A nurse is teaching a new emergency department nurse about emergency medications. When asked to describe the uses of pralidoxime (Protopam), the new nurse makes which correct statement?
a. "It exerts its greatest effects at muscarinic and ganglionic sites."
b. "It is used to treat poisoning by reversible cholinesterase inhibitors."
c. "It may not be effective if not given immediately."
d. "It reverses the effects of organophosphate insecticides in the central nervous system."
ANS: C
Pralidoxime must be given soon after organophosphate poisoning has occurred because of a process called aging, in which the bond between the organophosphate inhibitor and cholinesterase increases in strength, making pralidoxime ineffective. For some of these poisons, aging can occur within minutes. Pralidoxime has its greatest effects at the neuromuscular junction, not the muscarinic and ganglionic sites. It is used to treat poisoning by irreversible cholinesterase inhibitors. It does not cross the blood-brain barrier and thus does not have effects in the CNS.
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