☠️ Antidotes & Overdose

The reversal agents you get tested on, plus 110 drugs from the guide with a documented overdose treatment.

🚨 The three that show up most

acetaminophenacetylcysteine

opioidsnaloxone

benzodiazepinesflumazenil

⭐ Hyperkalemia — the order they ask for

1. Calcium gluconate 2. Insulin + D50 3. Albuterol 4. Kayexalate 5. Dialysis

Calcium is first because it stabilizes the myocardium. It does not lower the potassium.

🛡️ Antidote pairs to memorize

30 pairs. The search box filters these too.

💊 acetaminophen (Tylenol)

🛡️ acetylcysteine

Give within 8–10 hr for best effect. Watch the rising AST/ALT, not the symptoms — the client can look fine while the liver is failing.

💊 opioids (morphine, fentanyl)

🛡️ naloxone

Shorter half-life than most opioids — it can wear off and the client re-sedates. Keep monitoring.

💊 benzodiazepines (lorazepam)

🛡️ flumazenil

Can trigger seizures in chronic users or mixed TCA overdose. Use cautiously.

💊 warfarin (Coumadin)

🛡️ vitamin K (phytonadione)

Add FFP or PCC when bleeding is active — vitamin K alone is too slow.

💊 heparin

🛡️ protamine sulfate

1 mg protamine per ~100 units heparin. Monitor aPTT.

💊 enoxaparin (Lovenox)

🛡️ protamine sulfate (partial)

Only reverses about 60% — LMWH is not fully reversible.

💊 dabigatran (Pradaxa)

🛡️ idarucizumab (Praxbind)

Direct thrombin inhibitor with its own dedicated antidote.

💊 rivaroxaban / apixaban

🛡️ andexanet alfa

Factor Xa inhibitors. Expensive, not stocked everywhere.

💊 digoxin

🛡️ digoxin immune Fab (DigiFab)

Anorexia, nausea, yellow-green halos. Hypokalemia worsens toxicity.

💊 magnesium sulfate

🛡️ calcium gluconate

Classic in OB. First sign is loss of deep tendon reflexes, then respiratory depression.

💊 iron

🛡️ deferoxamine

Urine turns a reddish 'vin rosé' color as iron is chelated out.

💊 lead

🛡️ succimer, edetate calcium disodium

Chelation. Find the exposure source before discharge.

💊 organophosphates

🛡️ atropine + pralidoxime

SLUDGE — salivation, lacrimation, urination, defecation, GI upset, emesis.

💊 cyanide

🛡️ hydroxocobalamin

Suspect after enclosed-space smoke inhalation. Turns urine and skin red.

💊 carbon monoxide

🛡️ 100% oxygen (hyperbaric if severe)

Pulse ox reads falsely normal — draw a carboxyhemoglobin level.

💊 methotrexate

🛡️ leucovorin (folinic acid)

'Leucovorin rescue.' Hydrate and alkalinize the urine.

💊 ethylene glycol / methanol

🛡️ fomepizole (or ethanol)

Blocks alcohol dehydrogenase so the toxic metabolite never forms.

💊 beta blockers

🛡️ glucagon

Glucagon bypasses the blocked beta receptor. Atropine first for bradycardia.

💊 calcium channel blockers

🛡️ IV calcium + glucagon + high-dose insulin

Verapamil and diltiazem drop both rate and pressure.

💊 tricyclic antidepressants

🛡️ sodium bicarbonate

Watch for a widening QRS — that is the sign to treat, not the level.

💊 neuromuscular blockers

🛡️ sugammadex, or neostigmine + glycopyrrolate

Sugammadex encapsulates rocuronium and vecuronium.

💊 anticholinergics

🛡️ physostigmine

'Mad as a hatter, red as a beet, dry as a bone, hot as a hare, blind as a bat.'

💊 insulin / sulfonylureas

🛡️ dextrose 50%, glucagon

Conscious and able to swallow? 15 g fast carbs, recheck in 15 min.

💊 volatile anesthetics + succinylcholine

🛡️ dantrolene

Malignant hyperthermia. Earliest sign is rising end-tidal CO2, not fever.

💊 vasopressor extravasation

🛡️ phentolamine

Stop the infusion, leave the catheter in to aspirate, then infiltrate the site.

💊 alteplase bleed

🛡️ aminocaproic acid

Stop the infusion first. Have blood products ready.

💊 potassium (hyperkalemia)

🛡️ calcium gluconate first

Calcium protects the heart, it does not lower the potassium.

💊 isoniazid

🛡️ pyridoxine (vitamin B6)

Also given routinely with INH to prevent peripheral neuropathy.

💊 blood transfusion — citrate toxicity

🛡️ calcium gluconate

Tingling around the mouth, tremors, prolonged QT. See the Blood Products page.

💊 IV contrast / anaphylaxis

🛡️ epinephrine

Then antihistamines, steroids, oxygen and fluids.

📑 Documented overdose treatment

Drug Guide · study summary only, no dosing · always check the current package insert, your course materials and facility policy.