A farmer presents with severe salivation, lacrimation, urination, defecation, bronchospasm, and pin-point pupils after spraying crops. What is the initial muscarinic antagonist of choice?
Answer and explanation
Correct answer: C. Intravenous atropine
- Step 1: Organophosphate insecticides inhibit acetylcholinesterase, leading to massive acetylcholine accumulation at muscarinic and nicotinic receptors.
- Step 2: High-dose intravenous atropine is the essential first-line antidote, competitively blocking muscarinic receptors to dry respiratory secretions and relieve bronchospasm.
Answer
Intravenous atropine.
Why not the others: Physostigmine and neostigmine are acetylcholinesterase inhibitors that would further inhibit cholinesterase and worsen toxicity. Pilocarpine is a muscarinic agonist that would exacerbate the cholinergic crisis.
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