First Aid for the USMLE Step 1 2024, 34th Edition-273.jpeg

# Pharmacology - Toxities and Adverse Effects ## Section II **Specific Toxicity Treatments** | Toxin | Treatment | |---|---| | Acetaminophen | N-acetylcysteine (replenishes glutathione) | | AChE inhibitors, organophosphates | Atropine > pralidoxime | | Antimuscarinic, anticholinergic agents | Phy...

# Pharmacology - Toxities and Adverse Effects ## Section II **Specific Toxicity Treatments** | Toxin | Treatment | |---|---| | Acetaminophen | N-acetylcysteine (replenishes glutathione) | | AChE inhibitors, organophosphates | Atropine > pralidoxime | | Antimuscarinic, anticholinergic agents | Physostigmine (crosses BBB, control hyperthermia) | | Arsenic | Dimercaprol, succimer | | Benzodiazepines | Flumazenil | | Beta-blockers | Atropine, glucagon, saline | | Carbon monoxide | 100% O2, hyperbaric O2 | | Copper | "Penny" cillamine (penicillamine), trientine (3 copper pennies), Hydroxocobalamin, nitrites + sodium thiosulfate | | Cyanide | Idarucizumab | | Dabigatran | Digoxin-specific antibody fragments | | Digoxin | Andexanet alfa | | Direct factor Xa inhibitors (eg. apixaban) | Protamine sulfate | | Heparin | Deferoxamine, deferasirox, deferiprone | | Iron (Fe) | Penicillamine, calcium disodium EDTA | | Lead | Dimercaprol, Succimer (correct lead poisoning in PEDS patients) | | Mercury | Dimercaprol, succimer | | Methanol, ethylene glycol (antifreeze) | Fomepizole > ethanol, dialysis | | Methaemoglobin | Methylene blue, vitamin C (reducing agent) | | Methotrexate | Leucovorin | | Opioids | Naloxone | | Salicylates | NaHCO3 (alkalinize urine), dialysis | | TCAs | NaHCO3 (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) | | Cutaneous flushing | Vancomycin, Adenosine, Niacin, Ca2+ channel blockers, Echinocandins, Nitrates (flushed from VANCEN [dancing]) | | Vancomycin infusion reaction | Vancomycin infusion reaction (formerly called red man syndrome)-rate-dependent infusion reaction to vancomycin causing widespread pruritic erythema due to histamine release. Manage with diphenhydramine, slower infusion rate. | | Dilated cardiomyopathy | Alcohol, anthracycline (eg, doxorubicin, daunorubicin; prevent with dexrazoxane), trastuzumab| | Torsades de pointes | Agents that prolong QT interval: Methadone, antiArrhythmics (class IA, III), antiBiotics (eg, macrolides, fluoroquinolones), anti "C"ychotics (eg, ziprasidone), antiDepressants (eg, TCAs), antiEmetics (eg, ondansetron), antiFungals (eg, fluconazole) (Memorize your ABCDEF)|