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contraindicated because of the risk of bag rupture Instead, decontamination is confined to administration of activated charcoal and WBI, though in some cases surgical removal may be indicated Because cocaine bags and crack vials are radiopaque in up to 50% of cases, an abdominal radiograph is recommended to determine the location and extent of retained packets after decontamination has been initiated A contrast study or computed tomography scan may be considered to improve detection In the event of severe intoxication or ingestion of more than to g of cocaine, transfer to the intensive care unit for appropriate monitoring Central Anticholinergics Current Evidence Increasingly, drugs, plants, and mushrooms with anticholinergic properties are ingested for their psychoactive effects Because antidepressants, antihistamines, antispasmodics, and belladonna alkaloids are in widespread use, these compounds are more readily available than illicit psychoactive substances Also, many OTC drugs possess anticholinergic activity and are ingested to get “high.” These agents are competitive antagonists with acetylcholine at the neuroreceptor site ( Table 102.21 ) The major effects of these drugs are on the myocardium, CNS, smooth muscle, and exocrine glands The effects of anticholinergics vary according to the specific drug ingested, particularly because the many classes of drugs lead to secondary actions that are independent of anticholinergic actions An important universal anticholinergic effect, however, is decreased GI motility This is associated with delayed absorption of drug and, if GI decontamination is not performed, the appearance of severe toxicity may be delayed 12 to 24 hours after ingestion