Editing Nerve agent (section)

===Treatment===
Standard treatment for nerve agent [[Organophosphate poisoning|poisoning]] is a combination of an [[anticholinergic]] to manage the symptoms, and an [[oxime]] as an antidote.<ref>{{cite news |last1=Scutti |first1=Susan |title=Treatment for the Soviet-era nerve gas Novichok |url=https://www.cnn.com/2018/07/05/health/treating-patients-poisoned-with-novichok/index.html |work=CNN |date=5 July 2018 }}</ref> Anticholinergics treat the symptoms by reducing the effects of acetylcholine, while oximes displaces phosphate molecules from the [[active site]] of the [[cholinesterase]] enzymes, allowing the breakdown of acetylcholine. Military personnel are issued the combination in an [[autoinjector]] (e.g. [[ATNAA]]), for ease of use in stressful conditions.<ref name=":4">{{Cite web|date=17 January 2002|title=ATNAA Factsheet|url=https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21175_Atnaa_prntlbl.pdf|access-date=27 July 2020|website=FDA}}</ref>

[[Atropine]] is the standard anticholinergic drug used to manage the symptoms of nerve agent poisoning.<ref name=":1">{{Cite web|url=https://fas.org/nuke/guide/usa/doctrine/army/mmcch/NervAgnt.htm|title=NERVE AGENTS|date=2018-03-08|website=fas.org|archive-url=https://web.archive.org/web/20171212112437/https://fas.org/nuke/guide/usa/doctrine/army/mmcch/NervAgnt.htm|archive-date=2017-12-12}}</ref> It acts as an antagonist to [[muscarinic acetylcholine receptor]]s, blocking the effects of excess acetylcholine.<ref name=":4" /> Some synthetic anticholinergics, such as [[biperiden]],<ref name="pmid10877003">{{cite journal | vauthors = Shih TM, McDonough JH | title = Efficacy of biperiden and atropine as anticonvulsant treatment for organophosphorus nerve agent intoxication | journal = Archives of Toxicology | volume = 74 | issue = 3 | pages = 165–72 | date = May 2000 | pmid = 10877003 | doi=10.1007/s002040050670| s2cid = 13749842 }}</ref> may counteract the central symptoms of nerve agent poisoning more effectively than atropine, since they pass the [[blood–brain barrier]] better.<ref>{{cite journal |last1=Shih |first1=T.-M. |last2=McDonough |first2=J. H. |title=Efficacy of biperiden and atropine as anticonvulsant treatment for organophosphorus nerve agent intoxication |journal=Archives of Toxicology |date=19 May 2000 |volume=74 |issue=3 |pages=165–172 |id={{DTIC|ADA385192}} |doi=10.1007/s002040050670 |pmid=10877003 }}</ref> While these drugs will save the life of a person affected by nerve agents, that person may be incapacitated briefly or for an extended period, depending on the extent of exposure. The endpoint of atropine administration is the clearing of bronchial secretions.<ref name=":1" />

[[Pralidoxime chloride]] (also known as ''2-PAMCl'') is the standard oxime used to treat nerve agent poisoning.<ref name=":1" /> Rather than counteracting the initial effects of the nerve agent on the nervous system as does atropine, pralidoxime chloride reactivates the poisoned enzyme (acetylcholinesterase) by scavenging the phosphoryl group attached on the functional hydroxyl group of the enzyme, counteracting the nerve agent itself.<ref name="pmid11978898">{{cite journal | vauthors = Eddleston M, Szinicz L, Eyer P, Buckley N | title = Oximes in acute organophosphorus pesticide poisoning: a systematic review of clinical trials | journal = QJM | volume = 95 | issue = 5 | pages = 275–83 | date = May 2002 | pmid = 11978898 | pmc = 1475922 | doi=10.1093/qjmed/95.5.275}}</ref> Revival of acetylcholinesterase with pralidoxime chloride works more effectively on [[nicotinic receptors]] while blocking acetylcholine receptors with atropine is more effective on [[muscarinic receptors]].<ref name=":1" />

[[Anticonvulsant]]s, such as diazepam, may be administered to manage seizures, improving long term prognosis and reducing risk of brain damage.<ref name=":1" /> This is not usually self-administered as its use is for actively seizing patients.<ref>{{Cite web|title=Nerve Agent Treatment – Autoinjector Instructions – CHEMM|url=https://chemm.nlm.nih.gov/antidote_nerveagents.htm|access-date=2020-07-27|website=chemm.nlm.nih.gov|language=en}}</ref>