Organophosphates and carbamates are cholinergic agents used as insecticides and chemical warfare agents, notorious for their role in various terrorist attacks and high-profile poisonings. This chapter provides an in-depth review of these substances, detailing their toxicity, exposure routes, and clinical manifestations. Organophosphates and carbamates inhibit acetylcholinesterase, leading to a buildup of acetylcholine and a range of cholinergic symptoms. Acute poisoning can cause severe respiratory and neurological effects, with symptoms varying by exposure route and toxicity level. Management includes early decontamination, administration of antidotes like atropine and pralidoxime, and supportive care. The chapter emphasizes the importance of rapid identification and treatment to mitigate the severe health impacts of these agents, which can cause long-term effects and pose significant diagnostic challenges.