A 24 years old farmworker is rushed to a nearby emergency depament after accidental exposure to parathion. Which of the following drugs can be given to increase the activity of his anticholinesterases
**Core Concept**
The scenario presented involves parathion poisoning, a type of organophosphate (OP) intoxication. Parathion inhibits acetylcholinesterase (AChE), leading to an accumulation of acetylcholine (ACh) in the synaptic cleft, causing overstimulation of muscarinic and nicotinic receptors.
**Why the Correct Answer is Right**
To counteract OP poisoning, anticholinesterase inhibitors like pralidoxime (2-PAM) can be used. However, to increase the effectiveness of 2-PAM, a drug that can decrease the amount of AChE bound to the OP and promote the reactivation of AChE is needed. Oximes, specifically 2-PAM, work by reactivating phosphorylated AChE back to its active form. However, the efficacy of 2-PAM can be enhanced by administering a drug that can reduce the amount of AChE bound to the OP.
**Why Each Wrong Option is Incorrect**
* **Option A:** Atropine is an anticholinergic agent that can be used to treat some symptoms of OP poisoning, such as bradycardia and excessive salivation, but it does not increase the activity of anticholinesterases.
* **Option B:** Prazosin is an alpha-1 adrenergic receptor antagonist used primarily for hypertension and prostatic hyperplasia. It does not have a role in enhancing the activity of anticholinesterases in the context of OP poisoning.
* **Option C:** Succinylcholine is a depolarizing muscle relaxant that works by activating nicotinic receptors. It would not increase the activity of anticholinesterases in this scenario.
* **Option D:** Glycopyrrolate is another anticholinergic agent that can be used to reduce salivation and bronchial secretions in OP poisoning, but it does not increase the activity of anticholinesterases.
**Clinical Pearl / High-Yield Fact**
In the management of OP poisoning, it is essential to remember that atropine is used to treat muscarinic symptoms, while pralidoxime (2-PAM) is used to reactivate AChE. Oximes like 2-PAM can be more effective when used early in the course of poisoning.
**Correct Answer:** C. Succinylcholine is not the best answer here, however, the question asked which drug can increase the activity of anticholinesterases. The best answer is actually not listed here.