Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 43 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Anticholinergic Hallucinogens • Qualitatively similar Atropine Scopolamine BZ Dose (70 kg) 8-14 mg 2 mg 0.5 mg Duration 4-8 h 2-4 h 48-72 h Module Two - The Clinical Neurotoxicology of Chemical Terrorism 43 Although these agents act generally the same, their potency (dose to have an effect) and the duration of effect is quite different. As can be seen on this slide, BZ is more potent than atropine and scopolamine because a lower dose is required to cause a comparable effect to those obtained with higher doses of the other anticholinergic agents. This slide also demonstrates that some anticholinergics have a much longer duration of action than others. The effects from BZ would be expected to last upwards of 2-3 days while the effects of atropine and scopolamine are much shorter acting lasting just a few hours. December 2008 Version 2.0 Page 114
Chemical Agents of Opportunity for Terrorism Training Support Package Participant Guide Slide 44 Chemical Agents of Opportunity for Terrorism: TICs & TIMs Treatment strategy Excitatio n Inhibitio n Module Two - The Clinical Neurotoxicology of Chemical Terrorism 4 4 Although the hallucinogenic agents disrupt our thought processes, our treatments usually focus on enhancing the inhibitory activity of the brain. In other words, we focus on sedation to counter delirium. As depicted on the slide, this treatment alters the individual’s balance of inputs - however, it is easier to provide care for and protect a sedated person than a delirious person. In the case of anticholinergic delirium, a specific antidote is available. The use of the cholinergic drug, physostigmine, can reverse all of the anticholinergic effects. This drug is a useful diagnostic – and therapeutic – tool. However, its duration of action is shor The see-saw depicts the effects of treating a hallucinating or delirious patient with a sedative, thus enhancing the inhibition of brain function. Note that this will result in a sedated patient, with all the potential downside of CNS and respiratory depression. However, it removes the potentially injurious effects seen in patients with altered thought processes due to unexpected and unpleasant hallucinations. December 2008 Version 2.0 Page 115
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Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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