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248 SEcTIoN II Pharmacology ` PHARMACOLOGY—TOXICITIES ANd SIdE EFFECTS Pharmacology ` PHARMACOLOGY—TOXICITIES ANd SIdE EFFECTS

` PHARMACOLOGY—TOXICITIES ANd SIdE EFFECTS

Specific toxicity TOXIN TREATMENT
treatments Acetaminophen N-acetylcysteine (replenishes glutathione)
AChE inhibitors, organophosphates Atropine > pralidoxime
Antimuscarinic, anticholinergic agents Physostigmine (crosses BBB), control
hyperthermia
Arsenic Dimercaprol, succimer
Benzodiazepines Flumazenil
β-blockers Atropine, glucagon, saline
Carbon monoxide 100% O 2 , hyperbaric O 2
Copper “Penny”cillamine (penicillamine), trientine
(copper penny × 3)
Cyanide Hydroxocobalamin, nitrites + sodium
thiosulfate

Digitalis (digoxin) Digoxin-specific antibody fragments
Heparin Protamine sulfate
Iron (Fe) Deferoxamine, deferasirox, deferiprone
Lead Calcium disodium EDTA, dimercaprol,
succimer, penicillamine
Mercury Dimercaprol, succimer
Methanol, ethylene glycol (antifreeze) Fomepizole > ethanol, dialysis
Methemoglobin Methylene blue, vitamin C (reducing agent)

OpiOids NalOxOne
Salicylates NaHCO 3 (alkalinize urine), dialysis
TCAs NaHCO 3 (stabilizes cardiac cell membrane)
Warfarin Vitamin K (delayed effect), PCC (prothrombin
complex concentrate)/FFP (immediate effect)

Drug reactions—cardiovascular
dRUG REACTION CAUSAL AGENTS
Coronary vasospasm Cocaine, Amphetamines, Sumatriptan, Ergot alkaloids (CASE)
2+
Cutaneous flushing Vancomycin, Adenosine, Niacin, Ca channel blockers, Echinocandins, Nitrates (flushed from
VANCEN [dancing])
Red man syndrome—rate-dependent infusion reaction to vancomycin causing widespread pruritic
erythema due to histamine release. Manage with diphenhydramine, slower infusion rate.
Dilated Anthracyclines (eg, Doxorubicin, Daunorubicin); prevent with Dexrazoxane
cardiomyopathy
Torsades de pointes Agents that prolong QT interval: antiArrhythmics (class IA, III), antiBiotics (eg, macrolides),
anti“C”ychotics (eg, ziprasidone), antiDepressants (eg, TCAs), antiEmetics (eg, ondansetron)
(ABCDE)

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