NREMT Paramedic Practice

Which drug is used to reverse cholinergic overdoses?

1. Diazepam

2. Physostigmine

3. Atropine

4. Activated charcoal

The correct answer is: Atropine

Cholinergic overdoses, often resulting from exposure to substances that stimulate the parasympathetic nervous system, can lead to severe symptoms such as excessive salivation, lacrimation, urination, diarrhea, gastrointestinal distress, and muscle twitching. In such situations, the use of atropine is crucial. Atropine is an anticholinergic agent that works by blocking the action of acetylcholine at muscarinic receptors, effectively counteracting the overstimulation caused by cholinergic toxicity. By antagonizing these receptors, atropine can diminish secretions, improve heart rate, and alleviate symptoms such as bronchospasm and bradycardia. This makes atropine the preferred choice in the management of cholinergic poisoning. Physostigmine, while it is a reversible inhibitor of acetylcholinesterase, is not typically used as an antidote for overdoses due to its potential to worsen symptoms in certain cases. Diazepam has its own indications, primarily in managing seizures, while activated charcoal serves to absorb ingested toxins but not to reverse the effects of cholinergic overstimulation.