Case Contents

Table of Contents

Agency for Toxic Substances and Disease Registry
Case Studies in Environmental Medicine (CSEM)

Cholinesterase Inhibitors
Including Insecticides and Chemical Warfare Nerve Agents
Table of Contents

Course: WB 1098
CE Original Date: October 16, 2007
CE Expiration Date: October 16, 2010

Cover Page

Key Concepts

Notes

Authorship

Disclaimer

How to Use This Course

Introduction

Available Versions

Instructions

Instructional Format

Learning Objectives

Initial Check

Instructions

Case

Initial Check Questions

Initial Check Answers

Mass Casualty Events

Learning Objectives

Introduction

Community Needs

Evidence-Based Planning

Patient Self-Transport

Key Points

Progress Check

Cholinesterase Inhibitors

Learning Objectives

Primary Toxic Effect

Acetycholinestarase Action

Cholinestarase Inhibitors

Acethycholine Blockage

Blockage Effects

Other Inhibitory Effects

Definitions Review

Inhibitor Classes

Key Points

Progress Check

Pathological Conditions

Learning Objectives

Pathological Effects

Key Points

Progress Check

Cholinergic Toxidrome

Learning Objectives

Introduction

Cholinergic Receptors

Mixed Receptor Effects

Signs and Symptoms

Nicotinic vs. Muscarininc

Key Points

Progress Check

Nicotinic Receptors

Learning Objectives

Nicotinic Receptor Function

Molecular Physiology

Structure and Physiology

Receptor Location

Clinical Findings

Nicotinic Mnemonic

Key Points

Progress Check

Muscarinic Receptors

Learning Objectives

G-Protein Mediation

Molecular Physiology

Structure and Physiology

Receptor Location

Clinical Effects

Peripheral Effects

Muscarinic Mnemonics

Key Points

Progress Check

Nicotinic/Muscarinic Mixture

Learning Objectives

Sympathetic/Parasympathetic

CNS Effects

Cause of Death

Signs and Symptoms

Frequency

Key Points

Progress Check

Signs and Symptoms

Learning Objectives

Route of Exposure

Structure vs. Toxicity

Vapor Exposure

Dermal Exposure

Oral Exposure

Delayed Onset

Key Points

Laboratory Tests

Learning Objectives

Introduction

Key Points

Progress Check

Differential Diagnosis

Learning Objectives

Conditions Mimicked

Differential Diagnosis

Key Points

Progress Check

Pediatric Cases

Learning Objectives

Differences

Signs and Symptoms

Key Points

Progress Check

Exposure History

Learning Objectives

Introduction

Where Found

Home Exposures

Occupational Exposures

Consumer Exposures

Exposure Questions

Key Points

RBC & Serum Tests

Learning Objectives

Introduction

Cholinesterase Levels

Sources of Error

Case Example

Laboratory Variations

Correlation with Toxicity

Baseline Levels

Other Abnormalities

Key Points

Progress Check

Inhibitors & Byproducts

Learning Objectives

Introduction

Inhibitors Measured

Byproducts Measured

Key Points

Progress Check

Management Strategies

Prevention of Secondary Exposure

Supportive Care

Medications

First-Line Medications

Atropine

2-PAM

Diazepam

Medications: Atropine

Learning Objectives

Mechanism of Action

The “Atropine Challenge”

Available Forms

Stability of Solution

Administration Route

Appropriate End Point

Atropine Dose

Organophosphorus Compounds

Suicidal Ingestions

Nerve Agent Doses

Carbamates

Adverse Effects

Atropine Alternatives

Key Points

Progress Check

Medications: 2-PAM (Pralidoxime)

Learning Objectives

Introduction

How 2-PAM Works

Aging

Aging Onset

Delayed Onset

Mechanism of Action

Acetylcholinesterase

Inhibition Mechanisms

Cholinesterase Inhibitors

Molecular Level

Carbamate Toxicity

2-PAM: Availability

Blood Sampling

2-PAM: Dosing

2-PAM Dose Controversy

I.V. Infusion Need

2-PAM: Treatment Duration

Apparent Response Failure

Synergism with Atropine

Adverse Effects

Receptor Site Controversy

Blood-Brain Barrier

Efficacy Controversy

Factor Control

Human Studies

Key Points

Progress Check

Medications: Diazepam

Learning Objectives

Diazepam for Seizures

Indications

Dose

Key Points

Progress Check

Antidote Stocking

Learning Objectives

Stocking Inadequacies

Atropine in Bulk Powder

Mixing Protocol

CDC Support

Key Points

Deprecated Treatments

Learning Objectives

Deprecated Treatments

Key Points

Progress Check

Medico-Legal Issues

Learning Objectives

Introduction

Key Points

Progress Check

The Intermediate Syndrome

Learning Objectives

Intermediate Syndrome

Incidence

Signs & Symptoms

Complications

Treatment

Disposition

Prognosis

Key Points

Progress Check

Delayed Neuropathy

Learning Objectives

Introduction

Etiology

Pathology

Signs and Symptoms

Treatment

Prognosis

Key Points

Progress Check

Chronic Neurotoxicity

Learning Objectives

Introduction

Signs and Symptoms

Treatment

Key Points

Progress Check

Other Issues

Learning Objectives

Cancer Risks

Fetal Effects

Gulf War I Illness

Immune System Effects

Key Points

Progress Check

Posttest

Introduction

Instructions: Online

Posttest

Relevant Content

Literature Cited

References

Next Section

Revised 2007-10-16.

Agency for Toxic Substances and Disease RegistryCase Studies in Environmental Medicine (CSEM) Cholinesterase InhibitorsIncluding Insecticides and Chemical Warfare Nerve Agents Table of Contents

Agency for Toxic Substances and Disease Registry
Case Studies in Environmental Medicine (CSEM)

Cholinesterase Inhibitors
Including Insecticides and Chemical Warfare Nerve Agents
Table of Contents