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Multiple Choice

What is the antidote for a Tensilon-induced cholinergic crisis?

Tensilon (edrophonium) briefly inhibits acetylcholinesterase, causing excess acetylcholine and a cholinergic crisis with prominent muscarinic symptoms such as excessive secretions, bronchorrhea, bronchospasm, bradycardia, and GI cramping. The way to rapidly counter these muscarinic effects is with atropine, which blocks acetylcholine from binding to muscarinic receptors and reverses the problematic symptoms. It doesn't fix the enzyme inhibition itself or directly address nicotinic symptoms, but it promptly mitigates the life-threatening muscarinic manifestations as the edrophonium effect wears off. Pralidoxime would help only for organophosphate poisoning by reactivating phosphorylated acetylcholinesterase, not for a reversible inhibitor like edrophonium; naloxone treats opioid overdose, and epinephrine doesn’t specifically counteract the cholinergic crisis. So atropine is the appropriate antidote.

Tensilon (edrophonium) briefly inhibits acetylcholinesterase, causing excess acetylcholine and a cholinergic crisis with prominent muscarinic symptoms such as excessive secretions, bronchorrhea, bronchospasm, bradycardia, and GI cramping. The way to rapidly counter these muscarinic effects is with atropine, which blocks acetylcholine from binding to muscarinic receptors and reverses the problematic symptoms. It doesn't fix the enzyme inhibition itself or directly address nicotinic symptoms, but it promptly mitigates the life-threatening muscarinic manifestations as the edrophonium effect wears off. Pralidoxime would help only for organophosphate poisoning by reactivating phosphorylated acetylcholinesterase, not for a reversible inhibitor like edrophonium; naloxone treats opioid overdose, and epinephrine doesn’t specifically counteract the cholinergic crisis. So atropine is the appropriate antidote.