KeePosted - ICHP

Illinois Poison Center (IPC)
Antidote Preparedness – Is Your Pharmacy Ready?
by Nichole Cool, PharmD 1, , Kelly Mattes, PharmD Candidate 2 , Tony Burda, RPh, DABAT 3 , Michael Wahl, MD, FACEP 3
1 - Midwestern University-Chicago College of Pharmacy and Northwestern Memorial Hospital; 2 - University of Illinois College
of Pharmacy; 3 - Illinois Poison Control Center
Introduction
The Illinois Poison Control Center (IPC) is occasionally
contacted by clinical pharmacists asking specific antidote
stocking questions such as:
• What antidotes should we stock?
• How much of each antidote should be available?
• If there is more than one option available, which product
is better?
• If the hospital does not stock the antidote, how can we
get it quickly in an emergency situation?
In an effort to address these questions, the staff of IPC
has developed an antidote stocking chart specifically for
hospitals with emergency departments, which is posted on
www.illinoispoisoncenter.org. The list describes 34 antidotes,
13 adjunctive agents, and 3 agents for radiological
exposure along with suggested minimum inventory and
rational/indications for stocking each item. After studying
the antidote chart, please contact the IPC at 1-800-222-
1222 if there are further questions.
Background
Antidotes are critical for patients with
poisoning or overdose and can be
lifesaving when available and administered
within a timely manner.
In 2009, the United States Poison
Centers reported using 70,477 antidotes
per the national poison data system.
1 Studies have shown that small
and/or rural hospitals are less likely to
stock sufficient quantities of antidotes
due to the following reasons:
• Limited hospital resources
• Infrequent use of specific antidotes
• Lack of staff education or awareness
• Concern for high cost of inventory/exceeding
hospital drug budget
• Lack of efficient stocking guidelines
22 July 2011 | KeePosted | www.ichpnet.org
Currently, no regulatory committees mandate the
stocking of antidotes or specific quantities of these
agents.
Antidote Stocking Guidelines: Recommendations
by the Emergency Medicine Expert Consensus
Guidelines published in the Annals of Emergency Medicine
in September 2009, give recommendations on specific
antidotes to be stocked and the amount of each antidote
that should be available. 2 The consensus panel considered
a total of 24 antidotes for hospital stocking. Out of the
24 antidotes reviewed, they recommended that 12 of the
antidotes be immediately available, 9 of the antidotes be
available within 1 hour, and the other 3 could be stocked
but were not necessarily needed emergently. The group
also made recommendations on the amount of antidote
to be stocked based on an average patient weight of 100
kg and the average amount of antidote for the duration of
treatment (8 hrs or 24 hrs). 2
Review Questions – Antidote Stocking
1. What is the suggested stock quantity of pyridoxine HCl by the IPC?
a) 100 mg
b) 1gm
c) 5gm
d) 10gm
e) 20gm
2. What is the suggested stock quantity of glucagon by the IPC?
a) 1-2mg
b) 5-10mg
c) 10-20mg
d) 25-50mg
e) 50-90mg
3. True or False? The IPC recommends stocking 1-2 vials (1.5gm vials)
of fomepizole (Antizole®). One 1.5gm vial provides an initial dose of
15mg/kg/12hrs to an adult weighing up to 100 kg. Hospitals with critical
care and hemodialysis capabilities should consider stocking 1 kit of
4 vials or more.
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