Prophylaxis with antidotes

It appears from these results that simple prophylaxis (without post-exposure treatment) against OP is not sufficient. Therefore, pyridostigmine has importance as a prophylactic drug especially when it is combined with post-exposure antidotal treatment. For further development, it is necessary to search for novel prophylactic drugs and new routes of administration. In this context, preparations of cholinesterases are of special importance for the development of more effective prophylactics. 

Exposed skin should be washed promptly with soap and water. Dermal application of vitamin E oil preparations may be used for both prophylaxis and treatment of paresthesia. Eor contact with eyes, flush immediately and for an extended period with generous amounts of clean water or saline. Gastric lavage is indicated if patient has ingested a large amount of pyrethroid and can be treated soon after exposure. For ingestion of smaller amounts or if treatment has been delayed, activated charcoal and catharsis are indicated. Seizures can be treated with intravenous benzodiazepines (diazepam or loraze-pam) phenytoin or phenobarbital may be helpful for recurrent seizures. No specific antidotes for pyre-throid-induced neurotoxic effects have been approved for use in humans. Spontaneous recovery usually occurs with mild or moderate intoxication. 

The primary adverse effect associated with fondaparinux therapy is bleeding." " The rate of major bleeding in the VTE prophylaxis trials was approximately 2% to 3%. The risk of major bleeding appears to be related to weight therefore, in patients who weigh less than 50 kg, fondaparinux is contraindicated for VTE prophylaxis, and the treatment dose is only 5 mg every 24 hours. Similar to UFH and the LMWHs, fondaparinux should be used with extreme caution in patients with neuraxial anesthesia or following a spinal puncture owing to the risk for spinal or epidural hematoma formation. Unlike UFH and the LMWHs, fondaparinux does not cause heparin-induced thrombocytopenia and does not produce cross-sensitivity in vitro." A specific antidote to reverse the antithrombotic activity of fondaparinux is not currently available, but several potential products have been evaluated. 

When working out methods for prophylaxis and treatment of the postintoxication immunodeficiency states accompanied with different infectious complications, it is important to know the character of immune response modulation by antidotic means used for therapy of acute poisonings with OPC. 

B. Specific drugs and antidotes, if cyanide poisoning is suspected, administer sodium thiosulfate (see p 505). Sodium nitrite treatment may aggravate hypotension and should not be used. Hydroxocobalamin (p 453), 25 mg/h IV infusion, is sometimes coadministered with high-dose nitropmsside as prophylaxis against cyanide toxicity. 

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