USMLE Atropine vs Pralidoxime (First Aid vs Sketchy)

[MDScribe]

I’m having some trouble understanding the difference between Atropine and Pralidoxime when it comes to reversing organophosphate poisoning. More specifically, how do they differ when it comes to central/peripheral effects.

First Aid (2017, Page 233) has the following listed under Atropine: “Blocks DUMBBeLSS in cholinesterase inhibitor poisoning. Does not block excitation of skeletal muscle and CNS (mediated by nicotinic receptors).”

SketchyPharm (1.2, Acetylcholinesterase Inhibitors): “Atropine Alice is in your head: atropine reverses both peripheral and CENTRAL muscarinic toxicity from organophosphate poisoning (pralidoxime is peripheral only)”

What am I missing here...

Thanks for your help working through this one!

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[Gorne]

first aid is right.

 

[mw18]

UW says that if you give atropine they would still have the peripheral muscular effects, so I think First Aid is right as well.