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What is another name for the Mark-1 kit?
The NAAK: Nerve Agent Antidote Kit.
Militaries are now transitioning to an autoinjector, the ATNAA (Antidote Treatment Nerve Agent Autoinjector)
What is the functional class of the Mark-1 kit?
Atropine: parasympatholytic
Pralidoxime chloride: cholinesterase reactivator
Other oximes such as obidoxime and asoxime can also be used to restore enzyme functionality.
What is the mechanism of action of the Mark-1 kit?
- Atropine counters the parasympathetic response from muscarinic receptor over-stimulation associated with organophosphate and nerve agent poisoning, thus alleviating "SLUDGEM" symptoms.

- Pralidoxime chloride reactivates acetylcholinesterase by binding to it and subsequently releasing the phosphoryl group associated with the poisoning.
The US military issued servicemembers three Mark-1 kits with one CANA kit (Convulsive Antidote, Nerve Agent) containing diazepam.
What are the listed indications for the Mark-1 kit?
Organophosphate and nerve agent poisoning in mass casualty incidents
The Mark-1 kit is only effectve against Tabun (GA), Sarin (GB), Soman (GD) and VX.
What are the listed contraindications for the Mark-1 kit?
None in the emergency setting
Some sources list pediatric patients under the age of three as being relatively contraindicated.
What are the listed precautions for the Mark-1 kit?
- Mark-1 kits offer no prophylactic protection and should be administered only if signs and symptoms are present
- Mark-1 kits do not treat fasiculations associated with nicotinic receptor over-stimulation
Diazepam is the drug of choice for treating fasciculations.
What are the listed side effects for the Mark-1 kit?
- Dry mouth
- Flushing
- Pupil dilation
- Tachycardia
When atropine and pralidoxime are used together, these signs of atropinization may occur earlier than might be expected when atropine is used alone.
What is the dosage and route of the Mark-1 kit?
Each kit contains:
- Atropine 2mg
- Pralidoxime chloride 600mg

Minor initial symptoms:
- One Mark-1 kit IM via autoinjector

If severe symptoms appear within 10 minutes of first dose, administer an additional:
- Two Mark-1 kits IM via autoinjector

If severe symptoms are present initially administer:
- Three Mark-1 kits IM via autoinjector
The military instructs that administration (to self or others) of antidote kits should be performed after donning appropriate protective gear.
In what order are the two tubes of the Mark-1 kit administered?
Tube one (atropine) is always administered before tube two
(pralidoxime chloride).
The alternative ATNAA (Antidote Treatment Nerve Agent Autoinjector) contains the two medications separately but administers them simultaneously.