Antidotes, Anticholinergics and

Antibiotics

AMRIT POKHREL
PHARMACIST
Antidotes
 Classification of Antidotes

Depending on their action:

A. Chemical Antidotes:  change the chemical
nature of poison.
For example, sodium thiosulphate which changes toxic
cyanide to the non-toxic thiocyanate; sodium
calcium edetate chelates agents used for heavy
metal poison.
B. Physiological Antidotes: 
acts by producing the effect opposite to that of poison.
Naloxone against morphine overdose
N-Acetylcystine in paracetamol Poisning
C. Mechanical Antidotes: 
They prevent the absorption of poison into the body.
For example, activated charcoal adsorbs the
poison prior to absorption across intestinal wall
 Therapeutic Uses

Antidotes are used in treatment of poisoning as well as

in case of over dose of drugs.
S.N Poison/Drugs Antidotes Doses
.
1 Paracetamol (N-acetylcysteine) Initial Dose 140mg/Kg.
(acetaminophen) then 70mg/Kg every 4Hrs
X 17 Doses
2 Anticoagulants, (Vitamin K)
( Warfarin)
3 Anticoagulants, (Protamine) 1mg neutralize 90-115U
( Heparin) Heparin, Initial Dose
1mg/min to total dose
200mg in 2Hrs

4 Benzodiazepines (Flumazenil) Initial Dose 0.1-0.2mg IV

over 30-60Sec, repeat
0.1-0.2mg IV every min
5 Methanol (Ethanol or Fomepizole)
6 Organophosphate a. Atropine a. I.D- 0.5-2.0mg IV, repeat
s b. Pralidoxime every 3-5 minute until sweat
and secretion clears
b. I.D- 1gm IV over 15min then
IV infusion of 3-4mg/kg/hr
for 24-72hrs or until clinical
toxicity resolves
7 Opioids (Naloxone) I.D . 0.1-2.0mg IV
Opioid dependent patients
should receive 0.1mg IV every
30-60 Sec until clinical response
8 Atropine (Physostigmine) I.D. 0.5mg-2.0mg slow IV over
3-5 Min
 Anticholinergic Drugs

Are agents that blocks the neurotransmitter

Acetylcholine in the CNS and PNS.

S.N Organ/System Response

1 Eye Mydriasis(Dilatation of Pupil) , Cycloplegia

2 Respiratory Tract Drying the Secretion(Mouth, Nose, Throat,

Bronchi)
Relaxation of Smooth muscle of bronchi

3 GI Decrease Secretion as well as motility

4 CVS Increase Pulse rate

Example
Atropine
Dicyclomine
Glycopyrrolate
Ipratropium
Tiotropium
Uses
Excessive vagal-induced bradycardia
Diarrhoea
Motion sickness
Muscle spasms
Chronic obstructive pulmonary disease (COPD)
Asthma
As Preanaesthetic Medication
 Side Effects

Blurred vision
Dry mouth
Dry eyes
Decreased urine production
Decreased sweat production
Constipation
Memory impairment
Delirium
Confusion
 Antibiotics

Commonly known as antimicrobial agent are

chemical substances used in the prevention and
treatment of microbial(Bacterial /Fungal) infections.
Either kill or inhibit the growth of microorganism.
Not effective against viruses such as common Cold,
influenza.
Antiviral Drugs( Acyclovir)
 Antimicrobial Drugs example

1. B-lactam Antibiotics
A. Penicillins
Amoxycillin, ampicillin, piperacillin, Penicillin V
B-lactamase Inhibitors
Clavulanic Acid, Sulbactum, Tazobactum
B. Cephalosporins
Cefazolin, Cefadroxyl
Cefuroxime, Cefaclor
Ceftriaxone, Ceftazidime, Cefixime, Cefpodoxime
Cefepime
C. Newer
Aztreonam, Meropenem, Imipenem
 Antimicrobial Drugs example

2.Sulfonamides
3. Quinolones
Nalidixic Acid,Ciprofloxacin, Ofloxacin, Levofloxacin,
Moxifloxacin
4. Tetracyclins and Chloramphenicol
5. Aminoglycoside
Amikacin, Gentamicin, Tobramycin, Streptomycin
 Antimicrobial Drugs example

6. Macrolids
Erythromycin, Azithromycin, Clarithromycin
7. Glycopeptide
Vancomycin, Teicoplanin,
8. Polypeptide Antibiotics
Polymixin B
Colistine
Sensitivity test( Disc Diffusion Method)
 Problems that may arise

Toxicity
Local irritacy:- GI, pain and abcess at site of injection
Systemic:
Aminoglycosides: ototoxicity, nephrotoxicity
Tetracyclines: Liver and kidney damage
Chloramphenicol: Bone marrow depression
Polymyxin B- neurological and renal toxicity
Hyersensitivity Rxn
Drug Resistance
Unresponsiveness of a microorganism to an Antimicrobial
Nutritional Deficiency
Combined use of antimicrobials
Objectives:

1. To achieve Synergism
Cotrimoxazole
Amoxycillin+ Clavulanic Acid
Ampicillin + Sulbactum
2. To reduce severity of adverse effects
Amphotericin B+ minocyclin
3. To Prevent emergence of Resistance
Treatment of Leprosy, Tuberculosis,H.Pylori as well.
 Antimicrobial failure

Possible cause
1. Improper Selection
2. Treatment begun too late
3. Failure to take necessary adjuvent measures
4. Poor host defence
5. Trying to treat untreatable (viral) infection.
End!!