Welcome back to the channel where medical topics are made easy.
Today I’m going to show you simple memory tricks that will help you remember common
antidotes that show up on medical and board exams, and that you might encounter in practice.
Remember an antidote is a remedy or medication given to counteract the effects of poison,
toxicity, or overdose.
Antidotes frequently pop up on exams but they can be easy to forget, so I wanted to come
up with a simple way to help you remember them.
Just a quick reminder that you can find all of the lecture notes and study guides for
the videos linked down below.
As we go through the different antidotes, hit pause in the video and try to see how
many you can guess correctly.
Let’s start with acetaminophen.
One common source of acetaminophen is under the brand name Tylenol.
If someone overdoses on acetaminophen, can you guess the antidote that would be given
to treat the toxicity?
It’s N-Acetylcysteine
The trick to remember N-Acetylcysteine for acetaminophen is an easy one, simply use the
first 3 letters of the word.
Acetaminophen and Acetylcysteine both start with the letters A-C-E.
Here’s another cool trick.
We also said acetaminophen is Tylenol.
Look at the next 3 letters of Acetylcysteine after the A-C-E, and we have T-Y-L which will
help you remember T-Y-L for Tylenol.
A quick reminder as we go through these different antidotes to always get a poison control center
involved, or whatever your protocol recommends, to assist with care.
The next drug antidote is for opioids, which you might also hear referred to as narcotics.
Do you know the antidote for opioids?
It’s naloxone, also known by the brand name narcan.
The trick to remember naloxone for opioids is another easy one.
Simply use the N-A in narcotics, naloxone, and narcan, or the N-A-R for narcotics and
narcan.
You can also use the long “O” in Naloxone to remember “Opioids”
The next drug class is beta blockers, which are a class of medications commonly used for
hypertension or high blood pressure, arrhythmias, heart failure, among other indications.
Do you know how to manage beta blocker toxicity?
One of the treatments is glucagon.
The way I like to remember this is “BB gun”.
The BB stands for beta blockers,
and the gun will help you remember glucagon.
Glucagon is what’s commonly tested, but it’s important to note the treatment of
beta blocker toxicity may involve other medications and regimens as well.
This may include fluids, atropine, high-dose insulin with glucose, and ECMO to name a few.
Next we have ethylene glycol or methanol.
Hit pause in the video and try to name the antidote used to treat these toxicities?
It’s fomepizole.
The memory trick for this is another easy one because ethylene glycol, methanol, and
fomepizole all rhyme.
And you can use the O-L in each word to remember the associations.
Here’s another piece of advice.
Board exams like to use antifreeze or car wash fluids as the source of ethylene glycol.
So when you see antifreeze, car wash fluids, de-icing products, or vehicle brake fluids
in a question stem, think potentially ethylene glycol involvement.
Here’s one more trick for you.
When an exam is asking a question about methanol toxicity, there is usually ocular symptoms
described such as blurry vision, decreased visual acuity, photophobia, or “halo vision”.
Next we have benzodiazepines, which are a class of medications used for anxiety, seizures,
alcohol withdrawal, among other indications.
The antidote here is flumazenil.
This again is another easy trick if you just use the letters in the name.
Both benzodiazepine and flumazenil contain the letters A-Z-E.
It can be easy to mix up fomepizole and flumazenil when first learning them since they both start
with “F” and have a few similar letters in them, so hopefully these tricks will help
you remember them.
The next medication is digoxin, which can be used for heart failure, arrhythmias, among
other indications.
Do you know the antidote for this?
It’s Digoxin immune Fab, which you may know by the brand names of DigiFab or Digibind.
Again this is another easy one to remember because they all start with “DIG” or “D-I-G”.
Digoxin toxicity can also cause ocular symptoms that are commonly tested on medical and board
exams.
They are often described as yellow-green halos or discoloration.
The next toxicity on our table is iron.
Do you know the treatment for iron toxicity?
It’s deferoxamine.
The easy way to remember this is to think of the abbreviation for iron on the period
table which is “Fe”.
Deferoxamine contains the letters F-E in it.
The last toxicity in this group is copper.
The treatment for copper toxicity is penicillamine.
An easy trick to remember this is to think of a copper “penny” which will help you
remember penicillamine.
Let’s move on to the next group of antidotes.
First we have heparin, which is a blood thinner.
Hit pause in the video and try to guess the antidote for heparin.
It’s protamine sulfate.
The trick to remember this is to think of protamine and proton.
The symbol for a proton is “H” which will help you remember heparin.
The next drug is Warfarin which is also a blood thinner.
Vitamin K can be used to reverse the effects of Warfarin.
There are a couple tricks to remember Vitamin K.
First, Warfarin and Vitamin both end in “I-N”.
And you can also think of the phrase “War Kills” to help you remember War for Warfarin
and the K for Vitamin K.
Next we have methemoglobin, which is a form of hemoglobin that has been oxidized and makes
it more difficult to release oxygen to tissues.
Do you know the antidote for methemoglobinemia?
Methylene blue is an effective way to treat acquired methemoglobinemia.
The trick to remember methylene blue is an easy one because methemoglobin and methylene
blue both start with “M-E-T-H”
Next we have potassium.
Hit pause in the video and try to name the treatment for hyperkalemia, or high potassium
levels in the blood.
Some treatment options include bicarbonate, insulin along with glucose, and kayexalate.
There are other options as well including albuterol.
And if there are characteristic EKG changes or arrhythmias present, then consideration
should be given for calcium gluconate or chloride, which helps stabilize the cardiac cell membrane.
The trick I came up with to remember this is “BIG K”.
The symbol for potassium on the periodic table is a capital K or a big K.
This will help you remember “B” for bicarb, “I” for insulin, “G” for glucose,
and “K” for kayexalate.
Again just know there are other treatment options as well.
Next we have carbon monoxide.
Do you now the treatment for carbon monoxide poisoning or toxicity?
The initial treatment is to breathe in pure oxygen.
And at the hospital, this is done by giving 100% oxygen through a non-rebreather mask.
The easy way to remember this is to use the “oxide” in carbon monoxide to think of
oxygen.
A quick bonus tip for board and medical exams,
is if a question stem has to do with exposure to automotive exhaust, wood or coal-burning
heaters, space heaters, or propane-fueled heaters, then think of carbon monoxide exposure.
Especially if multiple people in the same household or pets are affected.
The next medication class is anticholinergics, which are drugs that block the effects of
acetylcholine.
Anticholinergics can be used to treat respiratory disorders such as asthma or COPD, Parkinson’s,
mydriasis, allergies, urge incontinence, to name a few.
Keep in mind that some over-the-counter medications or even prescribed medications can have anticholinergic
activity.
An example is antihistamines such as diphenhydramine which is over-the-counter.
Hit pause in the video and try to name the antidote for anticholinergic toxicity?
It’s physostigmine.
The way I like to remember this is to think of the prefix “anti” which means “against”,
and I associate that with the word stigma to remember physostigmine.
Another tip for medical and board exams,
is board exams like to test on Jimsonweed, which is an anticholinergic agent and can cause
anticholinergic toxicity.
There is a previous video on anticholinergic toxicity if you want more information on the
side effects and management.
And I’ll link that down below.
Next we have the opposite of anticholinergics, and now we have cholinergics.
Cholinergic agents mimic or enhance the effects of acetylcholine which will stimulate the
parasympathetic nervous system.
Do you know the antidote for cholinergic toxicity or overdose?
It’s atropine, which inhibits acetylcholine receptors.
The memory trick is an easy one.
When you think of cholinergic agents, think of acetylcholine because they’re going to
increase the levels or effects of acetylcholine.
Both acetylcholine and atropine start with “A” and end in “I-N-E”.
Another medical and board exam tip is question stems like to use organophosphate insecticides
when asking about cholinergic toxicity.
The final agent in this group is cyanide.
Sources of cyanide on exam questions could be burning of nitrogen-containing products
such as plastics, chemical weapon exposure, prolonged use of nitroprusside, and pits of
peaches, pears, or apricots.
Do you know how to treat cyanide toxicity?
There are couple different methods.
First line therapy for most protocols is hydroxocobalamin which is usually available in a Cyanokit.
The second line therapy if a Cyanokit is unavailable is a Cyanide Antidote Package or a Lilly Kit
which contains nitrites and thiosulfate.
The easy way to remember hydroxocobalamin is the letters that make up the word cyanide
appear in hydroxocobalamin.
You can also remember nitrites using the “N-I” for nitrites and the “N-I” in cyanide.
We have one final group of antidotes we’ll go through.
First we have lead.
There are several treatment options for lead toxicity, one of which is EDTA.
EDTA is chelating agent that binds tightly to metal ions, which is why chelating agents
are used to remove toxic metals from the body.
This is easy to remember because most of the word lead appears in the letters EDTA.
Other treatment options may include succimer or dimercaprol, also known as BAL.
On medical and board exams, sources of lead may include lead paint in older homes, moonshine
which is made in stills that contain lead, car batteries, or water from old pipes to
name a few.
Next we have salicylate toxicity.
Sources of salicylate include aspirin, Oil of Wintergreen, Pepto-Bismol, and Alka-Seltzer
to name a few.
Hit pause in the video and try to list the treatment for salicylate toxicity.
Management includes sodium bicarbonate, activated charcoal, and dialysis.
The easy way to remember this is to use the mnemonic “BAD”.
Think of salicylate toxicity as being “BAD”.
This will help you remember “B” for bicarbonate.
The sodium bicarbonate helps alkalinize the plasma and urine, and remember salicylate
toxicity can cause metabolic acidosis.
The “A” will help you remember activated charcoal.
Decontamination can be attempted, especially early in presentation, which can be performed
using activated charcoal, gastric lavage, or whole-bowel irrigation.
Be aware there are mixed reviews on morbidity, mortality, and overall benefits to some of
the decontamination approaches.
Finally, we have the “D” to remember dialysis, which may be indicated in altered mental status,
severe acidosis, end-organ damage, high salicylate levels, mechanical ventilation, among others.
Next we have mercury.
Mercury toxicity can be treated with dimercaprol, also known as BAL.
Dimercaprol is a chelating agent.
We know from our discussion on lead that chelating agents can bind to metal ions and are used
to clear toxic heavy metals from the body.
Dimercaprol for mercury is easy to remember because it contains “Merc-“ in the word.
Other chelating options may be succimer and penicillamine.
A source of mercury poisoning includes seafood or fish consumption such as King Mackerel,
swordfish, and tuna.
Moving on to TCAs, which are a class of antidepressants called tricyclic antidepressants.
The treatment for TCA overdose is sodium bicarbonate.
This can be remembered because the letters TCA appear in the word bicarbonate.
Just a reminder that TCA overdose can cause EKG changes such as a widened QRS complexes
due to the sodium channel blockade.
This is one of the reasons why sodium bicarbonate is indicated.
Next we have extrapyramidal symptoms which are not a drug or agent, but they are the
symptoms that can result from taking antipsychotic medications.
These symptoms may include involuntary muscle contractions, tremors, stiff muscles, and
involuntary facial movements.
The treatment is diphenhydramine.
The trick for this is another easy one.
When you think of extrapyramidal symptoms, think of pyramid.
And it just so happens that the letters in the word pyramid appear in the word diphenhydramine.
Of note, anticholinergics such as diphenhydramine may cause worsening tardive dyskinesia and
may work better for extrapyramidal symptoms such as dystonia, akathisia, and Parkinson-like
symptoms.
Next we have magnesium sulfate.
The antidote for magnesium toxicity is calcium gluconate.
This is easy to remember because magnesium and calcium end in the same letters and rhyme,
and sulfate and gluconate end in the same letters and rhyme.
Moving on to insulin.
This is an easy one.
We know insulin is used in diabetes and to treat high glucose levels.
So if someone takes too much insulin, the treatment is to give more glucose.
Again there is no trick necessary as the treatment is self-explanatory.
Finally we have dopamine.
One antidote option is phentolamine, which blocks alpha receptors.
Phentolamine will counteract the effect of vasoactive agents such as dopamine, epinephrine,
norepinephrine, and phenylephrine.
These medications cause vasoconstriction by stimulating alpha receptors, and phentolamine
blocks those effects.
Phentolamine can be remembered because dopamine and phentolamine end in “-amine”
Hopefully these memory tricks gave you a simple way to remember common antidotes.
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You can find the lecture notes and study guides for the video on our website linked down below.
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