Cholinergic Agents

Your Path

  • Cholinergic Agents


  • Organophosphate insecticide overdose or exposure
  • Inhibits cholinesterase, causing increased levels of acetylcholine

Risk Factors

  • Accidental (exposure via working w/pesticides, farmworkers)
  • Intentional (suicide attempt)
  • Biological weapons, terrorism → Sarin


  • Multiple acute symptoms, related to acetylcholine excess impact on various areas of nervous system
  • Muscarinic effects from over parasympathetic stimulation: blurred vision; excessive secretions including salivation, lacrimation, urination; defecation, gastric cramping, emesis, SOM from bronchorrhea, bronchospasm; bradycardia
  • Overstimulation of sympathetic ganglion: diaphoresis, tachycardia
  • Overstimulation of NMJ: profound weakness, paralysis
  • CNS effects: confusion, coma, apnea, seizures, death

Physical Exam Findings

  • Ill appearing
  • Bradycardia
  • Acute confusion
  • Lacrimation
  • Miosis
  • Sweating
  • Wheezing
  • Apnea
  • Excessive respiratory secretions
  • Weakness to paralysis; fasciculations