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UNC MEDICAL CENTER GUIDE

Antidotes Used in Poisonings and Ingestions The purpose of this guide is to describe the locations and quantities of to be maintained at UNC Medical Center for poisonings and ingestions. Please refer to PHARM 0207: Availability for additional information.

Chapel Hill Campus Hillsborough Campus Brand Generic Name Uses Name Location(s) Par Levels a Location(s) Par Levels

Acetylcysteine (oral) Min: 18 Min: 18 Mucomyst Acetaminophen Talyst (IP) Talyst 30 mL Max: 36 Max: 36

Min: 22 Talyst Min: 22 (IV) Acetadote Acetaminophen Talyst (IP) Max: 33 Max: 33 Bites of crotalides Antivenin Crotalidae (rattlesnakes, Min: 20 Min: 20 CroFab Talyst (Refrig) Pass-through polyvalent (ovine) copperhead, Max: 24 Max: 24 cottonmouth moccasins) Antivenin Latrodectus mactans Black widow Min: 2 N/A Talyst (Refrig) Min: 2 b Talyst (Refrig) (Black Widow) spider bites Max: 2 (equine) Antivenin Micruus Call Regional Poison Call Regional Poison Fulvius (Coral N/A Coral snake bites c N/A c N/A Control Center Control Center Snake) Min: 29 0.4 mg/mL; Cholinergic Min: 66 Talyst N/A Talyst (IP) Max: 44 1 mL vial agents Max: 99

Min: 13 Atropine 0.1mg/mL; Cholinergic Min: 22 Talyst; ED; Trauma Various Talyst (IP) Max: 23 10 mL syringe agents Max: 29

Botulism antitoxin Call CDC in Atlanta, Call CDC in Atlanta, N/A N/A N/A (ABE) GA d GA d

Developed by: UNC Drug Information Center Page 1 of 5 Reviewed by: Pharmacy Operations Council, Sept. 2017 Updated: May 2018

Chapel Hill Campus Hillsborough Campus Brand Generic Name Uses Name Location(s) Par Levels a Location(s) Par Levels

Min: 8 Calcium chloride 1g Various, Calcium channel Min: 59 Talyst, ED, Trauma Talyst (IP), ED Max: 18 syringes syringe blocker Max: 89

Min: 4 1 Charcoal, activated General Min: 1 Talyst, ED Various Talyst (IP), ED Max: 8 2 aqueous , 50 g (adsorbent) Max: 2

Charcoal, activated General Min: 3 Min: 3 Various Talyst (IP) Talyst in sorbitol, 50 g (adsorbent) Max: 4 Max: 4 Neuroleptic Talyst (IP), IV 20 mg vial: Min: 36 20 mg vial: Min: 36 Dantrolene malignant Pharmacy, Main OR Max: 49 Max: 48 20 mg vial Dantrium syndrome; Talyst Pharmacy, ACC 250 mg vial: Min: 1 250 mg vial: Min: 1 250 mg vial Ryanodex malignant (hyperthermia kit) Max: 1 Max: 2 hyperthermia Deferoxamine Min: 4 Min: 4 Desferal Talyst (IP) Talyst 500 mg/1 mL Max: 8 Max: 8 Min: 10 Min: 13 Talyst (Refrig) Digibind Digoxin Talyst (Refrig) Max: 12 40 mg/1 mL Max: 18

Arsenic, gold, Min: 10 (BAL) Talyst (IP) Talyst Min: 5 BAL mercury, copper, Max: 14 100 mg/mL (3 mL) Page AOC e Max: 15 Edetate calcium Min: 10 Not in Stock; order if disodium (EDTA) Various Lead Talyst (IP) N/A Max: 10 needed. 200 mg/mL (5 mL) Min: 5 Min: 28 Talyst, ED Romazicon Benzodiazepines Talyst (IP) Max: 10 0.1 mg/mL (5 mL) Max: 42

Fomepizole Min: 5 or Min: 6 Talyst 1000 mg/mL Antizol Talyst (IP) Max: 6 ethylene glycol Max: 9 (1.5 mL) Beta blockers, Min: 5 2+ Min: 20 Talyst, ED Various possibly Ca Talyst (IP), ED Max: 10 Max: 34 channel blockers Glucarpidase Methotrexate Min: 5 Voraxaze Talyst (CHIP), Refrig N/A N/A 1000 unit vial toxicity Max: 6

Developed by: UNC Drug Information Center Page 2 of 5 Reviewed by: Pharmacy Operations Council, Sept. 2017 Updated: May 2018

Chapel Hill Campus Hillsborough Campus Brand Generic Name Uses Name Location(s) Par Levels a Location(s) Par Levels

Hydroxocobalamin 2 kits in Talyst 1000 mcg/mL Cyanokit Talyst (IP) Not in stock N/A 2 kits in ED (30 mL) Folic acid antagonists Leucovorin Min: 100 Min: 12 Various (methotrexate, Talyst (CHIP), SPA Pass-through 500 mg vials Max: 130 Max: 15 trimethoprim, pyrimethamine) Methemoglobine mia- producing drugs or poisons (, Min: 20 Min: 5 Various Talyst (IP), OR Talyst 5 mg/mL (10 mL) benzocaine, Max: 30 Max: 10 dapsone, phenazopyridine, aniline dyes) Min: 60 Min: 40 0.4 mg/mL Talyst, ED Narcan Opioids Talyst (IP), Pyxis Max: 90 Max: 80 (1 mL)

Anticholinergic; Min: 18 Neostigmine 1:2000 nondepolarizing Min: 18 Prostigmin Talyst (IP), OR Max: 24 Talyst (10 mL) neuromuscular Max: 24

blockers Octreotide 1 mg/mL Oral Min: 4 Min: 4 Sandostatin Talyst (Refrig) Talyst (Refrig) (5 mL) sulfonylureas Max: 6 Max: 6 Min: 5 1 Min: 5 Talyst Antilirium Anticholinergics Talyst (IP) Max: 13 mg/mL (2 mL) Max: 13

1 mg/0.5mL: Min: 62 Phytonadione Oral Min: 8 Max: 93 Talyst, ED injection Various Talyst (IP), ED Max: 12 10 mg/mL: Min: 28 (Vitamin K) (Warfarin) Max: 42 Polyethylene glycol GI Min: 6 Min: 3 electrolyte solution Golytely Talyst (IP), ED Talyst (STR) decontamination Max: 9 Max: 4 255 gram jar

Developed by: UNC Drug Information Center Page 3 of 5 Reviewed by: Pharmacy Operations Council, Sept. 2017 Updated: May 2018

Chapel Hill Campus Hillsborough Campus Brand Generic Name Uses Name Location(s) Par Levels a Location(s) Par Levels

Min: 1 Min: 6 CIP oral liquids Talyst SSKI Radiation f Max: 2 Max: 9 30 mL Page AOC

Organophosphat es; Talyst (IP) Min: 18 Min: 3 (2-PAM) Protopam e Talyst anticholinesteras Page AOC Max: 24 Max: 9 50 mg/20 mL es 5mL solution: Min: 18 10 Talyst, ED Min: 5 Various Talyst (IP), OR Max: 27 mg/mL; 25 mL Max: 10

Anticholinergic; Regonol: Pyridostigmine nondepolarizing Min: 5 Talyst Min: 5 injection 5 mg/mL; 2 Mestinon Talyst (IP) neuromuscular Max: 10 Max: 13 mL blockers Pyridoxine injection Min: 5 Min: 11 Talyst (vitamin B6) Various Isoniazid Talyst (IP) Max: 10 Max: 17 100 mg/mL (1 mL) 4.2%: Min: 11 bicarbonate 4.2%: Min: 5 Tricyclic Max: 17 injection Max: 10 Various antidepressant; Talyst (IP), ED 8.4%: Min: 40 Talyst, ED, Trauma 4.2% 10 mL syr 8.4%: Min: 5 salicylates Max: 60 8.4% 50 mL syr Max: 10

Sodium and Min: 2 Min: 2 kits Talyst sodium Nithiodote Cyanide Talyst (IP) Max: 4 Max: 3 kits kit IP: Min: 8 25%; 50 mL *See Cyanide; sodium Min: 1 Max: 14 Talyst also sodium nitrite Various nitroprusside Talyst (IP), CHIP Max: 4 CHIP: Min: 1 and sodium toxicity Max: 2 thiosulfate kit Not stocked (not Succimer 100 mg Lead, arsenic, Chemet emergent); place order N/A N/A N/A capsule mercury from ABC if needed

Developed by: UNC Drug Information Center Page 4 of 5 Reviewed by: Pharmacy Operations Council, Sept. 2017 Updated: May 2018

Chapel Hill Campus Hillsborough Campus Brand Generic Name Uses Name Location(s) Par Levels a Location(s) Par Levels

Tetanus immune Tetanus HyperTET Min: 4 Min: 4 globulin prophylaxis/treat Talyst (Refrig) Talyst (Refrig) S/D Max: 8 Max: 8 250 unit syringe ment a Par levels for primary location only unless otherwise stated. b Manufacturer only allows 2 vials on site + notification when a bite occurs to replenish stock c Coral snake antivenin has been discontinued by Wyeth. Emergency supplies are available by contacting the regional Poison Control Center (1-800-222-1222) d The botulism equine trivalent antitoxin (ABE) is available only from the Centers for Disease Control (CDC) in Atlanta, GA. To obtain, call 404-639-3356 (8:00 a.m. to 4:30 p.m. Monday through Friday) or is available only through the Infant Botulism Treatment and Prevention Program (IBTPP) at the California Department of Public Health. To obtain, call 510-231-7600 in addition to the AOC as special purchasing documents are required. e Supplied in the Chemical Response Supply Cabinet-page AOC f Supplied in the biological response supply cabinet- page AOC

References: 1. Dart RC, Borron SW, Caravati EM, et al. Expert consensus guidelines for stocking of antidotes that provide emergency care. Ann Emerg Med. 2009;54:386-394. 2. LexiComp Online. Hudson, OH: Wolters Kluwer Health. 1978- [cited 2015 May 5]. Available from: http://www.crlonline.com

Developed by: UNC Drug Information Center Page 5 of 5 Reviewed by: Pharmacy Operations Council, Sept. 2017 Updated: May 2018