25..C
.
Reconstituted
solutions
are stable for
1
wk
at
room
temperature.
I
6241
'"" " -
:"irl:1:':i'̂ t:l::"::i.li :a lministratior'
lM
route
.
lM
is
preferred
and should
be used
for
all
pai"-:
who
are not in
shock.
.
The
reconstituted
solution may
be adminis::'=:
undiluted.
lV
route
.
Given by
lV infusion
.
lV
infusion
for
patient with cardiovascular
la
-'-_..
or shock. The required
amount
of
reconstr:--::
solution is added to
0.9%
NaCl
dextrose
in
na=
or
Lactated
Ringer's
solution
and administer?:
.
the
rate
of
15 mg/kg/hr
for the first 100
mg.
s^,rr-
l
not
exceed
125 mg/hr.
SC route
.
For
chronic
iron
overload, it may
be adminis:==:
by slow
subcutaneous
infusion.
.
The rate
of
infusion
must
be
individualized.
-i-'
effective dose range is 20-60
mg/kg
given
ove'
:-
-
hrs
or over
24 hrs
in
some
patients.
lnltpleuenrATroN
P
atienUf
am
i
ly
ed ucati
on
.
lnform
patient
that
pain
and
induration
at
the
s:.
-
injection may
occur.
.
Discuss
with
patient
that visual
disturbances
s-
r-
as blurred
vision,
night
blindness,
impairment
:,-
,:,..
of color
vision
may
occur but
it
usually
partia
:
=-
1
completely
resolve
following
discontinuance
:'
--
drug.
.
lnstruct patient
to
attend regular check
up
on
.
S*i'
auditory every
3
mos.
.
Warn
patient
to
avoid ascorbic
acid
upc-
Si:--':,
the therapy.
.
lnstruct
patient
to inform
physician
if
preE-,=-:
suspected
or
if
breastfeeding.
.
lnstruct
patient
not
to drive
or engage
in
a^.
'i
ardous task
that
required
mental, visual
d-,r
=-
tr
alertness.
.
Warn
patient
to
avoid
prochlorperazine,
as
:?-
rary loss of consciousness may occur.
Evauuanoru
Positive
therapeutic
outcome
.
Treat
toxicity
(nal-oks'one)
Philippine
brand/s:
Narcan
Australia
brandls:
DBL
Naloxone HCl,
1.,
-
Naloxone,
Narcan Neonatal,
Hospira Naloxc,^*
Canada
brand/s: Sandoz Naloxone
UK brands/s: Hospira Naloxone, lnter-:-
:-
Medication
Naloxone
HCl,
Suboxone,
Wc,:,
-
.
-'
Naloxone
US
brandls:
Hospira Naloxone
HCl,
lnte-=':-
Medication
Naloxone
HCI
Action:
May
displace opioid
analgesics
f':,-
receptors
(competitive
antagonism)
to
re'.:=
effects.
Pharmacokinetics
Absorption
Well
(SC,
lM), complete (lV
Distribution Rapid
Metabolism
Liver
Excretion
Kidneys
Half-life
60-90
mins.
(adults)
-
8/18/2019 medical common antidotes
7/7
naloxone
3
hrs
(neonates)
Pharmacodynamics
IV
IM/SC
Jnset
1-2 mins 2-5 mins
reak
Unknown
Unknown
Juration
Varies Varies
lndication:
Narcotic
overdose.
Post-op
narcotic
tepression
Dosage: Adult Narcotic overdose: lnitially 0.4-2
mg
V, may repeat
al2-3
mins intervals.
Post-op narcotic
-pression
lnitial increments
of 0.1-0.2
mg lV
at
2-3
rins
intervals. Pedia Narcotic
overdose:
Initially
0.01
rdkg
BW
lV. Post-op narcoticdepression:
lnitial incre-
rents
of 0.005-0.01
mg V in 2-3
mins intervals.
Contraindication:
Respiratory
depression
due to
-on-opioid
drugs.
Precaution:
Pregnancy
(Category
C).
Post-op
:atients especially
w/
pre-existing
CV disorders
or
'eceiving potentially cardiotoxic
drugs.
Newborns
ld
mothers known
or
suspected to
be
physically
-pendent
on opioids.
Adverse
Reactions:
Tachycardia,
increase BP,
-rpotension
tremulousness,
seizures, cardiac arrest,
:ulmonary
edema.
'i
U
RSING
CONSIDERATIONS
AssessueNr
.
Assess
patient's
opioid use before
starting
therapy,
and
reassess regularly
to-monitor drug's
effec-
tiveness. Duration
of
opioid may exceed
that
of
naloxone,
causing
relapse
of depression.
.
Assess for
signs
of opioid withdrawa in
drug-de-
pendent
individual
that
may
occur up to 2
hrs
after
administration: cramping,
hypertension,
anxiety,
vomiting
.
Assess cardiac status and monitor vital
signs
during
herapy: ECG
abnormalities,
tachycardia
and
hyper-
tension. Monitor also
patient's
oxygen saturation.
.
Assess for
pain:
duration, intensity, location before
and
afteradministration;
may
be used for
respiratory
depression
.
Assess
patient's
respiration to identify
depression:
character,
rate
and
rhythm. Respiration
-ANNING
V
route
.
Give
undiluted
by
direct lV,
give
0.4
mg
or
less
over
15
sec or titrate
infusion
to
response
.
Give
continuous
lV infusion
further
diluted
with DsW
J.9%
NaCl
.
Give
only
with resuscitative
equipment and oxygen
rearby
.
Jse
only solution prepared within
24
hrs
.
Store at
room temp in
darkness
\ri
n
ge
co
m
pati
bi
I
ities: Benzq
u
i
nam
ide,
hepa
ri
n
'
site
compatibilities:.
Propofo
rilitive
com
patibi
ities:
Ve
rapam
i
I
lupleuexrATroN
PatienUlamily
education
.
Explain to
patienUfamilythe
reason forand
expected
results
of
medication.
.
lnstruct
patient
to
report
adverse redction.
Eveluanon
Positive
therapeutic
outcome
.
Reversal
of
respiratory
depression
.
Patient does not develop adverse drug reactions.
.
Patient
and
family
state understanding
of
drug
therapy.
a
t
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