Cholinesterase inhibitor pesticides
Bev-Lorraine True, Robert H. Dreisbach in Dreisbach’s HANDBOOK of POISONING, 2001
Antidote: Atropine – In the presence of symptoms give atropine sulfate, 2 mg intramuscularly, and repeat every 3–8 min until signs of parasympathetic toxicity are controlled: eyelid and tongue tremors, miosis, salivation, sweating, slow pulse, muscular fasciculations, respiratory difficulty, pulmonary edema, heart block. Repeat dose of 2 mg of atropine frequently to maintain control of symptoms. As much as 12 mg of atropine has been given safely in the first 2 h. Interruption of atropine therapy may be rapidly followed by fatal pulmonary edema or respiratory failure.Cholinesterase reactivator – Do not use in the presence of carbaryl intoxication. Use only with maximum atropine administration. Give pralidoxime (Protopam, pyridine-2-aldoxime methochloride, 2-PAM), 1 g in aqueous solution, intravenously and slowly. Repeat after 30 min if respiration does not improve. This dose may be repeated twice within each period of 24 h. Obidoxim (Toxogonin) is available in some countries and is used similarly.
The Use of Medicines for Illness
Richard Blum, Andrew Herxheimer, Catherine Stenzl, Jasper Woodcock in Pharmaceuticals and Health Policy, 1981
Medicines cure illness much less commonly than many people believe, if cure is defined as the restoration of health. The main types of medicines which can do this are antimicrobial and antiparasitic drugs, anti-cancer drugs, and antidotes to poisons. It is easy to see how a drug which attacks a microbe can enable the patient’s own defences to rid the body of the infection, and similarly with parasites and cancer cells. With an antidote to a poison, the process is somewhat different. An antidote may work by inactivating the poison or by accelerating its removal from the body. Or it may antagonise the poison at its site of action: it may either block its access to the point of action or it may have an opposing effect. Preferably the effect of an antidote should last as long or longer than the effect of the poison, otherwise any improvement in the patient will be only transient, so that repeated doses of the antidote have to be given. This is the case when naloxone is used to treat morphine poisoning.
Drug Overdoses during Pregnancy
“Bert” Bertis Britt Little in Drugs and Pregnancy, 2022
Nalmefene is an opiate antagonist with an 11-hour half-life, and has potential benefits over naloxone (Kaplan and Marx, 1993). Naloxone has a shorter half-life (one to two hours). Nalmefene is longer acting, and period of withdrawal is longer and less abrupt in opioid-dependent patients (Kaplan and Marx, 1993). Overdose of other non-opioid constituents (e.g., acetaminophen) must be considered in formulating the antidote regimen and treatment plan. For opioid preparations that contain acetaminophen, serious hepatic and renal toxicities require immediate attention. Use of the acetaminophen antidote (NAC) should be given as soon as possible after toxicology documents toxic serum levels. Half-life in the post-absorptive period for morphine is 1.3–6.7 hours, and for codeine, 1.9–3.9 hours; oxycodone, 4.0–5.0 hours; and hydromorphone, 1.5–3.8 hours. Opioid analgesics are ultimately excreted (Baselt, 2017).
Design, characterization and comparison of transdermal delivery of colchicine via borneol-chemically-modified and borneol-physically-modified ethosome
Published in Drug Delivery, 2019
Yujia Zhang, Nan Zhang, Hui Song, He Li, Jin Wen, Xiaochuan Tan, Wensheng Zheng
Gout is a kind of joint disease characterized by the accumulation of monosodium urate (MSU) crystals in the joint and its surrounding tissue, causing persistent hyperuricemia (Ryszard et al., 2016). The acute gout attack is an acute inflammation caused by the disorder of purine metabolism and rising of hematuria acid by some influential factors (Pascual & Sivera, 2007). Severe pain and frequent attacks at night cause substantial adverse effects on patients’ lives. In the acute gout attack, the treatment mainly includes analgesic, and the commonly used drugs are nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, glucocorticoids, and IL-1 antagonist. Colchicine is a classic drug used for the treatment of acute gouty arthritis in 1945. But colchicine remains more toxic in the treatment of acute gout attack, and its clinical adverse reactions mainly include gastrointestinal symptoms such as spastic abdominal pain, diarrhea, nausea, and vomiting. There is no effective antidote as the amount of poisoning is very close to the amount of treatment (Mehmood et al., 2016).
Mass spectrometry in emergency toxicology: Current state and future applications
Published in Critical Reviews in Clinical Laboratory Sciences, 2019
Xander M. R. Van Wijk, Robert Goodnough, Jennifer M. Colby
Emergency toxicology does just this, and is centered around the diagnosis and management of the critically poisoned patient. Care of poisoned patients often starts with the “ABCs” of resuscitation (airway, breathing, and circulation), vital signs, and, where possible, identification of a specific toxic syndrome (toxidrome) [3,4]. Treatment is largely supportive and may include measures to limit absorption of the poison, e.g. gastric emptying or use of activated charcoal, or to enhance excretion, e.g. urine alkalization in salicylate overdose or hemodialysis [4]. Some poisons have specific antidotes that can be administered. For example, naloxone can be used to reverse an opioid overdose. Of note, naloxone use reported to US poison centers has almost tripled from 2000 to 2016 [5]. Other well-known examples of specific antidotes are N-acetylcysteine for acetaminophen and digoxin-specific antibody fragments for digoxin and other cardiac glycosides [4].
Cardiopulmonary resuscitation in poorly resourced settings: better to pre-empt than to wait until it is too late
Published in Paediatrics and International Child Health, 2020
There are always some exceptions to rules and likelihoods and one is drug overdose. If a child has taken a toxic dose of, for example, an opiate, anxiolytic or anti-epileptic, every attempt should be made to continue resuscitation until the drug effect has passed. Some drugs have an antidote which will hasten recovery and reverse some of the toxic effects of drugs. Another exception is drowning in very cold water. This is unlikely in hot climates but, should such an accident occur, slow warming and continued resuscitation over time are appropriate. However, in a study of 160 Dutch children <16 years old with cardiac arrest and hypothermia after drowning during 1993–2012, 98 (61%) required >30 min of CPR and 87 (89%) died. The 11 survivors were all neurologically damaged whereas, of the 62 (39%) who required CPR for <30 min, 17 survived, 10 were neurologically normal, 5 had mild disabilities and 2 had moderate disabilities [32].