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Pharmacological Interventions for OP Poisoning

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Toxicology of Organophosphate Poisoning

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Abstract

Organophosphate (OP) poisoning is very commonly seen in underdeveloped and develo** counties. Immediate medical intervention is required to save the life of a patient. The common strategy of managing OP-poisoned patients is using atropine for masking muscarinic symptoms that appear due to the accumulation of neurotransmitter acetylcholine, reactivation of phosphorylated acetylcholinesterase (AChE), and handling the seizure to protect the brain damage. This chapter has discussed the various pharmacological intervention (including bioscavengers) used in the management of acute poisoning and recent approaches that have been studied and published in peer-reviewed journals.

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References

  • Alozi, M., & Rawas-Qalaji, M. (2020). Treating organophosphates poisoning: Management challenges and potential solutions. Critical Reviews in Toxicology, 50, 764–779.

    Article  CAS  Google Scholar 

  • ATNAA Auto-Injector [Package Insert]. (2017). Columbia (MD): Meridian Medical Technologies; [accessed 2020 Oct 22]. https://dailymed.nlm. nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=596c7a8f-27cd-4de2-9491-476f43570b8b&type=display.

  • AtropenVR Auto-Injector [Package Insert]. (2017). Columbia (MD): Meridian Medical Technologies; [accessed 2020 Oct 22]. https://dailymed.nlm. nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=e2d4307d-da8f-49f5-aac0-02355dd9ffb7&type=display.

  • Bajgar, J. (2012). Nerve agents poisoning and its treatment in schematic figures and tables. Elsevier.

    Google Scholar 

  • Balali–Mood, M., Ayati, M-H., & Ali-Akbarian, H. (2005). Effect of high doses of sodium bicarbonate in acute organophosphorous pesticide poisoning. Clin Toxicol, 43, 571–574.

    Google Scholar 

  • Bardin, P. G., & Van Eeden, S. F. (1990). Organophosphate poisoning: Grading the severity and comparing treatment between atropine and glycopyrrolate. Critical Care Medicine, 18, 956–960.

    Article  CAS  Google Scholar 

  • Bates, N. (2020). Poisons affecting the neurological system. Veterinary Nursing, 11, 116–125.

    Article  Google Scholar 

  • Bilal, M., Khan, Y., Ali, S., & Naeem, A. (2014). The pattern of organophosphorus poisoning and it’s short term outcomes in various socioeconomic groups. KJMS, 7, 11.

    Google Scholar 

  • Bird, S., Traub, S. J., & Grayzel, J. (2014). Organophosphate and carbamate poisoning. UpToDate, 14, 339.

    Google Scholar 

  • Buckley, N. A., Eddleston, M., Li, Y., Bevan, M., & Robertson, J. (2011). Oximes for acute organophosphate pesticide poisoning. Cochrane Database of Systematic Reviews.

    Google Scholar 

  • Burton, A. (2003). Take your pyridostigmine: that’s an (ethical?) order! Lancet Neurology, 2, 268.

    Article  Google Scholar 

  • Cerasoli, D. M., Armstrong, S. J., Reeves, T. E., Hodgins, S. M., Kasten, S. A., Lee-Stubbs, R. B., Cadieux, C. L., Otto, T. C., Capacio, B. R., & Lenz, D. E. (2020). Butyrylcholinesterase, a stereospecific in vivo bioscavenger against nerve agent intoxication. Biochemical Pharmacology, 171, 113670.

    Article  CAS  Google Scholar 

  • Colovic, M. B., Krstic, D. Z., Lazarevic-Pasti, T. D., Bondzic, A. M., & Vasic, V. M. (2013). Acetylcholinesterase inhibitors: Pharmacology and toxicology. Current Neuropharmacology, 11, 315–335.

    Article  CAS  Google Scholar 

  • Dickson, E. W., Bird, S. B., Gaspari, R. J., Boyer, E. W., & Ferris, C. F. (2003). Diazepam inhibits organophosphate-induced central respiratory depression. Academic Emergency Medicine, 10, 1303–1306.

    Article  Google Scholar 

  • Eddleston, M. (2000). Patterns and problems of deliberate self-poisoning in the develo** world. QJM, 93, 715–731.

    Article  CAS  Google Scholar 

  • Eddleston, M., Buckley, N. A., Eyer, P., & Dawson, A. H. (2008). Management of acute organophosphorus pesticide poisoning. Lancet, 371, 597–607.

    Article  CAS  Google Scholar 

  • Eddleston, M., Eyer, P., Worek, F., Mohamed, F., Senarathna, L., von Meyer, L., Juszczak, E., Hittarage, A., Azhar, S., & Dissanayake, W. (2005). Differences between organophosphorus insecticides in human self-poisoning: A prospective cohort study. Lancet, 366, 1452–1459.

    Article  CAS  Google Scholar 

  • Eddleston, M., Szinicz, L., Eyer, P., & Buckley, N. (2002). Oximes in acute organophosphorus pesticide poisoning: A systematic review of clinical trials. QJM, 95, 275–283.

    Article  CAS  Google Scholar 

  • Greenblatt, D. J., Shader, R. I., Franke, K., Maclaughlin, D. S., Harmatz, J. S., Allen, M. D., Werner, A., & Woo, E. (1979). Pharmacokinetics and bioavailability of intravenous, intramuscular, and oral lorazepam in humans. Journal of Pharmaceutical Sciences, 68, 57–63.

    Article  CAS  Google Scholar 

  • Gunduz, E., Dursun, R., Icer, M., Zengin, Y., Gullu, M. N., Durgun, H. M., & Gokalp, O. (2015). Factors affecting mortality in patients with organophosphate poisoning. The Journal of the Pakistan Medical Association, 65, 967–972.

    Google Scholar 

  • Güven, M., Sungur, M., Eser, B., Sarı, Ä°., & AltuntaÅŸ, F. (2004). The effects of fresh frozen plasma on cholinesterase levels and outcomes in patients with organophosphate poisoning. Journal of Toxicology. Clinical Toxicology, 42, 617–623.

    Article  CAS  Google Scholar 

  • hetab-Boushehri, S. V. (2019). Dual opposite actions of sodium bicarbonate in treatment of acute organophosphate poisoning. EXCLI J, 18, 677.

    Google Scholar 

  • Hulse, E. J., Haslam, J. D., Emmett, S. R., & Woolley, T. (2019). Organophosphorus nerve agent poisoning: Managing the poisoned patient. British Journal of Anaesthesia, 123, 457–463.

    Article  CAS  Google Scholar 

  • John, H., van der Schans, M. J., Koller, M., Spruit, H. E. T., Worek, F., Thiermann, H., & Noort, D. (2018). Fatal sarin poisoning in Syria 2013: Forensic verification within an international laboratory network. Forensic Toxicology, 36, 61–71.

    Article  CAS  Google Scholar 

  • Kazemi, M., Tahmasbi, A. M., Valizadeh, R., Naserian, A. A., & Soni, A. (2012). Organophosphate pesticides: A general review. Agricultural Science Research Journal, 2, 512–522.

    Google Scholar 

  • Kuca, K., Musilek, K., Jun, D., Zdarova-Karasova, J., Nepovimova, E., Soukup, O., Hrabinova, M., Mikler, J., Franca, T. C. C., & Da Cunha, E. F. F. (2018). A newly developed oxime K203 is the most effective reactivator of tabun-inhibited acetylcholinesterase. BMC Pharmacology and Toxicology, 19, 1–10.

    Article  CAS  Google Scholar 

  • Kuruba, R., Wu, X., & Reddy, D. S. (2018). Benzodiazepine-refractory status epilepticus, neuroinflammation, and interneuron neurodegeneration after acute organophosphate intoxication. Biochim. Biophys. Acta (BBA)-Molecular Basis Dis, 1864, 2845–2858.

    Article  CAS  Google Scholar 

  • Lushchekina, S. V., Schopfer, L. M., Grigorenko, B. L., et al. (2018). Optimization of cholinesterase-based catalytic bioscavengers against organophosphorus agents. Front Pharmacol, 9, 211.

    Google Scholar 

  • Main, A. R. (1979). Mode of action of anticholinesterases. Pharmacology & Therapeutics, 6, 579–628.

    Article  CAS  Google Scholar 

  • Masson, P. (2016). Novel approaches in prophylaxis/pretreatment and treatment of organophosphorus poisoning. Phosphorus, Sulfur and Silicon and the Related Elements, 191, 1433–1443.

    Article  CAS  Google Scholar 

  • Mercey, G., Verdelet, T., Renou, J., Kliachyna, M., Baati, R., Nachon, F., Jean, L., & Renard, P.-Y. (2012). Reactivators of acetylcholinesterase inhibited by organophosphorus nerve agents. Accounts of Chemical Research, 45, 756–766.

    Article  CAS  Google Scholar 

  • Obata, H., Li, X., & Eisenach, J. C. (2005). α2-adrenoceptor activation by clonidine enhances stimulation-evoked acetylcholine release from spinal cord tissue after nerve ligation in rats. Journal of American Society of Anesthesiologists, 102, 657–662.

    CAS  Google Scholar 

  • Olney, J. W., de Gubareff, T., & Labruyere, J. (1983). Seizure-related brain damage induced by cholinergic agents. Nature, 301, 520–522.

    Article  CAS  Google Scholar 

  • Pajoumand, A., Shadnia, S., Rezaie, A., Abdi, M., & Abdollahi, M. (2004). Benefits of magnesium sulfate in the management of acute human poisoning by organophosphorus insecticides. Human & Experimental Toxicology, 23, 565–569.

    Article  CAS  Google Scholar 

  • Perera, P. M. S., Shahmy, S., Gawarammana, I., & Dawson, A. H. (2008). Comparison of two commonly practiced atropinization regimens in acute organophosphorus and carbamate poisoning, doubling doses vs. ad hoc: A prospective observational study. Human & Experimental Toxicology, 27, 513–518.

    Article  CAS  Google Scholar 

  • Peter, J. V., & Moran, J. L. (2004). Role of oximes in human organophosphate poisoning—A critical look at the evidence. Critical Care Update, 153–163.

    Google Scholar 

  • Placcio, D. C. (1982). New approach to treatment of OP poisoning. Anthropology Medicine Medeling, 31, 1–2.

    Google Scholar 

  • Pralidoxime Chloride Auto-Injector [Package Insert]. (2016). Columbia (MD): Meridian Medical Technologies; [accessed 2020 Oct 22]. https://www.meridianmeds.com/sites/default/files/pralidoxime_chloride_uspi_2016.pdf.

  • Raveh, L., Grauer, E., Grunwald, J., Cohen, E., & Ashani, Y. (1997). The stoichiometry of protection against soman and VX toxicity in monkeys pretreated with human butyrylcholinesterase. Toxicology and Applied Pharmacology, 145, 43–53.

    Article  CAS  Google Scholar 

  • 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. Biochemical Pharmacology, 45, 2465–2474.

    Article  CAS  Google Scholar 

  • Reddy, S. D., & Reddy, D. S. (2015). Midazolam as an anticonvulsant antidote for organophosphate intoxication—A pharmacotherapeutic appraisal. Epilepsia, 56, 813–821.

    Article  CAS  Google Scholar 

  • Sawasdiwipachai, P. (2017). Evaluation of clinical efficacy of intravenous Glyco-P®(Glycopyrrolate). Siriraj Medical Journal, 69, 24–31.

    Google Scholar 

  • Setlur, R., & Sharma, R. M. (2005). Severe metabolic acidosis secondary to organophosphate poisoning. Anesthesia and Analgesia, 101, 1894.

    Article  Google Scholar 

  • Shamoushaki, M. M. N., Soltani, M., Kamali, A., Imanpoor, M. R., Sharifpour, I., & Khara, H. (2012). Effects of organophosphate, diazinon on some haematological and biochemical changes in Rutilus frisii kutum (Kamensky, 1901) male brood stocks. Iranian Journal of Fisheries Sciences, 11, 105–117.

    Google Scholar 

  • Singh, S., Batra, Y. K., Singh, S. M., Wig, N., & Sharma, B. K. (1995). Is atropine alone sufficient in acute severe organophosphorus poisoning?: Experience of a North West Indian Hospital. International Journal of Clinical Pharmacology and Therapeutics, 33, 628–630.

    CAS  Google Scholar 

  • Thiermann, H., Steinritz, D., Worek, F., Radtke, M., Eyer, P., Eyer, F., Felgenhauer, N., & Zilker, T. (2011). Atropine maintenance dosage in patients with severe organophosphate pesticide poisoning. Toxicology Letters, 206, 77–83.

    Article  CAS  Google Scholar 

  • Tripathi, A., & Srivastava, U. C. (2010). Acetylcholinesterase: A versatile enzyme of nervous system. Annals of Neurosciences, 15, 106–111.

    Article  Google Scholar 

  • Tucker, J.B., 2007. War of nerves: Chemical warfare from World War I to Al-Qaeda. Anchor.

    Google Scholar 

  • Uwaifo, F., & John-Ohimai, F. (2020). Dangers of organophosphate pesticide exposure to human health. Matrix Science Medica, 4, 27.

    Article  Google Scholar 

  • Vale, J. A. (1998). Toxicokinetic and toxicodynamic aspects of organophosphorus (OP) insecticide poisoning. Toxicology Letters, 102, 649–652.

    Article  Google Scholar 

  • Vijayakumar, H. N., Kannan, S., Tejasvi, C., Duggappa, D. R., Gowda, K. M. V., & Nethra, S. S. (2017). Study of effect of magnesium sulphate in management of acute organophosphorous pesticide poisoning. Anesthesia, Essays and Researches, 11, 192.

    Article  CAS  Google Scholar 

  • Vijayaraghavan, R. (2020). Autoinjector device for rapid administration of drugs and antidotes in emergency situations and in mass casualty management. The Journal of International Medical Research, 48, 0300060520926019.

    Article  Google Scholar 

  • Wadia, R. S., Sadagopan, C., Amin, R. B., & Sardesai, H. V. (1974). Neurological manifestations of organophosphorous insecticide poisoning. Journal of Neurology, Neurosurgery, and Psychiatry, 37, 841–847.

    Article  CAS  Google Scholar 

  • Wong, A., Sandron, C., Magalhães, A., & Rocha, L. (2000). Comparative efficacy of pralidoxime vs sodium bicarbonate in rats and humans severely poisoned with OP pesticide. Journal of Toxicology, 38, 554–555.

    Google Scholar 

  • Wong, L., Radić, Z., Brüggemann, R. J. M., Hosea, N., Berman, H. A., & Taylor, P. (2000). Mechanism of oxime reactivation of acetylcholinesterase analyzed by chirality and mutagenesis. Biochemistry, 39, 5750–5757.

    Article  CAS  Google Scholar 

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  1. Amity Institute of Environmental Toxicology, Safety and Management, Amity University, Noida, Uttar Pradesh, India

    Anuj Ranjan & Tanu **dal

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  1. Anuj Ranjan
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  2. Tanu **dal
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Ranjan, A., **dal, T. (2022). Pharmacological Interventions for OP Poisoning. In: Toxicology of Organophosphate Poisoning. Springer, Cham. https://doi.org/10.1007/978-3-030-79128-5_5

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