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Atropine is often used in conjunction with the oxime pralidoxime chloride. Some of the nerve agents attack and destroy acetylcholinesterase by phosphorylation, so the action of acetylcholine becomes excessive and prolonged. Pralidoxime (2-PAM) can be effective against organophosphate poisoning because it can re-cleave this phosphorylation.
Organophosphate poisoning is poisoning due to organophosphates (OPs). [4] Organophosphates are used as insecticides , medications, and nerve agents . [ 4 ] Symptoms include increased saliva and tear production, diarrhea , vomiting, small pupils , sweating, muscle tremors, and confusion. [ 2 ]
Pralidoxime (2-pyridine aldoxime methyl chloride) or 2-PAM, usually as the chloride or iodide salts, belongs to a family of compounds called oximes that bind to organophosphate-inactivated acetylcholinesterase. [1] It is used to treat organophosphate poisoning [2] in conjunction with atropine and either diazepam or midazolam. It is a white solid.
In the treatment of organophosphate toxicity, cholinesterase reactivators such as Pralidoxime reactivate inhibited AChE at peripheral nicotinic receptors.Since AChE mediates effects on both nicotinic and muscarinic receptors, cholinesterase reactivators are co-administered with muscarinic antagonists, primarily atropine.
Whenever symptoms of chlorethoxyfos start to reappear, atropine should be injected again. The atropinized state of the patient should always be maintained. Dosage of atropine is different among different age-groups. Children and infants have a maximum dosage of 0.05 mg/kg. When adults are severely intoxicated the dose can go up to 4 mg.
As a result of cholinergic crisis, the muscles stop responding to the high synaptic levels of ACh, leading to flaccid paralysis, respiratory failure, and other signs and symptoms reminiscent of organophosphate poisoning. Other symptoms include increased sweating, salivation, bronchial secretions along with miosis (constricted pupils).
Atropine is the standard anticholinergic drug used to manage the symptoms of nerve agent poisoning. [14] It acts as an antagonist to muscarinic acetylcholine receptors, blocking the effects of excess acetylcholine. [13]
The ATNAA provides atropine and pralidoxime chloride in a single delivery system, although the two drugs are separate within the device. [1] [2] The use of the device is only to be administered in the extreme case of organophosphate poisoning.