medical common antidotes

8/18/2019 medical common antidotes

1/7

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


2/7

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=


3/7

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


4/7

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


5/7

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


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)


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

medical common antidotes

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