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Old 08-07-2012
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Drug Which antidote for malathion intoxication?

A 43-year-old man who works as a crop duster is brought to the emergency department suffering from weakness and profuse sweating. He is wheezing and has abdominal cramps and diarrhea. Physical examination shows miosis, bradycardia, and muscle fasciculations. The patient says that he was spraying a local cornfield with malathion and accidentally flew through his back-draft. Treatment aimed at correcting the patientís weakness and labored breathing would include

a) atropine
b) ipecac
c) nicotine
d) physostigmine
e) pralidoxime
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E. Pralidoxime: used with atropine for organophosphate poisoning.
It reverses the AChase inhibitor activity.


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Quote:
Originally Posted by koolkiller88 View Post
E. Pralidoxime: used with atropine for organophosphate poisoning.
It reverses the AChase inhibitor activity.


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so pralidoxime or atropine?
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Atropine causes competitive blockade at M receptors(meaning higher Ach conc will not allow it to work so we have to bring down Ach levels by regenerating AchE, making 2-PAM more important in management of of irreversible AchE inhibitors so i will go for E
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Quote:
Originally Posted by Casandra View Post
so pralidoxime or atropine?
It would be E.
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pralidoxime
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Two antidotes are administered to treat organophosphate poisoning.
Atropine is a competitive antagonist of acetylcholine at muscarinic receptors and is used to control the excessive bronchial secretions which are often responsible for death.
Pralidoxime relieves both the nicotinic and muscarine effects of organophosphate poisoning by regenerating acetylcholinesterase and can reduce both the bronchial secretions and the muscle weakness associated with poisoning. Pralidoxime should be administered as early in poisoning as possible as its efficacy may diminish when given more than 24 to 36 hours after exposure.

Last edited by curiousmind; 08-07-2012 at 08:42 PM.
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weakness and labored breathing are due to nicotinic effects of Ach(desensitization) and atropine is M-receptor antagonist. the only way to reverse the weakness is to use pralidoxime.....so E
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Pralidoxime
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Default correct answer :)

The answer is e) pralidoxime

The cholinergic syndrome caused by malathion is sometimes referred to as the SLUDGE-BAM syndrome and is characterized by the following:
S = salivation, sweating, and secretions
L = lacrimation
U = urination
D = defecation
G = gastrointestinal upset
E = emesis
plus
B = bronchoconstriction and bradycardia
A = abdominal cramps
M = miosis and muscle fasciculations
Muscle weakness, fasciculations, and labored breathing represent the nicotinic effects of malathion intoxication, while the other manifestations represent the muscarinic effects. Malathion is an irreversible organophosphate cholinesterase inhibitor. Its covalent binding with cholinesterase is stabilized through an "aging" process. If pralidoxime (2-PAM) is administered before the acetylcholinesterase has been irreversibly bound ("aged"), the drug will reverse the patientís skeletal muscle weakness and fasciculations.


As for atropine - In this case, atropine would be used to reverse the muscarinic effects of malathion intoxication. Atropine would not reverse the nicotinic effects.
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Quote:
Originally Posted by Casandra View Post
The answer is e) pralidoxime

The cholinergic syndrome caused by malathion is sometimes referred to as the SLUDGE-BAM syndrome and is characterized by the following:
S = salivation, sweating, and secretions
L = lacrimation
U = urination
D = defecation
G = gastrointestinal upset
E = emesis
plus
B = bronchoconstriction and bradycardia
A = abdominal cramps
M = miosis and muscle fasciculations
Muscle weakness, fasciculations, and labored breathing represent the nicotinic effects of malathion intoxication, while the other manifestations represent the muscarinic effects. Malathion is an irreversible organophosphate cholinesterase inhibitor. Its covalent binding with cholinesterase is stabilized through an "aging" process. If pralidoxime (2-PAM) is administered before the acetylcholinesterase has been irreversibly bound ("aged"), the drug will reverse the patientís skeletal muscle weakness and fasciculations.


As for atropine - In this case, atropine would be used to reverse the muscarinic effects of malathion intoxication. Atropine would not reverse the nicotinic effects.

so beautiful ... thanks alot casandra
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