Cholinoceptor-Activating & Cholinesterase-Inhibiting Drugs
stimulants and cholinesterase inhibitors make up a large group of drugs that
mimic acetylcholine (cholinomimetic agents) (Figure 7–1). Cholinoceptor
stimulants are classified phar-macologically by their spectrum of action,
depending on the type of receptor—muscarinic or nicotinic—that is activated.
Cholino-mimetics are also classified by their mechanism of action because some
bind directly to (and activate) cholinoceptors whereas others act indirectly by
inhibiting the hydrolysis of endogenous acetylcholine.
In mid-afternoon, a coworker brings 43-year-old JM to the emergency department because he is unable to continue pick-ing vegetables. His gait is unsteady and he walks with support from his colleague. JM has difficulty speaking and swallow-ing, his vision is blurred, and his eyes are filled with tears. His coworker notes that JM was working in a field that had been sprayed early in the morning with a material that had the odor of sulfur. Within 3 hours after starting his work, JM complained of tightness in his chest that made breathing dif-ficult, and he called for help before becoming disoriented.
How would you proceed to evaluate and treat JM? What should be done for his coworker?