Amyl Nitrate Information Wanted

[lex]

So, I spent most of the weekend studying and going through my drug cards from PCP school and noticed that I never made a card for Amyl Nitrate. I know that I am not likely to use this drug, especially with my current service since we don't stock it, but I would still like to have complete records, and have knowledge of the drug since there are services that I could end up working for that do carry the drug.

I've tried searching online but am not having much luck finding quality information. I am hoping that some of the wise folks here might be able to provide me with information, or at least point me in the direction of some reputable information sources.

The only indication in my protolols is for symptomatic cyanide poisoning, but I am open to information on other uses for this drug as well.

Thanks all!

 

[usafmedic45]

The only indication in my protolols is for symptomatic cyanide poisoning, but I am open to information on other uses for this drug as well.

In the field, that's about the only indication for it.

 

[TransportJockey]

Huh I've never actually seen that drug covered prehospitally. In NM we learned hydroxocobalamin (b12) for cyanide poisonings...

 

[samiam]

Cyanide Antidote (Adult)
Start: 1 amyl nitrite ampule inhaled x15-30sec q1min until sodium nitrite available; Dose: sodium nitrite 300 mg IV over 2-4min, then sodium thiosulfate 12.5 g IV over 10min; may repeat 1/2 of original IV doses x1 prn or in 2h as prophylaxis; Info: slow nitrite infusion if BP decr.; convenience pkg contains 12 ampules amyl nitrite, 2 vials sodium nitrite, 2 vials sodium thiosulfate

Pharmacology

Metabolism: liver (amyl nitrite, sodium nitrite), plasma (thiosulfate); CYP450: unknown

Excretion: urine (sodium nitrite 40% unchanged); Half-life: unknown (amyl nitrite, sodium nitrite), 15-20min (thiosulfate), 3-7 days (thiocyanate)

Subclass: Toxicity 6: Other

Mechanism of Action
nitrites promote formation of methemoglobin to detoxify cyanide to cyanmethemoglobin; sodium thiosulfate facilitates rhodanase-catalyzed conversion of cyanide to less-toxic thiocyanate

Cite: www.epocrates.com

 

[mikie]

Adverse Effects

Can't you get a "high" from amyl nitrate? Poppers was their old street name?

 

[usafmedic45]

In NM we learned hydroxocobalamin (b12) for cyanide poisonings...

Yeah, that's the newer treatment for it. Before that became accepted over here in the US, we would have to resort to using amyl nitrate and the other meds in the 'cyanide kit'.

Can't you get a "high" from amyl nitrate? Poppers was their old street name?

You can get a 'high' from just about anything to be quite honest. Amyl nitrate ampules were the one of the "pre-Viagra Viagras" in a lot of major cities' gay communities. One of the side effects though was the tendency of folks using them to hit the floor due to a hypotensive episode.

 

[18G]

Amyl nitrite is exclusively used as part of the old cyanide antidote kit for immediate treatment of cyanide poisoning. It's in the form of an ammonia inhalant... just crush and place on the inside of NRB or BVM mask. It is said that it's effects are negligible in creating methemoglobin. Your supposed to replace with a new amyl nitrite every 10-15mins or so.

Main side effects are hypotension since it is a nitrite and reduction of oxygen carrying capacity since it creates methemoglobin which does not carry oxygen. The idea is to create methemoglobin which binds cyanide pulling it out of the cell allowing cellular resp to occur and transforming the cyanide into a compound that can be cleared from the body. The real negative here is you usually also have concomitant CO toxicity which also reduces oxygen utilization so you can end up being counter productive in the attempt to improve the patient.

It's going to the wayside since hydroxocobalamin has been approved in the US in 2006. Hydroxocobalamin has a current drawback of cost. Currently it is under patent and costs around $700 for a single dose.

We don't carrying it either and have 99.999% faith in saying I will never use it. But still nice to be aware of its MOA.

 

[mycrofft]

Just went to a conference about industrial first aid kits.

One suggestion that was floated was for employers who have cyanide risks on premises to stock and maintain the antidotes for EMS personnel to use if there is an exposure and they do not stock it, or there are multiple patients.
How does that sound to you? Personally, it sounded a little sketchy unless it were in a vault or something.

 

[bigbaldguy]

The only "other" uses for amyl nitrate outside of cyanide poisoning is not something that should probably be disussed here. The side effects of amyl nitrate when used recreationally can be deadly under some circumstances.

 

[Smash]

Nitrate or Nitrite? Just checking...

 

[bigbaldguy]

Nitrate or Nitrite? Just checking...

I think your right it is nitrite my bad.

 

[Lifeguards For Life]

Can't you get a "high" from amyl nitrate? Poppers was their old street name?

I believe these were amyl nitrite, which is not the same as amyl nitrate.

The only reason I know this is a PM prof would constantly say one instead of the other, and when questioned about it, he insisted amyl nitrate is the same thing as amyl nitrite

 

[Lifeguards For Life]

I believe these were amyl nitrite, which is not the same as amyl nitrate.

The only reason I know this is a PM prof would constantly say one instead of the other, and when questioned about it, he insisted amyl nitrate is the same thing as amyl nitrite

never mind. didn't see this had already been discussed.