Antidotes

Antivenoms Atropine
Pralidoxime, 2-PAM
N-acetylcysteine
Sodium bicarbonate
Polyethylene glycol electrolyte solution

()


1 2556
5,000



270 6 10400
0 2201 1084
0 2201 1085 1
:
766/36-39 .
10120
. 0-229-0279-81, 0-2688-4840-41
Fax. 0-2688-4842
Email : scanart03@yahoo.com
:
257 . 1 . .
. 10270
. 0-2387-1452-4
Fax. 0-2387-1455
Email : scanandprint2010@yahoo.com

()

(.)


Snake antivenoms 1
Atropine 4
Pralidoxime (2-PAM) 6
N-acetylcysteine (NAC) 7
Sodium bicarbonate 11
Polyethylene glycol electrolyte 14
solution (PEG-ELS)

18
23
24
25
D
 Snake antivenoms
(Indications)



1.

2.

1. Systemic bleeding microscopic hematuria

2. Unclotted 20 minute whole blood clotting time
(20WBCT) prothrombin time (PT)
International normalized ratio (INR) 1.2
3. 50,000/mm3
4.
compartmental syndrome

1
 (Contraindications)

(Adverse reactions)
(early reaction)

(late reaction)
1-2

(Drug interaction)

(Dosage and administrations)

10 vials 10 vials
5 vials 10
vials 10 vials

2
 3-5 vials
3-5 vials 3 vials
5 vials

skin test
30

(Formulation)
(vial)
10

3
 Atropine
(Indications)
1.

muscarinic cholinergic
2. (bradycardia)
3. (asystole)
4. (bronchospasm)

(Contraindications)
1.
2. (narrow-angle glaucoma)

(Adverse reactions)

(Drug interaction)

4
 (Dosage and administrations)
Loading dose: 1.8 IV

Maintenance dose: 10-20% loading dose IV drip

(Formulation)
0.6

5
 Pralidoxime, 2-PAM
(Indications)

(Contraindications)
1. oximes
2.
(absolute contraindication)
(Adverse reactions)

(Drug interaction)

(Dosage and administrations)
Loading dose: 12 IV drip 30-60
Maintenance dose: 500-1000 / (10-20
//) IV
(Formulation)
1
6
 N-acetylcysteine (NAC)
(Indications)
1.

(150
/ )


treatment line Rumack-Matthew Nomogram
2.
(
8 )
150 //
6 /24 ()
48
100 //
4 /24 72

3.
chlorinated hydrocarbon
7
 (Contraindications)
NAC

(Adverse reactions)
1. NAC

2. NAC
anaphylactoid
angioedema

(Drug interaction)
NAC
NAC

(Dosage and administration)

1. : 140 /
70 / 4 17

2. :
2.1 ( 40 )

8
 NAC 150 / 5% Dextrose in
water 200 60
NAC 50 / 5% Dextrose in
water 500 4
NAC 100 5% Dextrose in water
1000 16
2.2 ( 20-40 )

NAC 150 / 5% Dextrose in

water 100 30
NAC 50 / 5% Dextrose in
water 250 4
NAC 100 / 5% Dextrose in
water 500 16
2.3 ( < 20 )

NAC 150 / 5% Dextrose in

water 3 / 30
NAC 50 / 5% Dextrose in
water 7 / 4
NAC 100 / 5% Dextrose in
water 14 / 16
9
 2.4
NAC 150 /
5% Dextrose in water 1000
24

NAC,

10 / 36

48

(Formulation)
(powder granules)
100, 200
600
(effervescent tablet)
600

(intravenous
infusion) 100 /
10
 Sodium Bicarbonate
(Indications)
1. Cardiotoxicity fast sodium channel blockade
(widening QRS complex) tricyclic antidepres-
sants ( amitriptyline, doxepin, imipramine, nortriptyline )
type Ia, Ic antiarrhythmic drugs ( quinidine, f lecainide,
encainide, propafenone, moricizine)
2. Urine alkalinization salicylate, phenobarbital, chlor-
propamide overdose severe rhabdomyolysis

3. Metabolic acidosis
4. Hyperkalemia

(Contraindications)
1. Severe alkalemia serum pH> 7.55
2. Severe hypernatremia
3. Severe hypokalemia
4. Severe pulmonary edema, congestive heart failure,
anuria without plan for dialysis

11
 (Adverse reactions)
1. Alkalemia hypokalemia, hypocalcemia
2. Hypernatremia volume overload
heart failure, pulmonary edema
3. Inf lflammation necrosis

(Drug interaction)

salicylate, phenobarbital,
chlorpropamide

(Dosage and administration)

1. Cardiotoxicity sodium channel blockade 1-2
/ IV bolus 1-2
(QRS complex widening, wide QRS complex
tachycardia, hypotension) 5
serum pH 7.45-7.55
(continuous IV infusion)
12
 2. Urine alkalinization 7.5% sodium bicarbonate
150 5% Dextrose in water 1000
2-3 //
( )
urine pH 7.5-8
serum pH 7.55

(Formulation)
: sodamint 300
: 7.5% sodium
bicarbonate injection (0.89 / 10
50 )

13
 Polyethylene glycol electrolyte solution (PEG-ELS)

(Indications)
1. (sustained-release)
(enteric-coated)
sustained-release verapamil
2.
/ activated charcoal
(iron),
(lead), lithium
3. /
(body packers) (body
stuffers)

(Contraindications)
1.
(unprotected,
compromised airway)
2.
(ileus), ,
(hemodynamic instability)

14
 3.

(Adverse reactions)



diverticulitis (upper gas-
trointestinal bleeding)

(Drug interaction)

(Dosage and administrations)

9 - 6 500
6 - 12 1,000
1,500-2,000

15
 (Formulation)
PEG-ELS
PEG-ELS PEG-ELS, 4000
PEG 4000
sodium and potassium salt

16
 17


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www.nhso.go.th
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3.

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US/PW
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