A patient is admitted to the emergency department with an overdose of a barbiturate. The nurse immediately prepares to administer which of the following from the emergency drug cart?
A. naloxone HCl (Narcan)
B. Activated charcoal
C. flumazenil (Romazicon)
D. Ipecac syrup
Correct Answer: B. Activated charcoal
There is no antidote for barbiturates. The use of activated charcoal absorbs any drug in the GI tract, preventing absorption. Treatment of barbiturate toxicity remains supportive as there is no specific antidote for overdose. Early treatment with activated charcoal may be useful and can be given via nasogastric tube. Patients will likely need to be admitted or observed.
Option A: Naloxone is indicated for the treatment of opioid toxicity, specifically to reverse respiratory depression from opioid use. It is useful in accidental or intentional overdose and acute or chronic toxicity. Common opioid overdoses treated with naloxone include heroin, fentanyl, carfentanil, hydrocodone, oxycodone, methadone, and others.
Option C: Flumazenil is a benzodiazepine antagonist. The primary FDA-approved clinical uses for flumazenil include reversal agent for benzodiazepine overdose and postoperative sedation from benzodiazepine anesthetics. Flumazenil injection is indicated for a complete or partial reversal of the sedative effects of benzodiazepines in conscious sedation and general anesthesia in adult and pediatric populations.
Option D: Ipecac, or syrup of ipecac (SOI), is a medication once used to induce vomiting. Its medical use has virtually vanished, and it is no longer recommended for routine use in toxic ingestion. Ipecac irritates the stomach lining and chemically stimulates the CRTZ (chemoreceptor trigger zone) in the medulla oblongata of the central nervous system to induce near-immediate vomiting.
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