Antidotes for nerve agents

Atropine Sometimes used as an antidote for nerve agents. It inhibits the action of acetylcholine by binding to acetylcholine receptors. 

CANA Convulsant Antidote for Nerve Agent, also called diazepam. 

Raveh, L., Grunwald, J., Marcus, D., Papier, Y., Cohen, E., Ashani, Y. (1993). Human butyrylcholinesterase as a general prophylactic antidote for nerve agent toxicity. In vitro and in vivo quantitative characterization. Biochem. Pharmacol. 45 2465-74. 

Baker, M.D. (2007). Antidotes for nerve agent poisoning should we differentiate children from adults Curr. Opin. Pediatr. 19(2) 211-15. 

Atropine administered repeatedly as necessary and pralidoxime (2-PAM Cl) are antidotes for nerve agent toxicity. Although atropine has no effect on nicotinic receptors, and therefore will not reverse muscle weakness or paralysis, it can reduce morbidity and mortahty by reversing some of the muscarinic effects such as bron-chospasm, bradycardia, sahvation, diaphoresis, diarrhea, and vomiting (2). These antidotes may not be available in the field, especially in or near the site of attack. If mihtary Mark 1 kits are available, they provide autoinjectors that automatically dehver 2mg of atropine and 600mg pralidoxime (9). 

Raveh, L. et al. Human butyrylcholinesterase as a general prophylactic antidote for nerve agent toxicity, Biochem. Pharmacol, 45, 2465, 1993. 

Tables 2 and 3 show the standard protocol for treatment of nerve agent casualties which includes administration of atropine as the gold standard antidote for nerve agent therapy and oxime as a complementary treatment which has a significant role in treatment of patients with nerve agent intoxication, as well as diazepam.

Convulsive Antidote Nerve Agent (CANA) is a convulsion antidote for nerve agents. CANA is an auto-injector that contains 2ml of diazepam (more commonly known as Valium) as the anticonvulsant. Diazepam is fully approved for this application by the USFDA. It is used only as buddy-aid, never self injected. CANA is a note Q item requiring vault or safe storage. Additionally, this item must be stored at a controlled room temperature of 59-86 degrees Fahrenheit. The shelf life is two years. 

No antidote for nerve agent poisoning, or pre-treatment when an attack is likely, is without danger, but faced with a choice between nerve agent poisoning and the side-effects of an antidote, the choice is clear. Untreated recovery can take months before the AChE levels are back to normal. 

TABLE 8-1 Potential Antidotes for Nerve Agent Poisoning... 

The atropine works quickly to block the receptor site for the nerve transmitter acetylcholine. This helps prevent the constant firing of the nerves and gives relief of the symptoms. The 2-PAM is a true antidote and it breaks the bond that has formed between the nerve agent and the enzyme acetylcholinesterase. This allows the enzyme to break down the acetylcholine. Some kits also include a CANA (con-vulsants antidote for nerve agent) injector for treatment of seizures. CANA injectors... 

If you have an autoinjector for diazepam or CANA (convulsants antidote for nerve agent), remove it from its packaging (not for use in children under 14). 

CANA convulsants antidote for nerve agent (Ecstasy)... 

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