McKenna's Drug Handbook for Nursing & Midwifery, 7e

1294      Miscellaneous drug categories

Indications & dosages ➤ Treatment of systemic envenoming from stonefish— Adults: Dose depends on number of visible puncture sites:

• Injection of local anaesthetic around the sting or a regional block may help reduce the pain. • As product is sourced from horse plasma, potential for transmission of infectious disease cannot be ruled out. • Anaphylactic reactions may be more likely in individuals who are atopic, have previously received equine serum or are receiving antivenom by IV route. • Although considered controversial, indi­ viduals at risk of anaphylactic reactions may be givenpremedicationwith adrenaline and antihistamine. • Have adrenaline 1:1000 available in case of anaphylactic reaction. • Severe cases should be managed in intensive care unit. • Monitor for delayed serum sickness within 8–13 days after the administration of antivenom, manifestedby albuminaemia, arthralgia, fever, lymphadenopathy and skin eruptions. • Monitor the person closely for at least 6 hours after administering antivenom. Patient teaching • Advise person of risk of possible infectious disease transmission as venom is sourced from horse serum. • Instruct person to report any adverse effects—such as shortness of breath, itching, skin swelling, fever or chest pain— immediately. taipan antivenom Taipan Antivenom Pregnancy risk category NR Use in sport: Permitted Available form Solution for injection: 12,000 U/vial Indications & dosages ➤ Treatment of systemic envenoming from taipanbite—

1–2 sites—2000 U (1 vial) 3–4 sites—4000 U (2 vials) 5 or more sites—6000 U (3 vials)

Usually administered IM; however, may be administered by IV infusion in extremely severe cases. Action Antivenom effective against venom of stonefish ( Synanceia verrucosa and/or Synanceia horrida ) found in Australian

tropical waters. Route Onset

Peak

Duration

IV

Unknown Unknown Unknown

IM Unknown

Unknown Unknown

Adverse reactions Skin: injection site reaction, urticaria, rash. Other: allergic reactions, anaphylaxis , delayed serum sickness . Interactions None reported. Contraindications Should not be used unless there is evidence of systemic envenoming with potential for serious toxic effects. care considerations • Stonefish venom contains an enzyme causing extensive local oedema, as well as systemic effects including pulmonary oedema, bradycardia, arrhythmias, fever, hypotension, muscle weakness and paralysis. • As the toxin is heat-labile, immersion of the limb in hot water (50 ° C) should be undertaken first as this usually gives some pain relief. The temperature of the water should be judged by the attendant to avoid scalding.

Reactions may be common , uncommon, life-threatening , or commonandlife-threatening.