Pralidoxime combination with atropine

Ventilate the patient. There may be an increase in airway resistance due to constriction of the airway and the presence of secretions. If breathing is difficult, administer oxygen. As soon as possible administer of atropine alone or in combination with pralidoxime chloride (2-PAMC1) or other appropriate oxime. Diazepam may be required to prevent or control severe convulsions. If diazepam is not administered within 40-minutes postexposure, then its effectiveness at controlling seizures is minimal. 

The standard treatment of nerve agent-induced muscle toxicity calls for (1) reactivation of the phosphorylated AChE with an oxime, and (2) blockage of the nicotinic ACh receptor sites from the stimulating action of ACh with fii-tubocurarine. Oximes such as obidoxime, pralidoxime (2-pyridine aldoxime methochloride, 2-PAM) and a few others have been found very effective when given in combination with other drugs such as atropine, pretreatment with oximes varies with the ehemieal structures of the nerve agents and depends on the time after exposure. For example, it has been... 

If exposure is through ingestion, the victim should seek medical help immediately. Emesis should not be induced. Initial management involves establishment of adequate ventilation and maintenance of adequate respiratory function. Activated charcoal therapy may be used to retard absorption from the gastrointestinal tract. Atropine sulfate alone, or in combination with pralidoxime chloride, can be administered as an antidote. Atropine is initially administered intravenously at a dosage of 1-2 mg kg every 5-10 min until... 

Atropine alone or in combination with pralidoxime chloride (2-PAMCl) or other oxime. Diazepam may be required to control severe convulsions. 

It has not been published how Novichok Nerve Agents will respond to treatment with standard antidotes (i.e., atropine in combination with pralidoxime chloride. See Class Indices COl through C03). It is known that some of the agents in this class have been designed to be resistant to therapy. 

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