Management of op poisoning-definitive treatment

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Management of op poisoning-definitive treatment

  1. 1.  Atropine  Cholinesterase reactivators (Oximes)
  2. 2. (a)ATROPINE      Anti cholinergic drug. Objective : To block the muscarinic receptors until the organophosphate is metabolised away from the body. Atropine : Adult dose : 2-5mg i.v. repeated every 5 min doubling the initial dose. Children : 0.05-0.1mg/kg Given till signs of atropinization appear. Continued treatment: maintenance dose (30% of atropinization dose) for 1-2 weeks.
  3. 3. (b)CHOLINESTERASE REACTIVATORS  Oximes are used to restore neuromuscular transmission.  If more reactive OH groups in the form of oximes (Generic formula R-CH=N-OH) are provided reactivation occurs more faster.  Eg: Pralidoxime ( 2-PAM)
  4. 4. Action of Pralidoxime (2-PAM)  Attaches to the anionic site of the enzyme.  Oxime end reacts with the phosphorus atom attached to the esteratic site.  Oxime-phosphonate form and diffuse away.  Reactivated ChE remain.  Treatment should be started within 24 hours before the phosphorylated enzyme undergoes ‘Aging’ and become resistant to hydrolysis.
  5. 5.  It is ineffective to carbamate poisoning as in that case the anionic site of the enzyme is not free.  It is rather contraindicated because it has weak anti-ChE activity of its own.
  6. 6.  Injected  Doses  Use i.v. slowly in a dose of 1-2g. may be repeated according to need. of oximes in OP poisoning is secondary to that of Atropine.
  7. 7. OTHER OXIMES:  Obidoxime: more potent than pralidoxime  Diacetyl-monoxime (DAM): Lipophilic; so if the OP poisoning symptoms are more central DAM is used as it can cross the blood brain barrier.

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