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history and clinical suspicion Along similar lines, serum drug levels not predict the degree of anticholinergic symptoms GI decontamination with activated charcoal may be valuable beyond an hour after anticholinergic poison ingestion because of the likelihood of extended drug persistence in the gut lumen On the basis of presenting signs and symptoms, the patient may require sedation and monitoring in an intensive care unit setting to provide ventilatory support for coma, anticonvulsants for seizures, and antiarrhythmic drugs for cardiac dysrhythmias Adequate sedation may be achieved with titrated doses of benzodiazepines Physostigmine, a potent anticholinesterase, is a recognized antidote for anticholinergic-induced mental status alterations and can be very effective in the correct clinical setting; however, its use is controversial Physostigmine can produce bronchospasm, bradycardia, hypotension, and seizures It is therefore reserved for those who have normal EKGs (QRS duration less than 100 ms) and life-threatening delirium Most such patients will respond to supportive care and benzodiazepines The adult dose is to mg via slow IV infusion over minutes The trial dose can be repeated in 10 to 15 minutes up to a maximum of mg The pediatric dose is 0.5 mg IV administered slowly, with repeat every 10 minutes up to a maximum of mg The smallest effective dose may be repeated every 30 to 60 minutes if symptoms recur over to hours The muscarinic toxicity of physostigmine may be treated with IV atropine at one-half the physostigmine dose given; physostigmine-related seizures may be treated with benzodiazepines Central Nervous System Sedative-Hypnotics Current Evidence The sedative-hypnotics have tranquilizing, euphoriant effects that may be similar to morphine With all these agents—prescribed for this tranquilizing action—it is difficult to draw the line between appropriate use, abuse, habituation, and addiction However, for all, tolerance is common and physical dependence quickly develops Therefore, their abuse potential is considered high Many of these agents, including glutethimide, meprobamate, methaqualone, and barbiturates, are uncommonly available and have been replaced by the benzodiazepines Because they have retained some popularity and still make periodic appearances on the streets, however, they should be included in discussions of such drugs For all sedative-hypnotics, patterns of abuse vary, ranging from infrequent sprees of intoxication to compulsive daily use Introduction may be through street