A 65-year-old male farmer presents to the emergency department with confusion, pinpoint pupils, diarrhea, vomiting, diaphoresis, and tremors, which began 12 hours prior while he was harvesting his crops. The patient has no significant medical history. His blood pressure is 100/70 mmHg, pulse 60/min, respirations 16/min, and temperature 98.0 F (36.7 C). On examination, the patient is diaphoretic, with pupils 2mm in diameter bilaterally. Diffuse muscle twitching and tremor are present. What is the most appropriate initial step in the management of this patient?

a Atropine

b Physostigmine

c Pyridostigmine

d Naloxone

Question from Pharmacology

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