Antidotes! Trivia Quiz

Answer: Naloxone (Narcan)

A patient with known or suspected narcotic overdose will receive intravenous naloxone at frequent intervals (every 2-3 minutes) until his respiratory rate is in a satisfactory range. Only small doses are given, since too much Narcan at once can result in immediate and extremely unpleasant withdrawal symptoms.

Answer: Heparin sodium

Vitamin K reverses the anticoagulant action of warfarin, but protamine sulfate is for heparin toxicity. If you're curious, do a little web research on protamine's origins and how it's made. The source might just surprise you.

Answer: Succinylcholine

Since succinylcholine has such a short duration of action, the simplest way to reverse it is to support the patient with mechanical ventilation until the drug wears off.

Answer: Cyanide

Hydroxocobalamin is sold under the trade name Cyanokit, and may also be used in certain cases of smoke inhalation.

Answer: Activated charcoal

You may have seen the labels on various chemical products warning the consumer not to induce vomiting in cases of ingestion. Syrup of ipecac has all but disappeared from the antidote scene for this reason - vomiting out a toxic or corrosive substance can severely damage the gastrointestinal tract. Often, a better course of action is to absorb or dilute the harmful substances in the victim's body.

By the way, some household filtration devices use activated charcoal to absorb impurities in drinking water.

Answer: Chelation

Chelation therapy may also be used in cases of arsenic, mercury, or antimony poisoning.

Answer: Eclampsia

Convulsions and coma are dangerous symptoms of eclampsia, which "must be treated immediately," according to "The Bantam Medical Dictionary." The same reference states that preeclampsia is synonymous with pregnancy-induced hypertension, which explains the conspicuous presence of the blood pressure-reducing agents labetalol and nifedipine on my hospital's labor and delivery unit.

Answer: Insulin

Dextrose 50% injection is another possible treatment for patients with dangerously low blood sugar levels - it's much less expensive than glucagon, but not necessarily the ideal choice in all situations.

Large amounts of glucagon may also be used to treat beta blocker overdose, an extremely serious medical emergency. Since glucagon is only supplied in 1 mg vials of dry powder, many, many vials must be reconstituted and added to saline solution. On several occasions I have been sent to various far-flung units of my hospital to raid glucagon stocks for this purpose.

Answer: Antifreeze

Automotive antifreeze is made with ethylene glycol, a chemical that breaks down into various toxins inside the body, causing severe symptoms including intoxication, vomiting, and eventually, kidney failure. While fomepizole prevents the antifreeze from breaking down into toxic metabolites, other forms of treatment may also be required to help the victim fully recover.

Answer: Acetaminophen (paracetamol, Tylenol)

Acetaminophen (abbreviated APAP) is a useful drug for treating pain and fever, but at the same time, it can be very dangerous - severe liver damage can occur at high levels. The rule of thumb (although this may differ for specific patients) is that intake should not exceed 4 grams in a given 24-hour period. As APAP frequently appears in combination with narcotic pain medications (e.g., oxycodone + APAP = Percocet; hydrocodone + APAP = Vicodin or Lortab), addicts seeking ever higher highs often overdose on APAP with disastrous results.

The possibility of APAP toxicity was (and still is) a concern at my hospital, prompting authorities several years ago to begin stocking only narcotic combinations containing 325 mg of APAP rather than the typical 500 mg.