Reference — Emergency Nursing
Common Antidotes Reference
The poison-to-antidote pairings the exam (and the bedside) demand on recall. Memorize the pairs, but never forget that supportive care and the ABCs come first — most poisonings are managed with support, and poison control guides the rest.
Educational use only. Antidote indications, dosing, and timing are individualized and provider/poison-control directed. Supportive care and decontamination decisions accompany — and often precede — any antidote. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Poison → Antidote
| Poison / drug | Antidote | Note |
|---|---|---|
| Acetaminophen (Tylenol) | N-acetylcysteine (NAC) | Most effective within ~8 h; check the level against the Rumack-Matthew nomogram |
| Opioids | Naloxone | Reverses respiratory depression; short-acting — may need repeat doses/infusion; can precipitate withdrawal |
| Benzodiazepines | Flumazenil | Used cautiously — can precipitate seizures, esp. in chronic users/co-ingestions |
| Warfarin | Vitamin K (± PCC/FFP) | Vitamin K for reversal; PCC/FFP for active major bleeding |
| Heparin | Protamine sulfate | Reverses unfractionated heparin (partially reverses LMWH) |
| Digoxin | Digoxin immune Fab (Digibind) | For life-threatening toxicity/hyperkalemia/dysrhythmia |
| Beta-blockers | Glucagon (± calcium, high-dose insulin) | Glucagon bypasses beta receptors for bradycardia/hypotension |
| Calcium channel blockers | Calcium, glucagon, high-dose insulin | Supports contractility/perfusion in overdose |
| Organophosphates / cholinergics | Atropine + pralidoxime | Atropine dries secretions (SLUDGE); pralidoxime reactivates cholinesterase |
| Iron | Deferoxamine | Chelates iron in significant ingestions |
| Magnesium sulfate | Calcium gluconate | For magnesium toxicity (lost reflexes, respiratory depression) |
| Ethylene glycol / methanol | Fomepizole (or ethanol) | Blocks alcohol dehydrogenase; dialysis for severe cases |
Before (and Around) the Antidote
Support first: airway, breathing, circulation, glucose, and monitoring — most overdoses are treated supportively, and the antidote is one piece.
Decontamination: activated charcoal for select recent ingestions (intact/protected airway; not for caustics, hydrocarbons, or poor absorbers like iron/lithium). Gastric lavage and whole-bowel irrigation are situational.
Call Poison Control early — they direct identification, antidote, and disposition.
NCLEX Pearls
- ✦Acetaminophen → NAC; opioids → naloxone; benzodiazepines → flumazenil (cautious).
- ✦Warfarin → vitamin K; heparin → protamine; digoxin → digoxin immune Fab.
- ✦Beta-blocker overdose → glucagon; organophosphates → atropine + pralidoxime; magnesium toxicity → calcium gluconate.
- ✦ABCs and supportive care come FIRST — most poisonings are managed supportively.
- ✦Activated charcoal needs a protected airway and isn't for caustics, hydrocarbons, iron, or lithium.
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with Emergency Nurses Association (ENA) · AHA ACLS / PALS Guidelines · Advanced Trauma Life Support (ATLS). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →