Applied Pharmacy
Toxidromes are pattern recognition with a management payoff, and antidotes are pharmacology exams in disguise. Every one works by a mechanism worth knowing. Educational cases, not poison-management software: real exposures go to poison control.
19-year-old presents 6 hours after impulsively taking 'two handfuls' of extra-strength acetaminophen.
Feels almost normal: mild nausea only. Asks to go home.
What drives the next step?
N-acetylcysteine restocks glutathione. An antidote that works by refeeding the detox pathway, which is why its value decays with every hour of delay.
23-year-old at a festival: agitated, hallucinating, skin flushed and DRY, pupils wide, bladder distended.
T 38.9, HR 128. Friends mention 'allergy pills to sleep'.
Which toxidrome, and what is the discriminating sign?
Toxidromes are pattern recognition with a management payoff: supportive care, benzodiazepines for agitation, and physostigmine in selected severe cases under toxicology guidance.
Roommate found unresponsive; RR 6, pinpoint pupils, cyanosed lips.
Fentanyl patches missing from a relative's supply.
First priorities?
Antidote pharmacokinetics matter as much as the antidote: whenever the agonist outlives the antagonist, observation and repeat dosing are built into the treatment.
Six exposures, six antidotes, and the mechanism revealed with every correct pairing.
Antidotes: pick one
Match to the exposure