R E V E R S A L A G E N T S Opioids Nalaxone (Narcan) Opioid effects may outlast the reversal's duration of action Continue monitoring 3-4 hrs Benzodiazepines Flumazenil (Romazicon) May lower seizure threshold May cause confusion, agitation, hypertension, and alterations in heart rate Beta Blockers Glucagon Monitor for hyperglycemia May cause hypokalemia Heparin Protamine Sulfate May cause hypotension Risk for anaphylaxis Has weak anticoagulant effect Risk for thrombotic event Warfarin PCC - Vitamin K - FFP Treatment based on severity of bleeding An exhibitImiomne tdoiauter - oPnCC R aandp Vhita Kel Joo's mostF aisct o- FnFiPc works! Within 6 hrs - Vitamin K Risk for thrombotic event Factor Xa Inhibitors Andexanet alfa Risk for thrombotic event May cause cardiogenic shock, heart failure exacerbations, UTI, acute respiratory failure, and pneumonia © Digital Health Media LLC R E F E R E N C E S APSF. (2018, August 5). New Factor Xa Inhibitor (Xarelto®) (Eliquis®) Reversal Agent. Retrieved from Anesthesia Patient Safety Foundation website: https://www.apsf.org/news- updates/new-factor-xa-inhibitor-xarelto-eliquis-reversal-agent/ CHEMM. (n.d.). Naloxone. Retrieved from https://chemm.nlm.nih.gov/countermeasure _naloxone.htm#adminHanley, Deglin, J. H., & Vallerand, A. H. (2007). Davis’s drug guide for nurses (11th ed.). Philadelphia, PA: F. A. Davis Company J. P. (2004). Warfarin reversal. Journal of Clinical Pathology, 57(11), 1132–1139 https://doi.org /10.1136/jcp.2003.008904 Kang, M., & Ghassemzadeh, S. (2019). Benzodiazepine Toxicity. In StatPearls. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK482238/ Ni Ainle, F., Preston, R. J. S., Jenkins, P. V., Nel, H. J., Johnson, J. A., Smith, O. P., …O’Donnell, J. S. (2009). Protamine sulfate down-regulates thrombin generation by inhibiting factor V activation. Blood, 114(8), 1658–1665. https://doi.org/10.1182/blood-2009-05-222109 Peterson, C. D., Leeder, J. S., & Sterner, S. (1984). Glucagon therapy for beta-blocker overdose. Drug Intelligence & Clinical Pharmacy,18(5), 394–398. https://doi.org/10.1177 /106002808401800507 Rx List. (n.d.). Protamine (Protamines): Side Effects, Interactions, Warning, Dosage & Uses. Retrieved from RxList website: https://www.rxlist.com/protamine-drug.htm UC San Diego Health. (n.d.). LMWH Reversal. Retrieved September 14, 2019, from UC Health —UC San Diego website: https://health.ucsd.edu/specialties/anticoagulation/providers /lmwh/Pages/reversal.aspx.