Antidote Treatment Nerve Agent, Auto-Injector (ATNAA)

<p><strong>ATNAA (atropine and pralidoxime chloride injection), for intramuscular use</strong></p> <p><strong>Cardiovascular risks</strong> include tachycardia, palpitations, premature ventricular contractions, flutter, fibrillation, asystole, and myocardial infarction. Other cardiovascular adverse reactions have also been reported. Use caution in patients with known CV disease or conduction problems.</p> <p><strong>Heat injury</strong> may occur. Atropine may inhibit sweating and lead to hyperthermia. Avoid excessive exercising and heat exposure.</p> <p><strong>Acute glaucoma</strong> may be precipitated in susceptible individuals, and therefore ATNAA should be administered with caution in patients at risk for acute glaucoma.</p> <p>Administer with caution in patients with bladder outflow obstruction as <strong>urinary retention</strong> may occur.</p> <p>ATNAA should be administered with caution in patients with partial <strong>pyloric stenosis</strong> because of the risk of complete pyloric obstruction.</p> <p>Atropine may cause inspiration of bronchial secretions and formation of dangerous viscid plugs and may <strong>exacerbate chronic lung disease</strong>. Monitor respiratory status.</p> <p>Common adverse reactions of atropine include dryness of the mouth, blurred vision, dry eyes, photophobia, confusion, headache, and dizziness, among others. The common adverse reactions of pralidoxime chloride include changes in vision, dizziness, headache, drowsiness, nausea, tachycardia, increased blood pressure, muscular weakness, dry mouth, emesis, rash, dry skin, hyperventilation, decreased renal function, excitement, manic behavior, and transient elevation of liver enzymes and creatine phosphokinase.</p> <p>Muscle tightness and pain may occur at the injection site.</p> <p>Patients who have received succinylcholine and mivacurium may exhibit an accelerated reversal of the neuromuscular blocking effects when treated with ATNAA. Monitor neuromuscular effects with concomitant administration.</p> <p>Geriatric patients may be more susceptible to the effects of atropine.</p> <p>Pralidoxime chloride can cause decreased renal function. Patients with severe renal impairment may require less frequent doses after the initial dose.</p> <p>Patients with severe hepatic impairment may require less frequent doses after the initial dose.</p> <p>For optimal reactivation of organophosphorus-inhibited cholinesterase, the ATNAA should be administered as soon as possible after appearance of symptoms of organophosphorus nerve agent poisoning. ATNAA should be self- or buddy–administered by service members after donning protective mask and hood at the first sign of a chemical attack, and only if some or all of the mild symptoms of organophosphorus nerve agent exposure are present.</p>