Part of being a nurse is knowing common drugs and their antidotes. But what does the word antidote even mean? Well, it comes from the Greek word, “antididonai” which means "given against."
Antidotes are used in the clinical setting mostly during emergencies when you need to reverse the effects of a particular medication or drug. This is why it's imperative for nurses to know the antidotes for drugs, especially if you work in acute care.
Here's a list of drugs and their antidotes for your reference. It's a great idea to share this list with your friends in case they need to use it too:
Indication: Organophosphates and carbamate poisoning
Mode of Action: Inhibits the action of acetylcholine at the muscarinic sites to interrupt initial effects of organophosphate and carbamate poisoning.
Dosage: 2 mg through IV
Mode of Action: Facilitates conversion of hemoglobin to methemoglobin to inhibit cyanide’s affinity to cytochrome oxidase enzymes thereby inhibiting its toxic effects.
Dosage: Ampoule contents should be inhaled for 30 seconds every minute. Use new ampoule every three minutes.
Indication: Most poisons
Mode of Action: Inhibits systemic absorption of toxin through its high adsorptive capacity.
Dosage: 50 gram orally every 4 hours until it appears in the stool for adult and 10-15 gram orally every 4 hours for children until it appears in the stool.
Mode of Action: Inhibits the absorption of anti-coagulants in the system by forming non-adsorbable complex with bile acids in the intestines.
Dosage: 4 grams orally up to three times daily
Indication: Cyanide toxicity
Mode of Action: Forms stable ion-complexes with cyanide to facilitate its excretion in the urine.
Dosage: 300mg through intravenous push for 1 minute followed by 50mL of 50% dextrose. Initial dose may be repeated if inadequate and can be further followed by a 300mg dose.
Indication: Arsenic, gold, and inorganic mercury poisoning
Mode of Action: Binds with heavy metals to form dimercaprol-metal complex which can be readily excreted in the urine.
Dosage: 2.5mg – 3mg per kilogram weight through deep IM every four hours for two days then 2-4 times daily on the third day and 1-2 times daily for 10 days until recovery.
Indication: Amatoxin poisoning
Mode of Action: Protects the liver by inhibiting entry of amatoxins into the hepatic cells.
Dosage: 600mg/kg on the first day and 300mg/kg on the second and third day
Indication: Hydrofluoric acid, calcium channel blockers and oxalates
Mode of Action: Increases calcium concentration to overcome calcium channel blockade in the cells and upkeep with depletion of calcium concentration in the system.
Dosage: 3grams for a 10% calcium gluconate that can be repeated every 10 to 20 minutes for a total of three to four doses
Indication: Cyanide poisoning
Mode of Action: Binds with cyanide ions to facilitate excretion into the urine.
Dosage: 5 grams through intravenous infusion for 15 minutes
Indication: Ethylene glycol and methanol poisoning
Mode of Action: Inhibits formation of toxic metabolites, so the toxic alcohol ingested can be excreted in the urine. It doesn’t directly affect the presence of the toxic metabolites that have already formed, so hemodialysis is also recommended.
Dosage: Adult dosage for 5% ethanol is 2.76/mL/kg/hr either through oral or intravenous route
indication: Benzodiazepine overdose
Mode of Action: Acts on benzodiazepine receptors to block central effects of benzodiazepine.
Dosage: 0.2mg through IV for 30 seconds. If there is no response, 0.3mg can be given for another 30 seconds. Additional doses at 0.5mg at 30-60 second intervals until a total dose of 3mg is achieved.
Indication: Beta blockers, calcium channel blockers and hypoglycemic toxicity
Mode of Action: Increases myocardial contractility and heart rate similar to beta-agonist effects. It also decreases vascular resistance to improve cardiac output. Glucagon works on improving glucose levels by activating hepatic glycogen.
Dosage: 2-10mg through IV push and may be repeated as required for beta-blocker and calcium channel blocker toxicity. For hypoglycemic toxicity, 1-2mg through intramuscular injection.
Indication: Opioid overdose
Mode of Action: A specific opioid antagonist that acts directly at opioid receptors to inhibit its toxicity effects.
Dosage: 0.4 mg through intravenous push as the initial dose which can be further repeated every 2-3 minutes to a maximum bolus of 2 mg.
Indication: Lead, copper, and arsenic poisoning
Mode of Action: Binds with heavy metals to form stable water-soluble complexes that can be excreted in the urine.
Dosage: Total of 1-2grams daily in divided doses throughout the day.
Indication: Alpha-adrenergic poisoning, cocaine toxicity
Mode of Action: Blocks alpha1 adrenoreceptors to inhibit vasoconstriction and decrease peripheral resistance thereby reducing blood pressure. For cocaine toxicity, it acts as an alpha-blocker to reduce cocaine-induced coronary vasoconstriction thereby resolving cocaine-induced myocardial ischemia.
Dosage: 2.5mg IV bolus and may be repeated if necessary.
Mode of Action: Acts as a precursor for the enzyme rhodanase which facilitates the conversion of cyanide to non-toxic thiocyanate and thereby promoting its excretion.
Dosage: 50mL of 25% sodium thiosulphate through IV for ten minutes
Mode of Action: Converts iodine to iodide which is less harmful.
Dosage: 15gram starch in 500 mL water orally
Mode of Action: Nitrites facilitate the conversion of hemoglobin to methemoglobin. Methemoglobin has higher binding affinity to cyanide which further facilitates its excretion.
Dosage: 10mL of 3% sodium nitrite solution through IV for 5-20 minutes followed by sodium thiosulphate
Sodium Calcium Edetate
Indication: Lead toxicity
Mode of Action: Binds with divalent and trivalent metals like lead to form water soluble ring-compound to be readily excreted in the urine.
Dosage: 30-40 mg/kg through intravenous infusion either in 5% Dextrose or 0.9% saline twice daily for up to 5 days.
Indication: Amatoxin poisoning
Mode of Action: Protects the liver by blocking entry of amatoxins into the hepatic cells.
Dosage: 20mg/kg daily divided into 4 infusions with each infusion running on two-hour duration
Indication: Thallium poisoning
Mode of Action: Mobilizes intracellular thallium by absorbing thallium into the insoluble crystal lattice of Prussian blue in the gastrointestinal tract.
Dosage: 250mg/kg per day orally in divided doses administered through a nasogastric tube
Indication: Heparin poisoning
Mode of Action: Binds with heparin to neutralize anti-coagulative effects in the bloodstream.
Dosage: Maximum of 50mg dosage in a ten-minute period.
Indication: Induced dystonia caused by anti-psychotic drugs and metoclopramide
Mode of Action: Elicits anti-muscarinic actions to relieve parkinsonian symptoms caused by antipsychotic drugs and metoclopramide
Dosage: 5-10mg through oral, IV or IM routes. Additional oral doses may be required for 2-3 days.
Indication: Organophosphorous insecticides
Mode of Action: Restores acetylcholinesterase activity by removing phosphate compounds in the phosphorylated acetylcholinesterase to reestablish normal acetylcholinesterase activities.
Dosage: 30mg/kg through intravenous for five to ten minutes and may be repeated at 4-6 hour intervals.
Phytomenadione (Vitamin K)
Indication: Anti-coagulant poisoning
Mode of Action: Interrupts anticoagulants antagonistic effects on vitamin-dependent coagulation factors thereby reducing anti-coagulant poisoning effects.
Dosage: 10-20mg orally
With this information, you can make more informed decisions as a nurse. Always stay abreast of the most up-to-date information about antidotes. Memorizing these drugs can help in emergency situations and share with other nurses to help them.