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File: 970101_sep96_decls27_0011.txt
Subject: USAMRICD TECH MEMO 90 1 CLINICAL NOTES ON CHEM CASUALTY CARE
Unit: OTSG
Parent Organization: HSC
Box ID: BX003205
Folder Title: CLINICAL NOTES ON CHEMICAL CASUALTY CARE
Document Number: 1
Folder Seq #: 31
ALJG 16 '90 11:40 P. 11
ICD Technical Memorandum 90-1
te agent-enzyme complex (although atropine is still effective
tGrapy). The use of the pretreatment "protects" an amount of
enzyme from being bound by the agent and enhances the efficacy of
therapy. Use of pyridosticjmine is intended primarily for OD
(Jordan) exposure, because the present therapy is quite effective
ainst the other major nerve agents.
SM OF ACTION
ridosti@ne attaches to the enzyme acetyleholinesterase and it
p@T
9 ven in large amounts would produce effects similar to those'
@used by nerve agents. While pyridostigminia is bound to the
e@zyme the nerve agent cannot bind to it, hence pyridostigmine
"]protects" the enzyme from nerve agent. However, whereas the bond
b tween nerve agent and the enzyme is irreversible (that is, the
n:rve agent does not leave) , the pyridostigmine-enzyme bond is soon
(hours) broken and the enzyme is again uninhibited and can resume
its physiological function.
Tiere are three characteristics of pyridastigmine that enable it
t6 be useful as a pretreatment (1) the bond between
pyridostigmine and the enzyme is reversible within hours (about 6)
a@d the enzyme is freed, (2) only a fraction (20--40.%) of total
agetyloholinesterase need be inhibited by pyridostigmine to offer
significant benefit, and (3) pyridosticrmine does not enter the
central nervous system (CNS). The latter is an advantage and a
d
C@sadvantage. The advantage is that there are no side effects of
S origin. The disadvantage is that pyridostigmine does not
potect against the CNS effects (e.g., convulsions) of nerve
alents, which do penetrate the CNS.
EIFICACY
0.@ current atropine/oxime therapy will savo rhesus monkeys from
asoman challenge of 1.6 lethal doses. Based on various estimates
battlefield delivery systems it would be desirable to have
erapy for 5 lethal doses.
t
In an initial study in rhesus monkeys, when pyridostigmine was
g@ven prior to a GD (soman) challenge and atropine/oxime were given
after, the animals survived the effects of 40 lethal doses of the
a ent. in other studies, the degree of protection has not been as
hh, but has been 5--25 lethal doses.
Algimals who received pre-treatment and adequate therapy after soman
continued to have adequate spontaneous ventilation after the agent
e.osure. Hence, it is felt that immediate field ventilation will
n"P be required for those taking the pretreatment. However, these
a?imals also continued to have seizure activity and when this was
10
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Document 22 f:/Week-36/BX003205/CLINICAL NOTES ON CHEMICAL CASUALTY CARE/usamricd tech memo 90 1 clinical notes on chem c:12249609312728
Control Fields 17
File Room = sep96_declassified
File Cabinet = Week-36
Box ID = BX003205
Unit = OTSG
Parent Organization = HSC
Folder Title = CLINICAL NOTES ON CHEMICAL CASUALTY CARE
Folder Seq # = 31
Subject = USAMRICD TECH MEMO 90 1 CLINICAL NOTES ON CHEM C
Document Seq # = 1
Document Date =
Scan Date =
Queued for Declassification = 01-JAN-1980
Short Term Referral = 01-JAN-1980
Long Term Referral = 01-JAN-1980
Permanent Referral = 01-JAN-1980
Non-Health Related Document = 01-JAN-1980
Declassified = 24-DEC-1996