Date & Time of Session - 11/10/25 - from 12:00 - 1:00 PM

Needs/Overview
Acetaminophen is widely regarded as safe when taken within recommended guidelines. However, excessive doses can lead to severe liver injury and, in critical cases, death. To mitigate these risks, N-acetylcysteine (NAC) has become the preferred antidote, shown to prevent liver damage when administered appropriately. Traditionally, NAC is delivered as a three-bag intravenous infusion. While effective, this method is associated with a high incidence of nonallergic anaphylactoid reactions (NAARs). As an alternative, the two-bag regimen has emerged as a simplified approach that may reduce adverse effects and improve patient tolerability. 

Toxic alcohol ingestions, methanol and ethylene glycol, are life-threatening emergencies requiring prompt recognition and antidotal therapy. While ethanol was historically used as an antidote due to its competitive inhibition of alcohol dehydrogenase, literature has shown fomepizole to be more predictable, easier to administer, and is associated with fewer adverse effects. Clinical studies have demonstrated improved safety profiles and reduced monitoring requirements with fomepizole, leading to its preferential use.  
Balfaxar is a newer 4-factor prothrombin complex concentrate (4F-PCC) indicated for urgent warfarin and direct oral anticoagulant (DOAC) reversal. With the recent transition from KCentra to Balfaxar, it is important to understand its clotting factor content and determine appropriate dosing strategies—especially in situations where fixed versus weight-based dosing may be considered. 

This presentation will review the treatment algorithm for acetaminophen, methylene and ethylene glycol, and anticoagulant toxicity. The goal is to ensure that pharmacists at St. Elizabeth Healthcare are equipped to make safe, timely, and confident decisions when managing toxicologic and anticoagulant-related emergencies.
 

Objectives
Upon completion of this activity, participants will be able to:
1. Apply knowledge of acetaminophen toxicity pathophysiology, including N-acetyl-p-benzoquinone imine (NAPQI) formation and liver damage, and compare the traditional 3-bag intravenous N-acetylcysteine (NAC) regimen with the 2-bag regimen in terms of efficacy, safety and clinical application. 
2. Demonstrate knowledge of fomepizole’s mechanism of action by interpreting laboratory data and recommending appropriate treatment strategies for methanol and ethylene glycol toxicity. 
3. Interpret clinical and pharmacological differences between 4-factor Prothrombin Complex Concentrate (PCC) products and evaluate weight-based versus fixed dosing strategies to recommend appropriate reversal approaches for direct oral anticoagulants (DOACs).

Target Audience
Free 1 credit hour of Continuing Education for St Elizabeth Health Care providers, Pharmacists, Residents and Students

Special Services
If you require special assistance to attend this event, please call Deanna Fliehman at (859) 301-6191

Speaker
Emily Bui, PharmD
PGY1 Pharmacy Resident
St Elizabeth Healthcare - Edgewood, Kentucky