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This week, we will look at blister agents and nuclear 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
Blister Agents
Blister agents, or vesicants, are potent alkylating agents that produce scarring blisters,
eye damage, and airway damage. They include lewisite, nitrogen mustard, and phosgene
oxime. Treatment may include the application of topical silver sulfadiazine or topical
mafenide acetate.
Only one blister agent, lewisite, has an antidotal compound (dimercaprol), which acts as a chelating agent for arsenicals and other heavy metals. Dimercaprol skin and eye ointment applied to victims after decontamination may reduce the severity of lesions.
Dimercaptosuccinic acid has been used successfully in animals for the treatment of lewisite
exposure and lead ingestion. Available in 100-mg capsules, dimercaptosuccinic acid can
be administered orally to treat multiple exposures to blister agents. Formulations that
counteract the effects of blister agents include (1) silver sulfadiazine cream, (2) mafenide
acetate cream, (3) dimercaprol injection, (4) dimercaprol ointment, and (5) dimercaptosuccinic
acid 100-mg capsules.
Nuclear Agents
Dirty bombs, conventional explosives used to spread hazardous radioactive material, might be involved in a terrorist attack. Radioactive materials can emit three types of harmful radiation:
α (alpha), β (beta), and γ (gamma). Inhalation or ingestion of α or β particles poses the greatest hazard. The most harmful type overall, γ rays, can penetrate most sheltering material in a wide area.
Exposure to a harmful radiological agent may require treatment with a chelator or a radionuclide blocker. Some general radionuclide chelating agents are penicillamine (Cuprimine), edetate calcium disodium (Calcium Disodium Versenate), dimercaprol (British anti-Lewisite, or BAL), succimer (Chemet), and deferoxamine (Desferal). (Colony-stimulating factors may be considered in patients experiencing significant bone-marrow suppression.) Information about this specialized class of drugs can be obtained 24 hours a day from the Radiation Emergency Assistance Center/Training Site (https://orise.orau.gov/reacts/), telephone 865-576-3131, or 865-576-1005 for emergencies.
A variation of radionuclide chelation to entrap and remove the radioactive agent is the use of radionuclide-blocking agents. These agents saturate tissues with a nonradioactive element that reduces the uptake of radioactive iodine. The most commonly known radionuclide-blocking agents are potassium iodide tablets and Lugol's solution, both of which reduce the uptake of radioactive iodine by thyroid tissue.
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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