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In this issue, we will look at Chemical Agents, Choking Agents, and Biological Agents.
Causative Agents
Terrorists may use:
- chemical agents, including blistering agents
- choking agents
- biological agents
- blood agents
- nerve agents
- lung agents
- blister agents
- nuclear agents
Chemical Agents
The availability, extreme toxicity, and rapid onset of action of many chemical agents have
made them desirable to terrorists. Agents of chemical warfare are commonly classified as:
- blood agents (cyanogen chloride, hydrogen cyanide)
- nerve agents (sarin, soman, tabun)
- lung agents (diphosgene, phosgene) or
- blister agents (lewisite, mustard gas, and phosgene oxime)
Choking Agents
Choking agents, include:
- nerve agents (mustard gas, sarin gas, soman, tabun, VX)
- cyanide
Biological Agents
Biological agents used as weapons may include:
- bacteria (e.g., those causing anthrax, brucellosis, plague, Q fever, tularemia),
- toxins (e.g., botulinum toxin, ricin, staphylococcal enterotoxin B), and
- viruses (e.g., those causing smallpox, Lassa fever, Rift Valley fever, and Venezuelan equine encephalomyelitis).
Genetic engineering is expanding the list of potential agents for use in terrorism. Novel forms of agents, including multidrug-resistant organisms, may be made available in vast quantities.
Dissemination
Biological agents may be disseminated through the use of conventional explosives or aerosol generators (aircraft, cruise missiles, mail) or through contamination of the food or water supply. Exposure may occur by the pulmonary (plague, Q fever, staphylococcal enterotoxin B) or systemic (botulinum toxin, viruses) route or through person-to-person (smallpox, pneumonic plague) or vector (plague, Rift Valley fever) contact.
Biological terrorism could involve sophisticated or unsophisticated techniques (i.e., use of dried anthrax spores or botulinum toxins or use of Salmonella or other common bacteria, respectively). Unlike chemical nerve agents, which can cause immediate death or severe injury at the site of attack, biological agents cause delayed signs and symptoms because of their incubation periods. If used against unsuspecting, nonimmune civilian populations, biological weapons could enable terrorists to cause a large number of casualties and create international panic.
In the event of an attack, frontline clinicians and primary-care practitioners will need to identify and manage exposed patients. Pharmacists will need to be knowledgeable about diseases caused by biological agents and about patient management, vaccines, and potential chemotherapeutic agents, so that they can educate the public and other healthcare practitioners.
Many oral and injectable medications, in extraordinarily large amounts, may be needed to treat an outbreak of illness caused by a biological weapon. The art, science, and technology of Pharmaceutical Compounding will depend on the duration of illness, the virulence of an outbreak of disease, and the number of patients affected. Uncommonly used vaccines and antitoxins should be prepositioned with the assistance of federal government storage and distribution programs.
Continued next week.
Loyd V. Allen, Jr., PhD, RPh
Editor-in-Chief
International Journal of Pharmaceutical Compounding
Remington: The Science and Practice of Pharmacy Twenty-second edition
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