Page 1 of 1: what should be done in atropine poisoning

shabana · Credits: 11510 My Scrapbook

hi my friends i want to know what should be done in atropine poisoning ,mainly what is the antidote of atropine which is given in its toxicity in pharma book the following is mentioned

ALTHOUGH the physostigmine antagonizes the central and peripheral effects of atropine ( can pass BBB ) it is NOT PREFERRED CLINICALLY because in atropine poisonig large amount of physostigmine needed to overcome the toxicity of atropine (as it has high affinity for muscarinic receptors)
so it will produce serious undesired effects on CNS as convulsions

BUT THE PREFERED ANTIDOTE is neostigmine which will antagonize the peripheral effects of atropine and sedatives should be accmpanied with neostigmine to antagonize the the central effects of atropine

but in many other book they mention the antidote is physostigmine
i want to know who is nearest to the truth

whiteguardian · Credits: 9523 My Scrapbook

* Physostigmine, given as an atropine antidote by slow intravenous injection of 1 to 4 mg (0.5 to 1.0 mg in children), rapidly abolishes delirium and coma caused by large doses of atropine in most situations.

Since physostigmine has a short duration of action, the patient may again lapse into coma after one or two hours and repeated doses are likely to be required.

Neostigmine, pilocarpine and methacholine are of little real benefit, since they do not penetrate the blood-brain barrier

rajponn · Credits: 4434 My Scrapbook

ATROPINE & ANTICHOLINERGICS
Atropine, scopolamine, belladonna, diphenoxylate with atropine, Datura stramonium, Hyoscyamus niger, some mushrooms, tricyclic antidepressants, and antihistamines are antimuscarinic agents with variable central nervous system effects. The patient complains of dryness of the mouth, thirst, difficulty in swallowing, and blurring of vision. The physical signs include dilated pupils, flushed skin, tachycardia, fever, delirium, myoclonus, ileus, and flushed appearance. Antidepressants and antihistamines may induce convulsions.
Antihistamines are commonly available with or without prescription. Diphenhydramine commonly causes delirium, tachycardia, and seizures. Massive overdose may mimic tricyclic antidepressant poisoning. The first-generation “nonsedating” agents terfenadine and astemizole caused QT interval prolongation and torsade de pointes (atypical ventricular tachycardia) and were removed from the United States market. Loratadine and fexofenadine have not caused this problem.
Treatment
A. EMERGENCY AND SUPPORTIVE MEASURES
Administer activated charcoal (see p 1612). Tepid sponge baths and sedation are indicated to control high temperatures (see p 1610).
B. SPECIFIC TREATMENT
For pure atropine or related anticholinergic syndrome, if symptoms are severe (eg, hyperthermia or excessively rapid tachycardia), give physostigmine salicylate, 0.5–1 mg slowly intravenously over 5 minutes, with electrocardiographic monitoring, until symptoms are controlled. Bradyarrhythmias and convulsions are a hazard with physostigmine administration, and it should not be used in patients with tricyclic antidepressant overdose.

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