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Pralidoxime chloride

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1. Pralidoxime chloride

Pralidoxime chloride Pralidoxime chloride Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Pralidoxime chloride Pralidoxime chloride (...) Aka: Pralidoxime chloride , Protopam chloride , 2-PAMCl II. Indications Exposure Not indicated for pure carbamate III. Pharmacokinetics Binds and breaks agent-enzyme bond Less effective after aging occurs (GD) ages in 2 minutes Other s age over 24-48 hours IV. Dosing: Emergency Department Initial IV bolus Adult: 1-2 grams IV over 10 minutes Child age < 12 years: 20-50 mg/kg IV over 30 minutes Maintenance Protocol 1 (bolus) Repeat dosing above in 1-2 hours May re-administer q10-12 hours prn

2018 FP Notebook

2. Clinical study of continuous micropump infusion of atropine and pralidoxime chloride for treatment of severe acute organophosphorus insecticide poisoning. (PubMed)

Clinical study of continuous micropump infusion of atropine and pralidoxime chloride for treatment of severe acute organophosphorus insecticide poisoning. Our study sought to assess the effectiveness of a constant micropump infusion of atropine and pralidoxime chloride compared with repeated-bolus doses in patients with severe acute organophosphorus insecticide poisoning (AOPP).A total of 60 patients with severe AOPP, defined as cholinergic crisis with respiratory failure or cerebral edema (...) , were randomly divided into two groups of 30 patients each. In the experimental group, patients received a continuous micropump of atropine and pralidoxime chloride; in the control group, patients were given intermittent injections of atropine and pralidoxime chloride. Primary outcome measures were the dose of atropine required for atropinization, Acute Physiology and Chronic Health Evaluation II (APACHE II) score at atropinization, time to atropinization and acetylcholinesterase (AchE) recovery

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2015 Journal of the Chinese Medical Association : JCMA

3. Efficacy of Recommended Pre-Hospital Human Equivalent Doses of Atropine and Pralidoxime against the Toxic Effects of Carbamate Poisoning in the Hartley Guinea Pig (PubMed)

acetylcholinesterase reactivator pralidoxime chloride [2-PAM Cl]) could afford therapeutic protection. However, oximes have been shown to be contraindicated for poisoning by some carbamates.A protective ratio study was conducted in guinea pigs to evaluate the efficacy of atropine and 2-PAM Cl. The ChE activity was determined in both the blood and the cerebral cortex.Coadministration of atropine free base (0.4 mg/kg) and 2-PAM Cl (25.7 mg/kg) demonstrated protective ratios of 2 and 3 against aldicarb and methomyl (...) Efficacy of Recommended Pre-Hospital Human Equivalent Doses of Atropine and Pralidoxime against the Toxic Effects of Carbamate Poisoning in the Hartley Guinea Pig Aldicarb and methomyl are carbamate pesticides commonly implicated in human poisonings. The primary toxic mechanism of action for carbamate poisoning is cholinesterase (ChE) inhibition. As such, it is logical to assume that the currently accepted therapies for organophosphate poisoning (muscarinic antagonist atropine and the oxime

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2016 International Journal of Toxicology

4. Reactivation of plasma butyrylcholinesterase by pralidoxime chloride in patients poisoned by WHO Class II toxicity organophosphorus insecticides. (PubMed)

Reactivation of plasma butyrylcholinesterase by pralidoxime chloride in patients poisoned by WHO Class II toxicity organophosphorus insecticides. Some clinicians assess the efficacy of pralidoxime in organophosphorus (OP) poisoned patients by measuring reactivation of butyrylcholinesterase (BuChE). However, the degree of BuChE inhibition varies by OP insecticide, and it is unclear how well oximes reactivate BuChE in vivo. We aimed to assess the usefulness of BuChE activity to monitor (...) pralidoxime treatment by studying its reactivation after pralidoxime administration to patients with laboratory-proven World Health Organization (WHO) class II OP insecticide poisoning. Patient data were derived from 2 studies, a cohort study (using a bolus treatment of 1g pralidoxime chloride) and a randomized controlled trial (RCT) (comparing 2g pralidoxime over 20 min, followed by an infusion of 0.5 g/h, with placebo). Two grams of pralidoxime variably reactivated BuChE in patients poisoned by 2

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2013 Toxicological sciences : an official journal of the Society of Toxicology

5. Pralidoxime chloride

Pralidoxime chloride Pralidoxime chloride Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Pralidoxime chloride Pralidoxime chloride (...) Aka: Pralidoxime chloride , Protopam chloride , 2-PAMCl II. Indications Exposure Not indicated for pure carbamate III. Pharmacokinetics Binds and breaks agent-enzyme bond Less effective after aging occurs (GD) ages in 2 minutes Other s age over 24-48 hours IV. Dosing: Emergency Department Initial IV bolus Adult: 1-2 grams IV over 10 minutes Child age < 12 years: 20-50 mg/kg IV over 30 minutes Maintenance Protocol 1 (bolus) Repeat dosing above in 1-2 hours May re-administer q10-12 hours prn

2015 FP Notebook

6. Regeneration of Red Cell Cholinesterase Activity Following Pralidoxime (2-PAM) Infusion in First 24 h in Organophosphate Poisoned Patients (PubMed)

Regeneration of Red Cell Cholinesterase Activity Following Pralidoxime (2-PAM) Infusion in First 24 h in Organophosphate Poisoned Patients Oximes such as pralidoxime chloride reactivate acetylcholinesterase. However their role in management of organophosphate poisoning is controversial. The study was carried out to find effectiveness of pralidoxime chloride (2-PAM) in regenerating red cell acetyl cholinesterase in first 24 h following administration of it in dose recommended by WHO. Eight

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2011 Indian Journal of Clinical Biochemistry

7. Mechanism of the antagonism by pralidoxime and 1,1-trimethylenebis(4-hydroxyiminomethylpyridinium) of the action of echothiophate on the intestine (PubMed)

Mechanism of the antagonism by pralidoxime and 1,1-trimethylenebis(4-hydroxyiminomethylpyridinium) of the action of echothiophate on the intestine Pralidoxime chloride (pyridine-2-aldoxime methochloride; Protopam Chloride) and 1,1'-trimethylenebis(4-hydroxyiminomethylpyridinium bromide) (TMB-4) antagonize the spasm of the isolated or intact small intestine of the rabbit caused by the anticholinesterase, echothiophate iodide (S-2-dimethylaminoethyl OO-diethyl phosphorothiolate methiodide (...) to cause 100% reactivation of cholinesterase, exhibit normal control tone and motility after washing. It is concluded that pralidoxime and 1,1'-trimethylenebis(4-hydroxyiminomethylpyridinium bromide) have an anticholinergic action as well as the ability to reactivate cholinesterase and that this action plays a significant part in the initial recovery of function under the conditions of these experiments.

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1962 British journal of pharmacology and chemotherapy

8. CRACKCast E163 – Pesticides

The second part of the treatment of organophosphate poisoning is the use of an oxime to regenerate acetylcholinesterase function. Evidence is not great, take with a grain of salt for 2-PAM use and discuss with your toxicologist Oximes bind to the organophosphate-cholinesterase complex causing a conformational change that allows for the cholinesterase to resume normal function. In other words, it re-activates the cholinesterase. There are currently five oximes in common use worldwide: pralidoxime (2-PAM (...) ) is most commonly used in North America. Indications for oxime treatment include: respiratory depression or failure, muscle fasciculations, seizures, dysrhythmias, hemodynamic instability, or the use of large amounts or repeated doses of atropine to completely control signs and symptoms of organophosphate intoxication. We recommend administering pralidoxime as a 1 to 2 g bolus (25 to 50 mg/kg in pediatric patients) over 30 minutes, which can be repeated as needed (up to hourly) based on response

2018 CandiEM

9. CRACKCast E147 – General Approach to the Poisoned Patient

of the parasympathetic system. Muscarinic effects: Diarrhea, diaphoresis Urination Miosis Bradycardia Bronchorrhea Emesis Lacrimation Lethargic Salivation Nicotinic effects: Mydriasis Tachycardia Weakness Tremors Fasciculations Seizures Somnolent Organophosphate and carbamate insecticides, nerve agents, nicotine, pilocarpine, physostigmine, edrophonium, bethanechol, urecholine, Liquids from e-cigarettes (muscarinic effects are less prominent) Antidotes: Atropine 2-pam aka Pralidoxime (2-pyridine aldoxime methyl (...) chloride) Benzos Supportive Sedative/hypnotic Sedation Vs. Hallucinogenic Depression of brain activity and muscular metabolism Altered mental status Pupils not changed clinically Benzodiazepines, barbiturates, carisoprodol, meprobamate, glutethimide, alcohols, zolpidem ( USA) Supportive Rule out traumatic injuries Opiate Sedation, diminished respiratory drive – responsive to naloxone Miosis, hypothermia, respiratory depression, apnea, Bradycardia, hyporeflexia, pulmonary edema Opioids (eg, heroin

2018 CandiEM

10. CRACKCast E191 – Weapons of Mass Destruction

of exposure (mild, moderate, or severe). Three drugs are the mainstay of treatment: Atropine for the muscarinic effects (improves ventilation), Titrate to SECRETIONS, no miosis or HR. Pralidoxime chloride (2-PAM) for the nicotinic effects (reverses paralysis), Less effective >6 hrs post exposure due to AGING = defined as the permanent attachment of sarin to the acetylcholinesterase enzyme. Diazepam/midazolam for the prevention and treatment of seizures An autoinjector kit (Mark I) approved by the FDA (...) activity in the management of patients exposed to chemical agents, and hospitals should provide this intervention. Nerve agents are organophosphates, and patients exposed to these agents are treated with large doses of atropine (repeated frequently), pralidoxime, and benzodiazepines. Rosen’s in perspective Besides managing the injuries and illnesses from common disasters such as earthquakes and airplane crashes, emergency clinicians should also have competence in treating victims generated by terrorist

2018 CandiEM

11. Pralidoxime in acute organophosphorus insecticide poisoning--a randomised controlled trial. (PubMed)

Pralidoxime in acute organophosphorus insecticide poisoning--a randomised controlled trial. Poisoning with organophosphorus (OP) insecticides is a major global public health problem, causing an estimated 200,000 deaths each year. Although the World Health Organization recommends use of pralidoxime, this antidote's effectiveness remains unclear. We aimed to determine whether the addition of pralidoxime chloride to atropine and supportive care offers benefit.We performed a double-blind randomised (...) placebo-controlled trial of pralidoxime chloride (2 g loading dose over 20 min, followed by a constant infusion of 0.5 g/h for up to 7 d) versus saline in patients with organophosphorus insecticide self-poisoning. Mortality was the primary outcome; secondary outcomes included intubation, duration of intubation, and time to death. We measured baseline markers of exposure and pharmacodynamic markers of response to aid interpretation of clinical outcomes. Two hundred thirty-five patients were randomised

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2009 PLoS medicine

12. Intraosseous administration of antidotes - a systematic review. (PubMed)

data also suggested an equivalent bio-availability between IO and IV administration for atropine, calcium chloride, dextrose 50%, diazepam, methylene blue, pralidoxime, and sodium bicarbonate. Adverse effect reporting of fat emboli after IO administration of sodium bicarbonate, for example, was conflicting due to the significant heterogeneity in the timing of lung examination across studies.The evidence supporting the use of IO route for the administration of antidotes in a context of poisoning

2017 Clinical toxicology (Philadelphia, Pa.)

13. Nanometric MIL-125-NH2 Metal–Organic Framework as a Potential Nerve Agent Antidote Carrier (PubMed)

and the release of drugs. The nerve agent antidote 2-[(hydroxyimino)methyl]-1-methyl-pyridinium chloride (2-PAM or pralidoxime) was effectively encapsulated into the pores of MIL-125-NH₂ as a result of the interactions between 2-PAM and the pore walls being mediated by π-stacking and hydrogen bonds, as deduced from infrared spectroscopy and Monte Carlo simulation studies. Finally, colloidal solutions of MIL-125-NH₂ nanoparticles exhibited remarkable stability in different organic media, aqueous solutions

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2017 Nanomaterials

14. [Transcutaneous Electrical Stimulation Undergoing Emergency Treatment of Zusanli (ST 36) Is Beneficial to Rescued Organophosphorus Pesticide Poisoning Patients]. (PubMed)

into control group and TAES group (n=58 in each group) according to the simple random sampling method. All the patients received comprehensive treatment including gastric lavage, catharsis, oral administration of atropine Pralidoxime Chloride, Omeprazole, etc. For patients of the TAES group, TAES stimulation (30 Hz/60 Hz, 15-20 mA) was applied to bilateral Zusanli (ST 36) for 30 min, 3 times a day till black stool was discharged. The vomiting times after catharsis, the time of the first defecation

2016 Zhen ci yan jiu = Acupuncture research / [Zhongguo yi xue ke xue yuan Yi xue qing bao yan jiu suo bian ji]

15. The Effect of Parathion on Red Blood Cell Acetylcholinesterase in the Wistar Rat (PubMed)

. Methods. Male Wistar rats were intubated and mechanically ventilated and then poisoned with between 20 mg/kg and 60 mg/kg of intravenous parathion. Upon developing signs of poisoning, the rats were treated with standard critical care, including atropine, pralidoxime chloride, and midazolam, for up to 48 hours. Acetylcholinesterase activity was determined serially for up to 8 days after poisoning. Results. At all doses of parathion, maximal depression of acetylcholinesterase occurred at 3 hours after

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2016 Journal of toxicology

16. Toxicity, Organophosphate (Treatment)

accordingly. Health care providers must avoid contaminating themselves while handling patients. Use personal protective equipment, such as neoprene gloves and gowns, when decontaminating patients because hydrocarbons can penetrate nonpolar substances such as latex and vinyl. Use charcoal cartridge masks for respiratory protection when decontaminating patients who are significantly contaminated. Irrigate the eyes of patients who have had ocular exposure using isotonic sodium chloride solution or lactated (...) to atropine, pralidoxime (2-PAM) and benzodiazepines (eg, diazepam) are mainstays of medical therapy (see Central venous access and arterial lines may be needed to treat the patient with organophosphate toxicity who requires multiple medications and blood-gas measurements. Continuous cardiac monitoring and pulse oximetry should be established; an electrocardiogram (ECG) should be performed. Torsades de pointes should be treated in the standard manner. The use of intravenous magnesium sulfate has been

2014 eMedicine.com

17. Toxicity, Organic Phosphorous Compounds and Carbamates (Diagnosis)

in organophosphate poisoning. Hum Exp Toxicol . 1997 Aug. 16(8):466-72. . Thompson DF, Thompson GD, Greenwood RB, Trammel HL. Therapeutic dosing of pralidoxime chloride. Drug Intell Clin Pharm . 1987 Jul-Aug. 21(7-8):590-3. . Thiermann H, Mast U, Klimmek R, Eyer P, Hibler A, Pfab R, et al. Cholinesterase status, pharmacokinetics and laboratory findings during obidoxime therapy in organophosphate poisoned patients. Hum Exp Toxicol . 1997 Aug. 16(8):473-80. . Johnson S, Peter JV, Thomas K, Jeyaseelan L, Cherian AM (...) reactivation in organophosphorus poisoned patients depends on the plasma concentrations of the oxime pralidoxime methylsulphate and of the organophosphate. Arch Toxicol . 1993. 67(2):79-84. . Thiermann H, Szinicz L, Eyer F, Worek F, Eyer P, Felgenhauer N, et al. Modern strategies in therapy of organophosphate poisoning. Toxicol Lett . 1999 Jun 30. 107(1-3):233-9. . Worek F, Backer M, Thiermann H, Szinicz L, Mast U, Klimmek R, et al. Reappraisal of indications and limitations of oxime therapy

2014 eMedicine Emergency Medicine

18. Toxicity, Organic Phosphorous Compounds and Carbamates (Follow-up)

in therapy of organophosphate poisoning. Toxicol Lett . 1999 Jun 30. 107(1-3):233-9. . Worek F, Backer M, Thiermann H, Szinicz L, Mast U, Klimmek R, et al. Reappraisal of indications and limitations of oxime therapy in organophosphate poisoning. Hum Exp Toxicol . 1997 Aug. 16(8):466-72. . Thompson DF, Thompson GD, Greenwood RB, Trammel HL. Therapeutic dosing of pralidoxime chloride. Drug Intell Clin Pharm . 1987 Jul-Aug. 21(7-8):590-3. . Thiermann H, Mast U, Klimmek R, Eyer P, Hibler A, Pfab R, et al (...) , Meredith TJ. Evaluation of antidotes for poisoning in organophorus pesticides. Emerg Med . 2000. 12(1):22-37. Willems JL, De Bisschop HC, Verstraete AG, Declerck C, Christiaens Y, Vanscheeuwyck P, et al. Cholinesterase reactivation in organophosphorus poisoned patients depends on the plasma concentrations of the oxime pralidoxime methylsulphate and of the organophosphate. Arch Toxicol . 1993. 67(2):79-84. . Thiermann H, Szinicz L, Eyer F, Worek F, Eyer P, Felgenhauer N, et al. Modern strategies

2014 eMedicine Emergency Medicine

19. Toxicity, Organic Phosphorous Compounds and Carbamates (Treatment)

and limitations of oxime therapy in organophosphate poisoning. Hum Exp Toxicol . 1997 Aug. 16(8):466-72. . Thompson DF, Thompson GD, Greenwood RB, Trammel HL. Therapeutic dosing of pralidoxime chloride. Drug Intell Clin Pharm . 1987 Jul-Aug. 21(7-8):590-3. . Thiermann H, Mast U, Klimmek R, Eyer P, Hibler A, Pfab R, et al. Cholinesterase status, pharmacokinetics and laboratory findings during obidoxime therapy in organophosphate poisoned patients. Hum Exp Toxicol . 1997 Aug. 16(8):473-80. . Johnson S, Peter JV (...) of respiratory muscles). Those manifestations require oxime antidotal therapy. Oximes The only oxime available in the United States is pralidoxime (2-PAM). OPCs and carbamates bind and phosphorylate one of the active sites of AChE and inhibit the functionality of this enzyme. Oximes bind to the OPC or carbamate, causing the compound to break its bond with AChE. Most of the effects are on the peripheral nervous system because entry into the CNS is limited. The main therapeutic effect of pralidoxime

2014 eMedicine Emergency Medicine

20. Toxicity, Organic Phosphorous Compounds and Carbamates (Overview)

in organophosphate poisoning. Hum Exp Toxicol . 1997 Aug. 16(8):466-72. . Thompson DF, Thompson GD, Greenwood RB, Trammel HL. Therapeutic dosing of pralidoxime chloride. Drug Intell Clin Pharm . 1987 Jul-Aug. 21(7-8):590-3. . Thiermann H, Mast U, Klimmek R, Eyer P, Hibler A, Pfab R, et al. Cholinesterase status, pharmacokinetics and laboratory findings during obidoxime therapy in organophosphate poisoned patients. Hum Exp Toxicol . 1997 Aug. 16(8):473-80. . Johnson S, Peter JV, Thomas K, Jeyaseelan L, Cherian AM (...) reactivation in organophosphorus poisoned patients depends on the plasma concentrations of the oxime pralidoxime methylsulphate and of the organophosphate. Arch Toxicol . 1993. 67(2):79-84. . Thiermann H, Szinicz L, Eyer F, Worek F, Eyer P, Felgenhauer N, et al. Modern strategies in therapy of organophosphate poisoning. Toxicol Lett . 1999 Jun 30. 107(1-3):233-9. . Worek F, Backer M, Thiermann H, Szinicz L, Mast U, Klimmek R, et al. Reappraisal of indications and limitations of oxime therapy

2014 eMedicine Emergency Medicine

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