Medical Aspects of Chemical Warfare (2008) - The Black Vault

Nerve Agentstivity of smooth muscles with bronchoconstriction, andCNS changes, including seizure activity and apnea.Therapy is based on the administration of atropine,which interferes with receptor binding of ACh at muscarinicbut not nicotinic receptors, the oxime 2-PAM Cl,which breaks the agent-enzyme bond formed by mostagents, and anticonvulsant treatment with diazepamor other benzodiazepines in cases of severe poisoning.Assisted ventilation and other supportive measuresare also required in severe poisoning.For proper protection, it may be necessary to pretreatthose at high risk of exposure to a rapidly agingnerve agent, such as soman, with pyridostigmine, acarbamate that reversibly binds a fraction of the body ’ sChE. This medication now carries FDA approvalagainst soman only.REFERENCES1. Koelle GB. Anticholinesterase agents. In: Goodman LS, Gilman A, eds. The Pharmacological Basis of Therapeutics. 5thed. New York, NY: Macmillan; 1975: 445.2. Davis W. The Serpent and the Rainbow. New York: Warner Books Inc; 1985: 36–37.3. Fraser TR. On the characters, actions, and therapeutic use of the ordeal bean of Calabar. Edinb Med J. 1863;9:124–132.4. Holmstedt B. Structure–activity relationships of the organophosphorus anticholinesterase agents. In: Koelle GB, ed.Cholinesterases and Anticholinesterase Agents. Berlin, Germany: Springer Verlag; 1963: 429.5. Harris R, Paxman J. A Higher Form of Killing. New York, NY: Hill and Wang; 1982: 53.6. Robinson JP. The rise of CB weapons. Vol 1. In: Stockholm International Peace Research Institute, ed. The Problem ofChemical and Biological Warfare. New York, NY: Humanities Press; 1971: 71.7. Koelle GB. Organophosphate poisoning—an overview. Fundam Appl Toxicol. 1981;1:129–134.8. Wilson Kenneth W. Research chemist, Directorate of Medical Research, Edgewood Arsenal, Md. Personal communication,interview, and lectures, 1976.9. Wills JH, DeArmon IA. A Statistical Study of the Adamek Report. Army Chemical Center, Md: Medical Laboratories;1954. Medical Laboratory Special Report 54.10. Program Executive Officer, Program Manager for Chemical Demilitarization. Chemical Stockpile Disposal Program:Final Programmatic Environmental Impact Statement. Aberdeen Proving Ground, Md: Program Manager for ChemicalDemilitarization; January 1988. Publication A3, vol 3.11. Smith RJ. Army poison gas stockpile raises worries in Kentucky. Washington Post. January 22, 1989:A1.12. Newmark J. The birth of nerve agent warfare: lessons from Syed Abbas Foroutan. Neurology. 2004;62:1590–1596.13. Newark J. Neurologist, Washington, DC. Personal examination of one patient, 2005.14. Koelle GB. Anticholinesterase agents. In: Goodman LS, Gilman A, eds. The Pharmacological Basis of Therapeutics. 4thed. New York, NY: Macmillan; 1970: 446.15. Taylor P. Anticholinesterase agents. In: Goodman LS, Gilman A, Hardman JG, Limbird LE, Gilman AG, eds. Goodmanand Gilman’s The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill; 2001: 175–191.16. Koelle GB. Protection of cholinesterase against irreversible inactivation by di-isopropyl fluorophosphate in vitro. JPharmacol Exp Ther. 1946;88:232–237.17. Koster R. Synergisms and antagonisms between physostigmine and di-isopropyl fluorophosphate in cats. J PharmacolExp Ther. 1946;88:39–46.205