Atropinics & Anticholinergics

 

(Atropine, Tricyclic, Antidepressants, Phenothiazines, Antihistamines)

 

• VS: fever, tachycardia, hypertension, cardiac arrhythmias
• CNS: delirium, psychosis, coma, convulsions
• Eye: mydriasis, dilated pupils

 

Amphetamines & Sympathomimetics

 

(OTC cold preps & diet pills)

 

• VS: fever, tachycardia, hypertension
• CNS: hyperactive, delirious,tremulous, myoclonus, psychosis, convulsions
• Eye: mydriasis, dilated pupils
• Skin: flushing, severe sweating

 

Barbiturates & Sedatives / Hypnotics

 

• VS: hypothermia, hypotension, bradypnea
• CNS: confusion, coma, ataxia
• Eye: nystagmus, miosis, mydriasis
• Skin: vesicles, bullae

 

Opiates

 

• VS: bradycardia, bradypnea, hypotension, hypothermia
• CNS: euphoria to coma, hyporeflexia
• Eye: pinpoint pupils

 

Organophosphate / Cholinergic

 

• VS: bradycardia or tachycardia, tachypnea
• CNS: confusion, drowsiness, coma, convulsions, muscle, fasciculations, weakness, paralysis
• Eye: pinpoint pupils, blurry vision, lacrimation
• Skin: sweating
• Odor: garlic
• Misc: salivation, bronchorrhea, bronchospasm, pulmonary edema, diarrhea, increased urine.

 

Phenothiazines

 

• VS: postural hypotension, hypothermia, tachycardia, tachypnea
• CNS: lethargy, coma, tremor, convulsions, ataxia, torticollis, back aching, oculogyric crisis, trismus, tongue protrusion
• Eye: Miosis

 

Salicylates

 

• VS: fever, tachypnea
• CNS: lethargy, coma
• Odor: oil of wintergreen with methyl salicylate
• Misc: vomiting, acidosis

 

Theophylline

 

• VS: tachycardia, arrhythmias
• CNS: headaches, restlessness, muscle twitching, seizure
• Misc: vomiting, hematemesis

 

Antidotes

 

acetaminophen

• [acetylcysteine]

 

anesthetic/vasoconstrictor combos, local dental

• [phentolamine]

 

anticholinergics

• [physostigmine]

 

arsenic

• [dimercaprol OR penicillamine]

 

benzodiazepines

• [flumazenil]

 

beta blockers

• [glucagon]

 

calcium channel blockers

• [calcium chloride]

 

carbamates

• [atropine OR pralidoxime (2-PAM)]

 

cholinergics

• [atropine OR pralidoxime (2-PAM)]

 

cholinesterase inhibitors

• [atropine OR pralidoxime (2-PAM)]

• • Info: may use glycopyrrolate or hyoscyamine to prevent muscarinic effects of cholinesterase inhibitors

 

copper

• [penicillamine OR trientine]

 

cyanide

• [hydroxocobalamin OR sodium nitrite AND sodium thiosulfate]

• • Info: may give amyl nitrite before sodium nitrite

 

digitalis/digoxin

• [digoxin immune Fab]

• • Info: may add colestipol if w/in 1-3h after last oral digoxin ingestion

 

ethylene glycol

• [ethanol OR fomepizole]

 

folate antagonists

• [leucovorin]

 

gold

• [dimercaprol]

 

heavy metals

• [dimercaprol OR penicillamine]

 

heparin

• [protamine sulfate]

 

hypoglycemics

• [glucagon]

 

iron

• [deferoxamine OR deferasirox]

 

lead

• [calcium EDTA OR dimercaprol OR penicillamine OR succimer]

 

mercury

• [dimercaprol OR penicillamine]

 

methanol

• [ethanol OR fomepizole]

 

methemoglobinemia

• [methylene blue]

 

methotrexate

• [leucovorin OR levoleucovorin]

 

neuromuscular blockers, non-depolarizing

• [edrophonium OR neostigmine OR physostigmine]

• • Info: may use glycopyrrolate or hyoscyamine

• • to prevent muscarinic effects of cholinesterase inhibitors

 

opioids

• [naloxone OR nalmefene]

 

organophosphates

• [atropine OR pralidoxime (2-PAM)]

 

scorpion sting

• [Centruroides immune Fab]

 

snake bite

• [antivenin (Micrurus fulvius)]

• • Info: for North American Coral snake bite

• [Crotalidae polyvalent immune Fab]

• • Info: for North American Crotalid snake (rattlesnake) bite

 

spider bite

• [antivenin (Latrodectus mactans)]

• • Info: for black widow spider bite

 

warfarin

• [phytonadione]