Combined evidence-based literature analysis and consensus guidelines for stocking of emergency antidotes in the United States

Dart, Richard C.; Goldfrank, Lewis R.; Chyka, Peter A.; Lotzer, D; Woolf, Alan D.; McNally, Jude; Snodgrass, Wayne R.; Olson, Kent R.; Scharman, Elizabeth J.; Geller, Robert J.; Spyker, Daniel A.; Kraft, Monica; Lipsy, Robert J.

doi:10.1067/mem.2000.108182

Cited by 72 publications

(64 citation statements)

References 8 publications

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“…Antidote supply for each hospital was classified as sufficient or insufficient based on the consensus guidelines. 2 …”

Section: Datamentioning

confidence: 99%

“…10,11 Prior to 2000, there were no concise, evidencebased guidelines for stocking of emergency antidotes. 2 In the absence of such guidelines, physicians and pharmacists may not know which antidotes need to be stocked. They may conclude, for example, that a rarely used antidote is not worth stocking, or they may be unaware of the need for timely administration of certain antidotes and assume they can obtain these from other facilities in the area at the time they are necessary.…”

Section: Why Is Antidote Stocking Inadequate?mentioning

confidence: 99%

“…2 Pralidoxime and fomepizole are not discussed here because pralidoxime was not included on the 1998 hospital survey and fomepizole was not available in Canada at the time of the survey. Instead, we looked at the availability of ethanol, an acceptable alternative to fomepizole for toxic alcohol ingestions.…”

Section: Datamentioning

confidence: 99%

“…Thus, hospitals that treat poisoned patients must maintain adequate antidote stocks to ensure timely administration. 2 British Columbia encompasses a vast geographical area with rugged mountainous terrain and harsh climate. These geographic factors add to the difficulty of moving patients or antidotes from one hospital to another.…”

Section: Introductionmentioning

confidence: 99%

“…These guidelines recommend that 16 essential antidotes should be stocked in all health care facilities that treat acutely poisoned patients. 2 Antidotes were considered essential if they are both effective and necessary within 1 hour of patient presentation. The quantity of antidote recommended was based on the dose necessary to treat 1 or 2 70-kg patients for the first 4 hours (after which a hospital could transfer the patient to another centre or replenish its antidote supply).…”

Section: Introductionmentioning

confidence: 99%

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Antidote stocking in British Columbia hospitals

Gorman

Zed

Purssell

et al. 2003

CJEM

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Introduction:Previous studies have demonstrated that antidotes are insufficiently stocked in Canadian and US health care facilities. The purpose of this study was to determine the adequacy of antidote stocking in British Columbia hospitals based on the current guidelines. Methods: A written survey was mailed to hospital pharmacy directors at all 93 acute care facilities in BC. Availability of 14 essential antidotes was classified as sufficient or insufficient based on the current guidelines. Facilities were stratified into small (<50 beds), medium (50-250 beds) or large (>250 beds); teaching or non-teaching; trauma or non-trauma, urban or rural, and isolated or non-isolated. Results: Complete responses were received from 75 (81%) of 93 hospitals. No hospital had adequate stock of all 14 antidotes. Overall, the average number (± standard deviation) of antidotes adequately stocked was 4.2 ± 2.9 per hospital. Urban hospitals had adequate stocks of 6.5 ± 2.6 antidotes while rural centres had adequate stocks of 2.6 ± 1.8 (p < 0.001). Corresponding figures were 9.0 ± 1.8 for teaching hospitals vs. 3.7 ± 2.4 for non-teaching hospitals (p < 0.001), 8.9 ± 2.0 for trauma centres vs. 3.8 ± 2.5 non-trauma centres (p < 0.001), and 2.5 ± 2.1 for isolated hospitals vs. 4.6 ± 2.9 for non-isolated hospitals (p = 0.018). Small, medium, and large hospitals adequately stocked 2.3 ± 1.7, 5.7 ± 2.2, and 7.7 ± 3.0 antidotes, respectively (p < 0.001). The 4 antidotes most adequately stocked were sodium bicarbonate (77%), N-acetylcysteine (64%), ethanol (49%) and naloxone (47%). Digoxin immune F ab fragments, glucagon, pyridoxine and rattlesnake antivenin were poorly stocked with sufficient supplies of 5%, 7%, 7% and 13%, respectively. Conclusion: BC hospitals do not have adequate antidote stocks. Provincial stocking guidelines and coordination of antidote purchasing and stocking are necessary to correct these deficiencies. RÉSUMÉIntroduction : Des études antérieures ont démontré une réserve insuffisante d'antidotes dans les services de santé canadiens et américains. La présente étude avait comme objectif de déterminer si, en se basant sur les directives existantes, les réserves d'antidotes dans les hôpitaux de la Colombie-Britannique sont suffisantes.

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“…Antidote supply for each hospital was classified as sufficient or insufficient based on the consensus guidelines. 2 …”

Section: Datamentioning

confidence: 99%

Section: Why Is Antidote Stocking Inadequate?mentioning

confidence: 99%

Section: Datamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antidote stocking in British Columbia hospitals

Gorman

Zed

Purssell

et al. 2003

CJEM

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Preparing for Chemical Terrorism: A Study of the Stability of Expired Pralidoxime (2-PAM)

Hoffman¹,

Mercurio-Zappala²,

Bouchard³

et al. 2011

Disaster med. public health prep.

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ABSTRACTObjectives: Oximes such as pralidoxime (2-PAM) are essential antidotes for life-threatening organophosphate poisoning. Unfortunately, oximes are expensive, have limited use, and have short shelf lives. As such, maintaining large stockpiles in preparation for terrorist activity is not always possible. We have demonstrated that atropine is stable well beyond its labeled shelf life and that recently expired 2-PAM was clinically efficacious in a series of poisoned patients. Because 2-PAM is often dosed empirically, clinical improvement does not guarantee pharmacological stability. We therefore chose to analyze the chemical stability of expired 2-PAM.Methods: Samples of lyophylized 2-PAM were maintained according to the manufacturer's recommendations for 20 years beyond the published shelf life. We studied 2-PAM contained in a MARK I autoinjector that was stored properly for 3 years beyond its expiration date. An Agilent LC/MSD 1100 with diode-array detector and an Agilent Sorbax SB-C-18, 4.6 × 150-mm, 5-μm column were used with the following solvent systems: water with 0.01% trifluoroacetic acid and methanol with 0.01% trifluoroacetic acid. Fresh reagent grade 2-PAM was used as a standard. Results were repeated for consistency.Results: Lyophylized 2-PAM was a white powder that was clear and colorless in solution. Liquid chromatography was identical to the standard and resulted in 2 isolated peaks with identical mass spectra, suggesting that they are stereoisomers. The autoinjector discharged a clear, yellowish solution. In addition to the 2 peaks identified for lyophylized 2-PAM, a small third peak was identified with a mass spectra corresponding to the reported N -methyl pyridinium carboxaldehyde degradation product.Conclusions: When properly stored, lyophylized 2-PAM appears to be chemically stable well beyond its expiration date. Although the relative amount of degradation product found in solubilized (autoinjector) 2-PAM was small, it is unclear whether this may be toxic and therefore is of concern. Further studies performed with lots of drug stored under varied conditions would be required to fully determine the stability of expired 2-PAM.(Disaster Med Public Health Preparedness. 2012;6:20–25)

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Progress in Development of Immunization Registries—United States, 2000

2001

JAMA

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Combined evidence-based literature analysis and consensus guidelines for stocking of emergency antidotes in the United States

Cited by 72 publications

References 8 publications

Antidote stocking in British Columbia hospitals

Antidote stocking in British Columbia hospitals

Preparing for Chemical Terrorism: A Study of the Stability of Expired Pralidoxime (2-PAM)

Progress in Development of Immunization Registries—United States, 2000

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