A young man presents with profuse sweating, miosis, bradycardia, excessive salivation, and muscle fasciculations after working in an agricultural field. Which drug should be administered FIRST?

• A Pralidoxime alone
• B Neostigmine
• C Atropine, then pralidoxime ✓
• D Physostigmine

Explanation

This presentation is classic organophosphate poisoning (SLUDGE + nicotinic effects). Atropine should be given first and in large doses (2-4 mg IV, repeated) to counter the life-threatening muscarinic effects such as bronchospasm and bradycardia. Pralidoxime (2-PAM) regenerates acetylcholinesterase if given early before ageing of the enzyme-OP bond, and counters nicotinic and CNS effects. Neostigmine and physostigmine are anticholinesterases and would worsen toxicity.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.