Title : 36 Common Drugs and Their Antidotes that Nurses should Know

36 Common Drugs and Their Antidotes that Nurses should Know

BY LIANE CLORES

Levi is up all night to study for her exams. Tonight, her focus is on Pharmacology. She sighs in frustration as she reads the third paragraph over and over and still not get it. Oh sure, she really wants to be a nurse, but Pharma is just not one of her favorite subjects. Memorizing all those drugs, classifications and dosages give her a terrible headache. And now she’s worried. How will she be able to remember all these when it comes to the nursing board? With all the difficulty that she is experiencing in this subject, she fears that she might fail.

To help her, and all other nurses to remember, below is a list of common drugs and their antidotes that we, nurses, should know:

Antidote

Indication

Mode of Action

acetylcysteine (Mucomyst)

Acetaminophen/ Tylenol/ Paracetamol

Restores depleted glutathione stores and protects against renal and hepatic failure.

Activated charcoal

Non-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, kayexalate

Potassium

 

anticholinesterase agents

Neuromuscular blockade (paralytics)

 

atropine sulfate or pralidoxime

Anticholinesterase

Competitive inhibition of muscarinic receptors.

Benzylpenicillin

Amanita 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 salts

Fluoride ingestion

Rapidly complexes with fluoride ion.

deferoxamine

Iron

Deferoxamine acts by binding free iron in the bloodstream and enhancing its elimination in the urine.

digibind
digoxine immune fab

Digoxin

Binds molecules of digoxin, making them unavailable for binding at their site of action on cells in the body.

dimercapol, edetate calcium, disodium,

Lead

Chelation 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.

flumazenil

Benzodiazepines

Reverses the effects of benzodiazepines by competitive inhibition at the benzodiazepine binding site on the GABAA receptor.

fomepizole

Ethylene glycol

A 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.

glucagon

Beta blockers and calcium channel blockers

Stimulates the formation of adenyl cyclase causing intracellular increase in cycling AMP and enhanced glycogenolysis and elevated serum glucose concentration.

Glucose (Dextrose 50%)

Insulin reaction

Dextrose (the monosaccharide glucose) is used, distributed and stored by body tissues and is metabolized to carbon dioxide and water with the release of energy.

Heparin

Ergotamine

Reverses hypercoagulable state by interacting with antithrombin III. Used in combination with vasodilator phentolamine or nitroprusside to prevent local thrombosis and ischemia.

Hydroxocobalamin

Cyanide

Forms cyanocobalamin, a non-toxic metabolite that is easily excreted through the kidneys.

leucovorin calcium

Fluorouracil

 

Methotrexate

Protects the healthy cells from the effects of methotrexate while allowing methotrexate to enter and kill cancer cells.

Magnesium sulfate

calcium gluconate

 

mesna

Cyclophosphamide

A “chemoprotectant” drug that reduces the undesired effects of certain chemotherapy drugs.

Methylene blue

Chemical producing severe methemoglobinemia. Ifosamide-induced encephalopathy.

Reduces methemoglobin to hemoglobin.

nalmefene or naloxone

Opioid analgesics

Prevents or reverses the effects of opioids including respiratory depression, sedation and hypotension.

naloxone (Narcan)

Narcotics

Naloxone is believed to antagonize opioid effects by competing for the µ, ? and ? opiate receptor sites in the CNS, with the greatest affinity for the µ receptor.

Neostigmine

Anticholinergics

Anticholinesterase which causes accumulation of acetylcholine at cholinergic receptor sites.

Nitrite, sodium and glycerytrinitrate

Cyanide

Oxidizes hemoglobin to methemoglobin which binds the free cyanide and can enhance endothelial cyanide detoxification by producing vasodilation.

Penicillamine

Copper, gold, lead, mercury, zinc, arsenic

Chelation of metal ions.

phentolamine (Regitine)

Dopamine

Regitine 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 NaHCO3

Tricyclic antidepressants

A reversible anticholinesterase which effectively increases the concentration of acetylcholine at the sites of cholinergic transmission.

Phytomenadione (Vitamin K.)

Coumadin/Warfarin

Bypasses inhibition of Vitamin K epoxide reductase enzyme.

protamine sulfate

Heparin

Protamine that is strongly basic combines with acidic heparin forming a stable complex and neutralizes the anticoagulant activity of both drugs.

Pyridoxine

Isoniazid, 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-venin

Cobra bite

Neutralizes venom by binding with circulating venom components and with locally deposited venom by accumulating at the bite site.

Sodium Bicarbonate

Iron

Prevents convertion of ferrous to ferric.

Cardiotoxic drug affecting fast sodium channel (TCA, cocaine)

Decreases affinity of cardiotoxic drugs to the fast sodium channel.

Weak acids

Promotes ionization of weak acids.

Chlorine gas inhalational poisoning

Neutralization of hydrochloric acid formed when chlorine gas reacts with water in the airways.

Sodium thiosulphate

Cyanide

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 Syndrome

Reverses acute thiamine deficiency

Adjunctive in ethylene glycol

Enhances detoxification of glyoxylic acid.

Vitamin C

Chemicals causing methemoglobinemia in patients with G6PD deficiency

Reduces methemoglobin to hemoglobin.

 

Sources:

http://www.nursebuff.com/2015/05/common-drugs-and-their-antidotes/

http://nurseslabs.com/wp-content/uploads/2012/01/Table-of-Antidotes.pdf

nursingcibe.com