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This week, we will look at blood, nerve, and lung agents
Terrorists may use:
- chemical agents, including blistering agents
- choking agents
- biological agents
- blood agents
- nerve agents
- lung agents
- blister agents
- nuclear agents
Blood Agents
Blood agents produce their effects by interfering with oxygen use at the cellular level. Certain types of cyanide are referred to as blood agents. Nitrite is the common ingredient used to displace cyanide from the oxygen that carries hemoglobin after contact with a blood agent has occurred. Other pharmaceuticals that serve as adjunctive therapy for cyanide poisoning are injectable sodium bicarbonate, which can correct metabolic acidosis, and benzodiazepines (e.g., diazepam, lorazepam), which are used as anticonvulsants. Formulations that counteract the effects of blood agents include (1) sodium nitrite 3% injection, (2) sodium thiosulfate 25% injection, (3) sodium bicarbonate 8.4% injection, (4) diazepam 5-mg/mL injection, and (5) lorazepam 2-mg sublingual tablets.
Nerve Agents
Nerve agents are organophosphorus cholinesterase inhibitors and include the organophosphate agent, Novichok. Chemotherapeutic intervention generally consists of the use of three antidotal agents: (1) atropine sulfate, which blocks muscarinic receptor sites; (2) pralidoxime chloride, which regenerates cholinesterase activity; and (3) diazepam or lorazepam, both of which are used as anticonvulsants. Topical ophthalmic homatropine or atropine can be used to relieve dim vision, pain, and possible nausea. Formulations to counteract the effects of nerve agents include (1) pralidoxime chloride injection (1-g vial), (2) atropine sulfate 1-mg/mL injection, and (3) diazepam 5-mg/mL injection.
Lung Agents
Chemical agents that attack lung tissue are also referred to as pulmonary agents or choking agents. They inflict injury on the respiratory tract, including the nose, throat, and especially the lungs. Victims typically inhale these agents, which can all lead to pulmonary edema and respiratory failure. These agents include chlorine and phosgene, deadly and unpredictable gases that were used in World War I. Because they have many industrial applications, pulmonary agents are readily available to terrorists in large quantities. No specific antidotes exist for these lung and eye irritants, but supportive care may include the use of bronchodilators such as nebulized albuterol sulfate or sodium bicarbonate. Methylprednisolone acetate injection also has been used as supportive therapy to counteract the effects of these agents. Formulations that counteract the effects of pulmonary agents include (1) albuterol sulfate 0.5% inhalation solution, (2) sodium bicarbonate 3.75% inhalation solution, and (3) methylprednisolone acetate 40-mg/mL injection.
More 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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