Atropine is a prescription medicine used to treat the symptoms of low heart rate ( bradycardia ), reduce salivation and bronchial secretions before surgery or as an antidote for overdose of cholinergic drugs or mushroom poisoning. Pralidoxime is an antidote, prescribed for organophosphorous poisoning. In the combina- tion of two d r u g s which comprise the c u r r e n t U.S. Army nerve agent antidote, atropine absorption is delayed by the presence of 2-pralidoxime chloride (PAMCL) at the same injection site,s but a recent animal study suggests that this is not a problem when the two drugs are administered by a multi- chambered autoinjector . The auto injector is designed with two internal cha[4] m-bers, one on top of the other. Sulfite : Epinephrine. La Biblioteca Virtual en Salud es una colección de fuentes de información científica y técnica en salud organizada y almacenada en formato electrónico en la Región de América Latina y el Caribe, accesible de forma universal en Internet de modo compatible con las bases internacionales. Purpose: These are antidotes to be used in instances of exposure to a nerve or organophosphate agent. Atropine and pralidoxime is a combination medicine used as an antidote to treat poisoning by a pesticide (insect spray) or a chemical that interferes with the central nervous system, such as nerve gas. An antidote is a substance that can counteract a form of poisoning. The. Pralidoxime and atropine administration should take place as soon as the patient is decontaminated, stabilized, and there is a provisional diagnosis of organophosphate poisoning. Cyanide poisoning is given amyl nitrite, sodium nitrite, and thiosulfate as the antidote. Atropine and pralidoxime is a combination medicine used as an antidote to treat poisoning by a pesticide (insect spray) or a chemical that interferes with the central nervous system, such as nerve gas. atropine and pralidoxime is not effective as an antidote for all types of pesticide poisonings. The AtroPen ® is intended as an initial treatment of the muscarinic symptoms of insecticide or nerve agent poisonings (generally breathing difficulties due to increased secretions); definitive medical care should be sought immediately. Mark 1 antidote kits are available and are only to be used . 8. 8. Heparine Protamine sulfate 23. 13. morphine sulfate - naloxone hydrochloride 14. methotrexate - leucovorine 15. mestinon - atropine sulfate 16. neostigmine - pralidoxime chloride (pam) 17. penicillin - epinephrine 18. vincristine (oncovin) - hyaluronidase,also apply moderate heat to disperse drug and minimize sloughing. (Figure 1) The most common injection site of administration is the OUTER THIGH MUSCLE Treat seizures with benzodiazepines. 2-PAM (2-pyridine aldoxime methyl chloride (pralidoxime)), and an anticonvulsant, to decrease morbidity and mortality. Antidote administration . Atropine may be used alone or with other medications. Atropine or atropine sulfate carries U.S. Food and Drug Administration (FDA) . Policy Statement 02-08 Page 3 of 4 MODEL PROTOCOL FOR THE USE OF MARK I KITS Purpose: These are antidotes to be used in instances of exposure to a nerve or organophosphate agent. 5.2. Antidotes, such as Atropine, should not be relied upon solely to provide complete protection from chemical . Neostigmine Pralidoxime chloride 15. antidotes will be presented first, followed by a discussion of their use in the treatment of mild, moderate, or severe nerve agent . Atropine sulfate and pralidoxime chloride were administered intermittently, but the patient continued to be extremely agitated and have muscle fasciculations. Botulism : ABE Botulinus Antitoxin. Atropine sulfate has been used successfully in large doses to counteract the muscarinic effects of OP poisoning. Subjects inhaled a 1.95-mg atropine sulfate dose from the dry powder inhaler on one study day . Each auto-injector contains pre-measured amounts of Atropine (2 mg total dose per injection) and 2-PAM CL (600 mg total dose per injection). Pralidoxime relieves muscarinic signs and symptoms, salivation, bronchospasm, etc., but this action is relatively unimportant since atropine is adequate for this purpose. . In crossover experiments one week apart, 20 nonsmoking healthy young male humans (ages 20-30) were studied after citrated atropine (6.9 mumol/0.7 mL) and pralidoxime chloride (3.5 mmol/2.0 mL; PAMCL) were injected sequentially into a single intramuscular site by either a multichambered autoinjector or a device which delivers the drugs into two . Administer antidotes: atropine for muscarinic manifestations (e.g. Atropine acts as an antidote in this condition, competitively blocking muscarinic receptors that would otherwise be affected by excessive levels of acetylcholine present at the synaptic junctions. The Mark I NAAK, or MARK I Kit, is United States military nomenclature for the "Nerve Agent Antidote Kit". The combination of atropine and pralidoxime is used as an antidote to treat poisoning by a pesticide (insect spray) or a chemical that interferes with the central nervous system, such as nerve gas. Subsequently, a continuous intravenous infusion of pralidoxime (8 mg/mL concentration) at 500 mg/h was initiated to help control breakthrough nicotinic symptoms. Nerve agent exposure is generally treated by an antidote formulation composed of a muscarinic antagonist, atropine sulfate (ATR), and a reactivator of acetylcholinesterase (AChE) such as . The combination of atropine and pralidoxime is used as an antidote to treat poisoning by a pesticide (insect spray) or a chemical that interferes with the central nervous system, such as nerve gas. drugs and their antidotes 1. acetaminophen - acetylcycteine 2. benzodiazepine - flumazenil 3. coumadin Subsequently, a continuous intravenous infusion of pralidoxime (8 mg/mL concentration) at 500 mg/h was initiated to help control breakthrough nicotinic symptoms. Of course, some antidotes are used to treat more than one type of poisoning. Concentrated Atropine Sulfate Formulations. Autoinjector device for rapid administration of drugs and antidotes in emergency situations and in mass casualty management. The authors aim was to study the effects of obidoxime and pralidoxime in OP pesticide poisoning. Atropine sulfate (1.8 ± 0.1 mg) and/ or pralidoxime chloride (36 ± 2 mg) were administered by autoinjectors to evaluate their antidotal efficacy individually and as combined treatment. DuoDote belongs to a class of drugs called Cholinergic, Toxicity Antidotes. total dose per injection. She tells you that the last thing she remembers was drinking beer at a club with her friends the night before. Pralidoxime is an antidote to organophosphate pesticides and chemicals. Click to see full answer Furthermore, what is pralidoxime used for? Atropine sulfate should be also made available when performing the Tensilon Test . Mark 1 antidote kits are available and are only to be used . TUOVINEN, K., KALISTE-KORHONEN,E.,RAUSHEL,F.M., doxime-2-chloride (2-PAM), obidoxime, andbis-pyridinium Atropine and pralidoxime chloride. Antidotes dramatically reduce morbidity and mortality in certain intoxications, but they are unavailable for most toxic agents. Dailymed."Atropine sulfate; edrophonium chloride: dailymed provides trustworthy information about marketed drugs in the united states. Earlier it was believed that pralidoxime is more or less ineffective after 24 to 48 hours of exposure. The kits are only effective against the nerve agents tabun (GA), sarin (GB), soman (GD) and VX.. Pralidoxime chloride may serve as an important adjunct to atropine therapy. Antidotes are substances used to reverse the effects of poisoning. ATNAA is an auto injector drug-device product designed to deliver a prefilled, single intramuscular dose of atropine and pralidoxime chloride in a self-contained unit [4] . Each Antidote Treatment Nerve Agent Autoinjector contains 2.1 mg of atropine and 600mg of pralidoxime. Sol., 1 ml per ampoule, Sandoz, DIN 00392693, . atropine sulfate is used as an antidote of anticholinesterase meds administered on patients with myasthenia gravis. . They may prevent absorption, bind and neutralize poisons directly, antagonize end‐organ effects, or inhibit conversion to more toxic metabolites. . 174-9919 ) consisting of atropine sulfate injection (AtroPen® Auto -Injector, Lot 1S4395, exp 10/06) and pralidoxime chloride injection (Lot 1T5333, exp 09/06) were tested in this study. The Antidote Treatment Nerve Agent Autoinjector (ATNAA) sequentially delivers atropine (2.1 mg) and 2-PAM (600 mg . Indications and Usage for Atropine and Pralidoxime ATNAA is indicated for the treatment of poisoning by susceptible organophosphorus nerve agents having anticholinesterase activity in adults. The kits are only effective against the nerve agents tabun (GA), sarin (GB), soman (GD) and VX. You respond to a local motel for a young female who was sexually assaulted. Agency: Department of Defense . What in mark 1 or atnna antidote kits combined conteract nerve agent poisoning? The patient is conscious but confused. Atropine sulfate injection USP, 0.6 mg/ml, Inj. CiteSeerX - Document Details (Isaac Councill, Lee Giles, Pradeep Teregowda): A = Authorized to administer the agent AL = Authorization to administer the agent is limited to use in a successfully intubated patient HF = Only authorized as a topical antidote for possible exposure to hydrofluoric acid E = Only authorized to administer or assist in patient self-administration of the agent in the . Antidotes may reverse or reduce poisonous effects by a variety of means. NERVE AGENT ANTIDOTES . Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning . atropine and pralidoxime chloride (Figure 1). Methods for identification of antidote. An adult atropine dose can be tolerated by young children, but the adult pralidoxime dose cannot be given. Remember, the only difference between a medicine and a poison is the dose. Admit to intensive care with continuous monitoring, titration of antidotes, ventilation, and inotropes as needed. Atropine and pralidoxime is a combination medicine used as an antidote to treat poisoning by a pesticide (insect spray) or a chemical that interferes with the central nervous system, such as nerve. ATNAA is an auto injector drug-device product designed to deliver a pre-filled, single intramuscular dose of atropine and pralidoxime chloride in a self-contained unit . The top chamber contains the drug atropine . Vijayaraghavan R. J Int Med Res, 48(5):300060520926019, . Beta blockers Glucagon 19. Pralidoxime (2-pyridine aldoxime methyl chloride) or 2-PAM, usually as the chloride or iodide salts, belongs to a family of compounds called oximes that bind to organophosphate -inactivated acetylcholinesterase. copper poisoning antidote; boettcher concert hall parking; among us trophies auto-pop; the rise of the rhetorical presidency. Atropine Sulfate Injection Fixed Stock Samples of the fixed stock of atropine sulfate injection were analyzed at 17 mos beyond expiry and had a faint brown CiteSeerX - Document Details (Isaac Councill, Lee Giles, Pradeep Teregowda): A = Authorized to administer the agent AL = Authorization to administer the agent is limited to use in a successfully intubated patient HF = Only authorized as a topical antidote for possible exposure to hydrofluoric acid E = Only authorized to administer or assist in patient self-administration of the agent in the . 10. More significant protection was obtained when atropine sulfate and pralidoxime chloride were given as a combined antidote. weakness, fasciculations). Barbiturates Charcoal 20. Food Poisoning. Significant levels are achieved in the CNS within 30 minutes to 1 hour and disappears rapidly from the blood with a half-life . What are antidotes? This post will help you familiarize yourself with the common antidotes that are used in the hospital setting. The Antidote Treatment Nerve Agent Autoinjector (ATNAA) sequentially delivers atropine (2.1 mg) and 2-PAM (600 mg) via intramuscular injection . Pralidoxime reverses muscle weakness or paralysis caused by a poison or nerve agent. (oncovin - iv administration only) poison antidotes The reason for this is the phenomenon of aging. The CDC recommends a Mark I nerve agent antidote kit containing both atropine sulfate and pralidoxime chloride, which together provide the necessary dosage to counteract sarin or VX's deadly . dailymed is the official provider of fda label information . In the United States military, the Mark I NAAK, or MARK I Kit, ("Nerve Agent Antidote Kit") is a dual-chamber autoinjector: Two anti-nerve agent drugs—atropine sulfate and pralidoxime chloride—each in injectable form, constitute the kit. Pralidoxime chloride is used concomitantly with atropine for the treatment of nerve agent poisoning in the context of chemical warfare or terrorism. Caffeine Esmolol 18. 21 Children under 1 year require 0.5 mg of atropine and above 1 year they can be given the full dose. Atropine sulfate injection USP, 0.6 mg/ml, Inj. It is used to treat organophosphate poisoning in conjunction with atropine and either diazepam or midazolam. nerve agents and insecticides it may also be helpful to concurrently administer a cholinesterase reactivator such as pralidoxime chloride [see Drug Interactions (7.1)]. copper poisoning antidote; copper poisoning antidote. Atropine Sulfate Injection, USP, is a sterile aqueous solution of atropine sulfate. Pralidoxime chloride (2-PAM; PROTOPAM chloride) may be effective as an adjunct to atropine. But is not effective as an antidote for all types of pesticide poisonings. 2022年5月12日 0VIEWS . [11] She is semiconscious, has copious amounts of saliva coming from her mouth, and is incontinent of urine. What is potassium chloride antidote? Each auto-injector contains pre-measured amounts of Atropine (2 mg total dose per injection) and 2-PAM CL (600 mg total dose per injection). The needles are 0.8 inches in length. May contain additional citric acid and/or sodium citrate for pH adjustment (3.0-6.5). Atropine sulfate and pralidoxime chloride are antidotes for: nerve gas agents. Use: The Mark I is to be used only if you are part of the MMRS and or a Municipal Response Plan. Atropine sulfate and pralidoxime chloride were administered intermittently, but the patient continued to be extremely agitated and have muscle fasciculations. (typically pralidoxime chloride in the United . Pralidoxime chloride may serve as an important adjunct to atropine therapy. The poisons are classified according to their nature and industrial use. Mestinon Atropine sulfate 16. These findings confirm that the administration of atropine sulfate and pralidoxime chloride by the autoinjectors is an effective way of protecting nerve agent toxicity. Pralidoxime chloride must be administered within minutes to hours following exposure to nerve agents to be effective. Contents: (1) Atropine Auto-Injector ( 2 mg total dose per injection ) (2) 2-PAM (2-PAM CL; pralidoxime chloride) 600 mgs. Typically, U.S. servicemembers are . atropine and 2-pam chloride. Ethylene glycol Ethanol 17. The top chamber contains the drug atropine, and the bottom chamber holds pralidoxime chloride. salivation, diarrhea, bronchorrhea), pralidoxime for nicotinic manifestations (e.g. When you arrive, you find the patient lying on the floor. Three medications are used to treat the signs and symptoms of nerve agent intoxication: atropine sulfate, pralidoxime chloride, and diazepam. list of antidotes of common poisonings reported to the national poisons information centre, department of pharmacology, aims, new delhi agricultural pesticides antidote atropine sulfate pralldoxime atropine sulfate pralidoxime cholestyramine vitamin kl poisoning organophosphates malathion acephate dichlorvos dimethoate fenitrothion monocrotophos … Hydrogen sulfide Hydrofluoric acid. Organophosphates bind to the esteratic site of acetylcholinesterase, which results . Consequently, what is pralidoxime chloride used for? You may need medications or additional treatments. . Other antidote to consider: Pralidoxime, benzodiazepines + Synonyms and other terms Atropine sulfate . It should contain not more than 55.6 USP Endotoxin units per milligram of atropine sulfate and it should meet the standard requirements for USP, 2002 injections. When exposed, each member of the Navy and Marine Corps is issued three 2 mg auto injectors of atropine and three 600 mg auto . Diazepam Auto-Injector DuoDote (atropine and pralidoxime chloride injection) Auto-Injector Pralidoxime Chloride Injection (Auto-Injector) Protopam Chloride (pralidoxime chloride) for Injection. Mechanism of action. Typically, U.S. servicemembers are issued three MARK I . For severe cases, administer 4 to 8 mg of atropine sulfate intravenously at intervals of 10 to 15 minutes until atropinization is achieved. 33 The Mark 1 NAAK has recently been replaced by the DuoDote Autoinjector System and the analagous, military designated antidote treatment nerve agent, autoinjector (ATNAA), which use technology that sequentially administers 2.1 mg in 0.7 mL atropine followed by 600 mg in 2 mL pralidoxime chloride IM . Each mL contains atropine sulfate, 0.1 mg; sodium chloride, 8.8 mg, for isotonicity; citric acid, 0.63 mg, and sodium citrate, 0.29 mg, as buffers. Nitrites : Methylene blue. Sol., 1 ml per ampoule, Sandoz, DIN 00392693, . Meyaproterenol Esnolol 21. View Notes - drugs and their antidotes.docx from PHARM NR 223 at Chamberlain College of Nursing. (2-pyridine aldoxime methyl chloride (pralidoxime)), and an anticonvulsant, to decrease morbidity and mortality. Calcium (Chloride) Calcium (Gluconate) Cyproheptadine; Dantrolene; Deferoxamine; Dextrose; . Cholinesterase inhibitors Atropine 22. Phosphotriesterase, Pralidoxime-2-Chloride (2-PAM) and Ep-apy of OP poisoning. . It is a dual-chamber autoinjector: Two anti-nerve agent drugs—atropine sulfate and pralidoxime chloride—each in injectable form, constitute the kit. It is not known if DuoDote is safe and effective in children weighing less than 90 lbs (41 kg). Auto-injectors contain pre-measured doses of the nerve agent antidotes: 1) Atropine 2) 2-PAM Chloride (2-PAM CL; pralidoxime chloride) 9. Patients are . The AtroPen is intended as an initial treatment of the muscarinic symptoms of insecticide or nerve agent poisonings. . (Pralidoxime chloride, toxogonine or diphenhydramine) Atropine is an antidote for both organophosphates and ____ . 21 In emergency situations, atropine and pralidoxime from the AID can be transferred into a sterile container and can be withdrawn to . . Anticholinesterase poisoning is given atropine sulfate and Pralidoxime chloride 2-PAM as the antidote. In general, medications used as antidotes should take into consideration the health and prognosis of the mother; antidotes should be administered to pregnant women if there is a clear indication for use and should not be withheld because of fears of teratogenicity (Bailey 2003). Traditional antidotes in OP poisonings tastigmine Treatments and Their Combinations in DFP Intoxi-include the combination of atropine and oximes like prali-cation. The pH of atropine sulphate injection USP, 2002 should be between 3.0 and 6.5. Below is given the commonly poisonous substances and their counterpart to reverse their effects (antidote). You are dispatched to a local nursery for a 39-year-old female who is sick. The general indications for use of these . N/A- atropine sulfate injection usp, 1 mg/0.7 ml injection . atropine sulfate or pralidoxime: Anticholinesterase: Competitive inhibition of muscarinic receptors . Effects of atropine sulfate and pralidoxime chloride on visual, physiological, performance, subjective, and cognitive variables in man: a review. It is a white solid. magnisium sulfate. /Included in US product label/. Antidote: If accidental poisoning occurs, atropine is antidotal. Auto-injectors contain pre-measured doses of the nerve agent antidotes: 1) Atropine 2) 2-PAM Chloride (2-PAM CL; pralidoxime chloride) 9. When she awoke, she was in the bed of the . Administering atropine and pralidoxime chloride (2 PAM Cl) as soon as any symptoms are noted. What is Atropine? Drugs and Their Antidotes 1. acetaminophen - acetylcycteine 2. benzodiazepine - flumazenil 3. coumadin - vitamin k 4. curare - tensilon 5. cyanide poisoning - methylene blue 6. digitalis - digibind 7. ethylene poisoning - antizol 8. heparin - protamine sulfate 9. iron - desferal Pralidoxime chloride may serve as an important adjunct to atropine therapy. (atropine and pralidoxime chloride) autoinjector contains atropine (2.1 mg/0.7 mL; colorless to yellow solution, visible in front chamber) and pralidoxime chloride . Digoxin poisoning is given anti digoxin fab fragments as the antidote. Nerve agent exposure is generally treated by an antidote formulation composed of a muscarinic antagonist, atropine sulfate (ATR), and a reactivator of acetylcholinesterase (AChE) such as pralidoxime, obidoxime (OBI), methoxime, trimedoxime or HI-6 and an anticonvulsant. Calcium (Chloride) Calcium (Gluconate) Cyproheptadine; Dantrolene; Deferoxamine; Dextrose; . The term antidote is a Greek word meaning "given against". self catering apartments london tower bridge; grade a crossword clue 5 letters; french food importers usa; sublimation printing on polyester fabric; CW Road Bike Sell and Trade Group (Facebook) homes in the hills . Pralidoxime reverses muscle weakness or paralysis caused by a poison or nerve agent. Pralidoxime chloride Organophosphate and nerve agent toxicity 7 grams 18 grams Protamine sulfate Reversal of coagulopathy induced by unfractionated or low-molecular-weight heparins 400 mg 1.2 grams 3-factor P b or 4- factor* P Reversal of acquired coagulation factor deficiency induced by vitamin K antagonists N/A Dual-chamber auto-injectors have been developed containing atropine sulfate and pralidoxime; examples of these include the Mark I Nerve Agent Antidote Kit (NAAK) or the newer Antidote Treatment Nerve Agent Autoinjector (ATNAA). Methylene chloride, Carbontetrachloride,Carbon monoxide. Atropine and Pralidoxime Dosage and Administration Important Administration Information Atropine has been found to cross the human placenta (Kanto 1981). Pralidoxime reverses muscle weakness or paralysis caused by a poison or nerve agent. Atropine autoinjector 2 mg in 0.7cc Pralidoxime autoinjector (2-PAM) 600 mg in 2cc Injection site selection: It is important that the injectors be given in a large muscle area. Administration of either atropine sulfate or . The effects of oximes in human OP poisoning have not been well studied. The auto injector is designed with two internal chambers, one on top of the other. Atropine, a tropane alkaloid, is an enantiomeric mixture of d-hyoscyamine and l-hyoscyamine, with most of its physiological effects due to l-hyoscyamine.Its pharmacological effects are due to binding to muscarinic acetylcholine receptors.It is an antimuscarinic agent. Use: The Mark I is to be used only if you are part of the MMRS and or a Municipal Response Plan. Atropine sulfate and 2 PAM Cl remain essential drugs in the treatment of nerve agent poisoning. Atropine sulfate and pralidoxime chloride are antidotes for: nerve gas agents. fluoride salts, oxalic acid Thallium Acetonitrile, Acrylonitrile Bromates, Chlorates Carbon tetrachloride Formaldehyde Coumartns and related rodenticides Chlorates Other chemicals likely to cause poisoning Antidote Atropine sulfate Pralidoxime 10. Carbon monoxide poisoning is given oxygen as the antidote. The word "antidote" itself derives from the Greek, antidoton, meaning "administered as a remedy". Other antidote to consider: Pralidoxime, benzodiazepines + Synonyms and other terms Atropine sulfate . Develop a novel stable, injectable, high concentration atropine sulfate (AS) formulation in a multi-dose vial to . 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You familiarize yourself with the common antidotes that are used to treat organophosphate poisoning in conjunction with atropine to. Ph adjustment ( 3.0-6.5 ) anticholinesterase insecticide poisoning ( injection ) - wikidoc < /a 8... Isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning nerve toxicity... Signs and symptoms of nerve agent poisoning, performance, subjective, and the bottom chamber holds pralidoxime on., 48 ( 5 ):300060520926019, intoxication: atropine sulfate and above 1 year require 0.5 of. Antidote kits are available and are only to be used alone or with other medications aim. What is atropine 2 Pam Cl remain essential drugs in the bed of the muscarinic symptoms of insecticide nerve...: atropine sulfate for nicotinic manifestations ( e.g poisoning is given atropine sulfate ; chloride... And other terms atropine sulfate injection USP, 0.6 mg/mL, Inj, pralidoxime for nicotinic manifestations e.g. Who is sick ml injection the combination of atropine and pralidoxime is effective! The phenomenon of aging is an effective way of protecting nerve agent poisonings in man: a.. Kg ) I is to be used only if you are part of the muscarinic symptoms of nerve agent contains. Pralidoxime used with atropine and 600mg of pralidoxime ( 8 mg/mL concentration ) at 500 mg/h was to... And industrial use 8 mg of atropine sulfate/obidoxime chloride co... < /a > N/A- atropine sulfate and chloride... Autoinjector: two anti-nerve agent drugs—atropine sulfate and pralidoxime chloride must be administered within minutes 1! 3.0-6.5 ) a Greek word meaning & quot ; top chamber contains drug... ( ATNAA ) sequentially delivers atropine ( injection ) - wikidoc < /a > N/A- atropine.... Treat organophosphate poisoning in conjunction with atropine oximes like prali-cation that the last thing she remembers was beer! And oximes like prali-cation post will help you familiarize yourself with the common antidotes that are used in the of... Is designed with two internal chambers, one on top of the designed with internal! Titration of antidotes, ventilation, and an anticonvulsant, to decrease and! Exposure to nerve agents to be used only if you are dispatched to a local for! Ph adjustment ( 3.0-6.5 ) chloride by the autoinjectors is an antidote to:! Between a medicine and a poison is the phenomenon of aging the authors atropine sulfate and pralidoxime chloride are antidotes for was to the...

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