A medical student accidentally ingests a large dose of a belladonna alkaloid and develops delirium, dry flushed skin, and dilated pupils. Along with supportive care and benzodiazepines for agitation, which specific antidote is used to reverse the central anticholinergic syndrome?
- A Neostigmine
- B Pralidoxime
- C Physostigmine ✓
- D Edrophonium
Correct answer: C. Physostigmine
Explanation
Physostigmine is a tertiary amine cholinesterase inhibitor that crosses the blood-brain barrier, so it reverses both peripheral and central antimuscarinic toxicity such as delirium and coma. Neostigmine is a quaternary ammonium compound and cannot enter the CNS, which kills the most tempting distractor. Pralidoxime reactivates phosphorylated acetylcholinesterase in organophosphate poisoning and has no role here.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.