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AChE inhibitors
Edrophonium, physostigmine, neostigmine, pyridostigmine, donepezil, tacrine, rivastigmine, galantamine, Organophosphates (echothiophate, malathion, parathion, sarin, VX)
- DUMBBELSS= PANS + sweating + skel muscle
- miosis, salivation, sweats, GI cramps, diarrhea, muscle twitches --> seizures, coma, respiratory failure
Antidotes: respiratory support: atropine + pralidoxime (for irreversible (organophosphates) AChE inhibitors)
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Atropine & Muscarinic blockers
homatropine, cyclopentolate, tropicamide (ophthalmology), ipratropium, scopolamine, benztropine, trihexyphenidyl, biperiden, (parkinsonism) glycopyrrolate, dicyclomine (GI)
- SANS + block sweating (hyperthermia)
- inc HR, inc BP, hyperthermia (hot,dry skin), delirium, hallucinations, mydriasis
Antidote: physostigmine (crosses BBB)
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Carbon Monoxide
N/V, dyspnea w/ hyperventilation, mydriasis, vertigo, dec BP, syncope, inc HR, arrhythmias
Antidote: hyperbaric O2
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Salicylates (ASA)
confusion, lethargy, hyperventilation, hyperthermia, dehydration, ototoxicity (tinnitus), hypokalemia, acidosis, seizures, coma
Antidotes: urinary alkalinization (NaHCO3) possible hemodialysis
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Arsenic
wood preservatives, pesticides, ant poisons, drinking water, coal combustion
- binds to hemoglobin and decreases erythrocyte glutathione levels, causing membrane fragility and resulting hemolysis.
- Acute: gastroenteritis, garlic breath, "rice water" stools
- Chronic: skin pigmentation (raindrop pattern- "milk and roses" complexion results from vasodilation and anemia), stocking glove neuropathy
Antidotes: dimercaprol, penicillamine
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Iron
- Acute: severe GI distress --> necrotizing gastroenteritis w/ hematemesis, bloody diarrhea,
- Antidotes: deferoxamine IV
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Lead
- inhibits ferrochelatase and ALA dehydratase --> dec heme synthesis...also inhibits rRNA degradation
- multisystem effects: LEAD
- Lines on gingivae (Burton's lines) and on epiphyses of long bones on x-ray
- Encephalopathy (MR) and Erythrocyte basophilic stippling (aggregation of ribosome)
- Abdominal colic and sideroblastic anemia
- Drops- wrist and foot drop (neuropathy).
- Rx:
- Dimercaprol and EDTA are 1st line of Rx
- Succimer for kids only used in mild to moderate lead poisoning. Not used as 1st line when encephalopathy.
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Mercury
- salts in amalgams, batteries, dyes, fireworks, photography
- Vapor inhalation: chest pain, dyspnea, pneumonitis
- Inorganic salt ingestion: gastroenteritis, tubular necrosis
- chronic: CNS effects, ataxia, paresthesias, auditory and visual loss
Antidotes: Succimer PO or Dimercaprol (IM)
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Theophylline, beta agonists
Esmolol (b1 specific)
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Mathanol or ethylene glycol
ethanol, fomepizole
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BZs (BZ1,2), zolpidem (BZ1), zaleplon (BZ1)
Flumazenil (block BZ1 and BZ2)
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Copper (wilson's disease), iron, lead, mercury
penicillamine
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Warfarin and coumarin anticoagulants
Vit K
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Acetaminophen
N-acetylcysteine (replenishes glutathione)
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Amphetamines (basic)
NH4Cl (acidify urine)
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digitalis
stop dig, normalize K+, Lidocaine, Anti-dig Fab fragments, Mg2+
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cyanide
nitrite, hydroxocobalamin, thiosulfate
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methemoglobin
methylene blue, vit C
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TCAs
NaHCO3 (plasma alkalinization)
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tPA, streptokinase, urokinase
Aminocaproic acid
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