Pralidoxime

Question 1

Pralidoxime Trade Name

Answer 1

(2-pyridine aldoxime methyl chloride)
2-PAM
Protocam

Question 2

Pralidoxime Classification

Answer 2

Medscape:
Cholinergic, Toxicity Antidotes

Question 3

Pralidoxime Mechanism

Answer 3

Medscape:
Binds to organophosphates and breaks alkyl phosphate-cholinesterase bond to restore activity of acetylcholinesterase.

Question 4

Pralidoxime Onset of Action

Answer 4

Medscape:
5-15 min

Question 5

Pralidoxime Duration of Action

Answer 5

Mr. Fortin:
Duration: 3-6 hrs

Question 6

Pralidoxime Indications

Answer 6

CT Protocols:
Antidote for Nerve Agents or Organophosphate Overdose. Administered with Atropine.

Question 7

Pralidoxime Contraindications

Answer 7

CT Protocols:
None in the prehospital setting

Question 8

Pralidoxime Side Effects/ Precautions/ Comments

Answer 8

Medscape:
Not effective in treatment of poisoning due to phosphorus, inorganic phosphates, or organophosphates not having anticholinesterase activity. Not indicated as antidote for intoxication by pesticides of carbamate class since may increase toxicity of carbaryl.

Statpearls:
Adverse effects of pralidoxime iodide in healthy volunteers included blurred vision, diplopia, dizziness, impaired accommodation, headache, and nausea. Other rare side effects may be tachycardia, raised blood pressure, and hyperventilation.

Question 9

Pralidoxime Adult Dose

Answer 9

CT Protocols:
1 – 2 gram over 30 – 60 minutes.
Medical Control: Maintenance infusion: up to 500 mg per hour (maximum of 12 grams/day).

Use with atropine, which affects muscarinic receptors; pralidoxime’s actions most striking at nicotonic sites (increase muscle strength 10-40 min)

IM: 600 mg IM x3 doses; administer each dose 15 minutes apart for mild symptoms, or in rapid succession for severe symptoms; not to exceed 1800 mg total dose initially; if symptoms persist may repeat series of three injections 1 hr after last injection.

Question 10

Pralidoxime Pediatric Dose

Answer 10

CT Protocols:
Atropine 0.05 – 0.1 mg/kg IV/IO or IM (minimum dose of 0.1 mg, maximum single dose 5 mg); repeat every 2 – 5 minutes as needed

Pralidoxime 25 mg/kg IV/IO/IM (max 2 grams), may repeat within 30 – 60 minutes as needed.

Question 11

Pralidoxime
Max Dose Adult (Pediatric)

Answer 11

2g

Question 12

Pralidoxime Routes of Administration

Answer 12

IM/IV/IO

Question 13

Pralidoxime How Supplied

Answer 13

DuoDote kit. 600mg autoinjector