💓 Savvy Nurse打开应用

💊 药理学 · 第4课，共6课 · 6 min

考试当天你会看到的解毒剂表

The Antidote Table You Will See on Exam Day

🧪 Acetaminophen过量在24小时内看起来无害，然后会破坏肝脏。解毒剂在最初8小时内效果最好。考试会给你一条时间线和一个药物名称，并期望你立即匹配。

🧪 Acetaminophen overdose looks harmless for 24 hours and then destroys the liver. The antidote works best in the first 8 hours. The exam gives you a timeline and a drug name and expects an instant match.

💡 核心要点

阿片类用naloxone，苯二氮卓类用flumazenil，acetaminophen用acetylcysteine，heparin用protamine，warfarin用vitamin K，magnesium用calcium gluconate。

Naloxone for opioids, flumazenil for benzodiazepines, acetylcysteine for acetaminophen, protamine for heparin, vitamin K for warfarin, calcium gluconate for magnesium.

🧠 为什么重要

阿片类药物：NALOXONE，它可能在阿片类药物失效前先失效，因此要监测并重复给药。苯二氮卓类：FLUMAZENIL，要谨慎使用，因为它可能在依赖患者中诱发癫痫发作。Acetaminophen：ACETYLCYSTEINE，在8小时内最有效；肝损伤在72至96小时达到峰值。Heparin：PROTAMINE SULFATE。Warfarin用VITAMIN K，digoxin用digoxin immune Fab。Magnesium sulfate（用于子痫前期）：CALCIUM GLUCONATE，要放在床边；注意深腱反射消失、呼吸低于12和尿量低于30 mL/hr。铁：deferoxamine。抗胆碱能毒性（热如野兔、干如骨头、红如甜菜、疯如帽匠）：physostigmine。胆碱能危象，如重症肌无力中胆碱酯酶抑制剂过量（流涎、流泪、排尿、排便、心动过缓）：atropine。有机磷中毒：atropine加pralidoxime。Beta-blocker过量：glucagon。一氧化碳：100%氧气。Methotrexate：leucovorin。铅：用succimer或EDTA螯合治疗。氰化物：hydroxocobalamin。Dabigatran：idarucizumab。对于任何疑似中毒，致电毒物控制中心；不要催吐。

OPIOIDS: NALOXONE, which can wear off before the opioid does, so monitor and repeat. BENZODIAZEPINES: FLUMAZENIL, used cautiously because it can trigger seizures in dependent clients. ACETAMINOPHEN: ACETYLCYSTEINE, most effective within 8 hours; liver damage peaks at 72 to 96 hours. HEPARIN: PROTAMINE SULFATE. WARFARIN: VITAMIN K. DIGOXIN: digoxin immune Fab. MAGNESIUM SULFATE (for preeclampsia): CALCIUM GLUCONATE, kept at the bedside; watch for loss of deep tendon reflexes, respirations under 12 and urine output under 30 mL/hr. IRON: deferoxamine. ANTICHOLINERGIC toxicity (hot as a hare, dry as a bone, red as a beet, mad as a hatter): physostigmine. CHOLINERGIC crisis, such as cholinesterase-inhibitor excess in myasthenia gravis (salivation, lacrimation, urination, defecation, bradycardia): atropine. ORGANOPHOSPHATE poisoning: atropine plus pralidoxime. BETA-BLOCKER overdose: glucagon. CARBON MONOXIDE: 100% oxygen. METHOTREXATE: leucovorin. LEAD: chelation with succimer or EDTA. CYANIDE: hydroxocobalamin. Dabigatran: idarucizumab. For any suspected poisoning, call the poison control center; do not induce vomiting.

🏥 真实场景

🕗 一名青少年在吞下了一瓶acetaminophen六小时后到达，除了轻微恶心外感觉良好。她的肝酶正常。护士抽取四小时以上的acetaminophen水平并准备acetylcysteine，不等待症状出现，因为等到肝脏显示损伤时，解毒剂最具保护作用的窗口已经过去了。

🕗 A teenager arrives six hours after swallowing a bottle of acetaminophen, feeling fine except for mild nausea. Her liver enzymes are normal. The nurse draws a four-hour-plus acetaminophen level and prepares acetylcysteine without waiting for symptoms, because by the time the liver shows damage, the antidote's most protective window has passed.

📌 要点总结

  • Naloxone可能需要重复给药；flumazenil可引起癫痫发作Naloxone may need repeating; flumazenil can cause seizures
  • Acetylcysteine在acetaminophen过量后8小时内效果最好Acetylcysteine works best within 8 hours of acetaminophen overdose
  • 子痫前期每次magnesium sulfate输注时，床边备好calcium gluconateCalcium gluconate at the bedside for every magnesium sulfate infusion in preeclampsia

📖 本课术语

解毒剂 (Antidote): 能逆转另一种药物作用的药物，如用于阿片类药物的naloxone，或用于warfarin的vitamin K。

SLUDGE（胆碱能危象） (SLUDGE (cholinergic crisis)): Salivation（流涎）、Lacrimation（流泪）、Urination（排尿）、Defecation（排便）、GI upset（胃肠不适）、Emesis（呕吐）：乙酰胆碱过多（有机磷中毒或胆碱能危象）的征象，用atropine逆转。

Acetaminophen水平（毒性） (Acetaminophen level (toxic)): 高于约150 mcg/mL的水平（摄入4小时后测得）在Rumack-Matthew列线图上为毒性水平，需要使用acetylcysteine；肝酶通常在2到4天后达到峰值，此时早期恶心已消退。

Atropine: 加快有症状的缓慢心率的抗胆碱药（1 mg IV，每3到5分钟重复一次，至3 mg），也是胆碱能危象和有机磷中毒的解毒剂；预期会出现口干、视力模糊、尿潴留和面部潮红。

Protamine和维生素K (Protamine and vitamin K): 抗凝逆转组合：protamine在数分钟内中和heparin，但快速推注会引起低血压和过敏反应；维生素K在数小时内逆转warfarin，口服或缓慢IV给药，严重出血时加用4因子PCC；皮下吸收不稳定，IV/IM剂量带有黑框警告。

Naloxone: 阿片类解毒剂，IV、IM或鼻内给药，每2到3分钟重复一次，直到患者恢复呼吸；它在大多数阿片类药物之前失效，因此要持续监测镇静是否再现，并预期会出现突发疼痛和戒断症状。

Acetaminophen: 止痛退热药，过量会破坏肝脏，而第一天看起来无害；每日总量保持在4克以下（肝脏疾病或经常饮酒时更少），计算复方制剂的含量，并给予acetylcysteine，最好在8小时内。

✅ 自我测试

一名因先兆子痫接受IV magnesium sulfate的患者膝反射消失，呼吸频率为10。护士应准备哪种药物？A client receiving IV magnesium sulfate for preeclampsia has absent patellar reflexes and a respiratory rate of 10. Which medication should the nurse prepare?
  1. Naloxone
  2. Calcium gluconate
  3. Protamine sulfate
  4. Flumazenil

答案: B · Calcium gluconate

反射消失和呼吸抑制是镁毒性的征象；calcium gluconate是解毒剂。先停止输注。Naloxone仅逆转阿片类引起的呼吸抑制；它对magnesium没有作用，因此不会恢复这里的反射或呼吸。

Lost reflexes and respiratory depression are signs of magnesium toxicity; calcium gluconate is the antidote. Stop the infusion first. Naloxone reverses opioid-induced respiratory depression only; it has no effect on magnesium, so it would not restore reflexes or breathing here.

哪种解毒剂用于acetaminophen过量？Which antidote is administered for acetaminophen overdose?
  1. Acetylcysteine
  2. Deferoxamine
  3. Glucagon
  4. Atropine

答案: A · Acetylcysteine

Acetylcysteine补充谷胱甘肽并保护肝脏，理想情况下在摄入后8小时内使用。Deferoxamine是铁中毒的解毒剂；它结合铁，对损伤肝脏的acetaminophen代谢物没有作用。

Acetylcysteine replenishes glutathione and protects the liver, ideally within 8 hours of ingestion. Deferoxamine is the antidote for iron toxicity; it binds iron and has no effect on the acetaminophen metabolite that injures the liver.

给予naloxone后，一名过量服用长效阿片类药物的患者醒来并呼吸正常。为什么护士必须继续密切监测？After naloxone, a client who overdosed on a long-acting opioid wakes up and breathes normally. Why must the nurse continue close monitoring?
  1. Naloxone在阿片类药物之前失效Naloxone wears off before the opioid
  2. Naloxone之后必须使用flumazenilNaloxone must be followed by flumazenil
  3. Naloxone会引起肝损伤Naloxone causes liver damage
  4. 患者会发生血清素综合征The client will develop serotonin syndrome

答案: A · Naloxone在阿片类药物之前失效

Naloxone的作用持续时间比许多阿片类药物短。再次镇静和呼吸抑制可能复发，需要重复给药。Flumazenil逆转苯二氮卓类，而不是阿片类，因此在这次阿片类过量中不起作用。

Naloxone's duration is shorter than many opioids. Resedation and respiratory depression can recur, requiring repeat doses. Flumazenil reverses benzodiazepines, not opioids, so it plays no role in this opioid overdose.

免费开始这节课 →

在应用中练习 NCLEX 风格的题目，赚取 XP、保持连续天数，英文学习，中文辅助。无需注册。

更多：药理学

🔗 相关课程