Plant Poisons and Digitalis Effects

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Questions and Answers

Which character is NOT associated with drug dependence?

Psychic dependence

Withdrawal symptoms

Optical tolerance (correct)

Compulsive desire to take the drug

What is a method of abusing addicting drugs that does NOT involve smoking or inhalation?

Oral consumption

Nasal insufflation

Inhalation

Intravenous injection (correct)

Which type of addict primarily uses drugs for therapeutic purposes?

Professional addicts

Therapeutic addicts (correct)

Street addicts

Congenital addicts

What is meant by 'cellular adaptation' in the context of drug dependence?

Cells adjust to the presence of a drug over time Signup and view all the answers

Which of the following symptoms typically indicates withdrawal from a drug?

Physical discomfort Signup and view all the answers

What is the primary mechanism of action of digitalis at therapeutic doses?

Elongate diastolic period and improve heart filling Signup and view all the answers

Which symptom is most commonly associated with digitalis toxicity?

Green-yellow vision Signup and view all the answers

What effect does digitalis have on potassium levels in acute toxicity?

Hyperkalemia Signup and view all the answers

Which of the following is NOT an effect of digitalis at toxic doses?

Increased contractility Signup and view all the answers

Which plant is a source of digitalis?

Digitalis purpurea Signup and view all the answers

What is the first clinical manifestation of digitalis toxicity often seen?

Gastrointestinal symptoms Signup and view all the answers

In chronic digitalis toxicity, what is usually the status of serum potassium levels?

Normal or low Signup and view all the answers

How can the need for antidotal therapy in digitalis toxicity be predicted?

By assessing blood potassium levels Signup and view all the answers

What is the recommended dose of Digibind based on a total body load of digoxin?

Body Load (mg) = (SDC ng/ml)(5.6)(wt in kg) / 1000 Signup and view all the answers

Which of the following is NOT a treatment option for digoxin toxicity?

Calcium carbonate Signup and view all the answers

What is the serious prognosis threshold for digoxin levels in ng/ml?

15 ng/ml Signup and view all the answers

Which form of cannabis contains dried resin from the flower tops?

Hashish Signup and view all the answers

What is a common method for treating bradycardia associated with digoxin toxicity?

Atropine administration Signup and view all the answers

Which of the following indicates the administration of Digibind?

Ingestion of more than 10 mg in adults Signup and view all the answers

What is the primary ingredient in hashish oil?

Crude plant material Signup and view all the answers

Which electrolyte disturbance is treated with potassium chloride?

Acute toxicity-induced hypokalemia Signup and view all the answers

What is the primary psychoactive component found in Cannabis Sativa?

Delta-9-Tetrahydrocannabinol (THC) Signup and view all the answers

Which of the following routes of administration for cannabis has the fastest absorption?

Smoking in a cigarette Signup and view all the answers

What condition is NOT typically associated with cannabis poisoning?

Technical asphyxia Signup and view all the answers

Which of the following best describes the metabolism of THC?

Metabolized by the liver Signup and view all the answers

What effect does THC have on the sympathetic and parasympathetic nervous systems?

It stimulates sympathetic receptors and inhibits parasympathetic receptors Signup and view all the answers

Which physiological response is commonly associated with cannabis use?

Dilated pupils Signup and view all the answers

What is the consequence of an overdose of cannabis?

Central asphyxia Signup and view all the answers

Which of the following statements about the clinical presentation of THC is incorrect?

Visual hallucinations are a common symptom of cannabis use. Signup and view all the answers

What is a prominent characteristic of LSD's effect on perception?

Intense color and flowing visuals Signup and view all the answers

Which mechanism is primarily associated with LSD's action?

Changes in mood and behavior via CNS Signup and view all the answers

Which symptom is least likely associated with LSD intoxication?

Severe respiratory distress Signup and view all the answers

What form of management is recommended for someone under the influence of LSD?

Quiet environment and reassurance Signup and view all the answers

Which of the following is a common psychological consequence of LSD use?

Flashbacks and prolonged psychosis Signup and view all the answers

What is the common cause of death related to LSD use?

Suicide as a consequence of psychological effects Signup and view all the answers

How quickly can tolerance to LSD develop?

Rapid production of tolerance Signup and view all the answers

Which statement best describes the sensory effects of LSD?

Altered auditory and tactile sensations Signup and view all the answers

Study Notes

Plant Poisons

Plant poisons are substances derived from plants that induce harmful effects when ingested or contacted.

Digitalis

Cardiac glycosides, of which digitalis is the most known, have a long history in pharmacology.
Cardiac glycosides are active compounds in various plants, including:
- Digitalis purpurea (purple foxglove)
- Digitalis lanata (white foxglove)
- Mediterranean sea onion (sea squill)
- Oleander
Active principles include Digoxin, Digitoxin, Digitalin, and Digitonin.
Digoxin is frequently prescribed for congestive heart failure and atrial arrhythmias, available as 0.125 and 0.25 mg tablets.
Poisoning causes: Accidental (therapeutic overdose, children), or intentional (suicide).
Mechanism of action (therapeutic dose):
- Prolongs diastolic period, improving heart filling (negative chronotropic).
- Enhances systolic power, improving contraction (positive inotropic).
- Increases renal blood flow.
Mechanism of action (toxic dose):
- Cardiac poison.
- Gastrointestinal (GIT) distress.
- Visual disturbances.
- Central nervous system (CNS) symptoms.
Pathophysiology:
- Stimulates the vagus nerve (bradycardia).
- Inhibits Na+-K+ ATPase, leading to:
  - Increased intracellular sodium.
  - Increased intracellular calcium.
  - Increased extracellular potassium (hyperkalemia) in acute toxicity; normally, serum potassium levels are normal or reduced in chronic toxicity due to diuretic therapy.
Clinical presentation (Cardiac):
- Arrhythmias are a common manifestation, including both:
  - Tachyarrhythmias (e.g. tachycardia, flutter, fibrillation in atrium and ventricle)
  - Bradyarrhythmias (e.g., sinus bradycardia, AV block, sinus arrest)
Clinical presentation (Other):
- Gastrointestinal (GIT): Anorexia, nausea, vomiting, colic, diarrhea.
- Visual: Green-yellow vision (rods & cones affection).
- Central Nervous System (CNS): Headache, delirium, disorientation, drowsiness.
Cause of death: Arrhythmias and cardiac arrest.
Investigations:
- ECG and continuous cardiac monitor to detect arrhythmias, heart blocks.
- Electrolyte levels (hyperkalemia in acute toxicity, hypokalemia, hypercalcemia, hypomagnesmia in chronic toxicity).
- Kidney function tests (renal impairment affects glycoside elimination).
- Digoxin levels (therapeutic level is 2 ng/mL; levels above 15 ng/mL are serious).
Treatment:
- Prevent further exposure.
- Supportive measures (e.g., ABCs).
- Gastrointestinal decontamination (e.g. gastric lavage, charcoal, cholestyramine)
- Physiological antidote: Digibind (digoxin-specific antibody fragments). Dosage based on total body digoxin load.

Cannabis Sativa

Cannabis is a psychoactive drug (psychedelic, psychotomimetic, hallucinogen), used medicinally and recreationally.
Sources: Cannabis sativa, Cannabis indica
Forms:
- Hashish: dried resin from flower tops.
- Hashish oil: dark viscous concentrate of cannabinoids.
- Bango: from dried leaves.
- Marijuana: mixture of crushed leaves, flower, and stem.
- Sinsemilla: 'seedless' mixture of flowering tops and leaves of cultivated female plants .
Active principle: Delta-9-tetrahydrocannabinol (THC), cannabinol, and cannabidiol. THC is the primary.
Routes of administration: smoking, ingestion, inhalation; also via tablets (Marinol, dronabinol).
Pharmacokinetics:
- Absorption: Inhalation or ingestion; rapid distribution to brain and adipose tissue
- Metabolism: By liver
- Excretion: Urine and stool
Poisoning cause: Accidental overdose.
Mechanism of action
- Effects on basal ganglia, cerebral cortex, cerebellum, hippocampus.
- Stimulates sympathetic receptors and inhibits parasympathetic receptors.
- Effects vary based on user’s mood, THC concentration, and route of administration.
Clinical presentation (Mental): Euphoria, sexual/erotic dreams, increased sensory sensitivity (auditory, tactile, olfactory), dysphoria, time and space disorientation
Clinical presentation (Physical): Dilated pupils, conjunctival congestion, tachycardia, orthostatic hypotension, respiratory depression, increased appetite/dry mouth, urinary frequency
Cause of death: Central asphyxia, car accidents.
Investigations: Routine investigations, blood and urine samples for THC.
Treatment
- Supportive measures (ABCs; care of respiration).
- GI decontamination (gastric lavage, charcoal).
- Symptomatic support if needed (e.g., mild sedation with diazepam).
- Psychiatric follow-up.

LSD

Lysergic acid diethylamide (LSD) is an ergot alkaloid.
Source: Natural: Claviceps purpurea; Synthetic: LSD
Mechanism of action:
- Primarily affects the central nervous system (changes in mood and behavior).
- Affects pyramidal & extrapyramidal systems
- Affects sympathetic & parasympathetic systems.
- Has sensory effects
Clinical presentation (Mental/Physical):
- Euphoria, laughter, dysphoria, sadness, visual distortions (intense colors, depth perception), auditory, tactile, olfactory, and gustatory hallucinations, alterations in time perception, ego disruption, fear of self-destruction.
- Physical symptoms such as mydriasis, hyperthermia, piloerection, hyperglycemia, tachycardia, and hypertension.
Cause of death: Suicide.
Management:
- Provide a quiet, lighted environment.
- Reassurance.
- Sedation/Tranquilization (e.g., Diazepam, Chloropromazine).

Drug Dependence

Definitions:
- Drug of abuse: The use (oral, smoking, etc.) of a substance to alter mood or state of consciousness.
- Substance of abuse: Usage for non-medical reasons, to achieve a state of well-being, or avoid discomfort – often condemned by society.
- Drug habituation: A desire to take drug without compulsion.
- Drug addiction/dependence: Compulsive and repeated drug use resulting in physical and psychological dependence.
Mechanism of drug dependence:
- Cellular adaptation (neuronal or receptor changes) to the presence of the drug.
- Interruption or decrease in drug administration leading to disturbed cellular function.
Characteristics of dependence:
- Compulsive desire for drug.
- Tolerance.
- Physical dependence.
- Psychological dependence.
- Withdrawal symptoms.
- Detrimental effects on the individual, family, and society.
Methods of abuse of addicting drugs:
- Nasal insufflation (e.g., heroin).
- Inhalation (e.g., cocaine).
- Smoking (e.g., hashish).
- Intravenous injection (e.g., morphine).
- Dissolving tabs then intravenous injection
Types of addicts:
- Therapeutic.
- Professional.
- Street.
- Congenital.

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Description

This quiz explores the harmful effects of plant poisons, specifically focusing on digitalis and its uses in pharmacology. Learn about cardiac glycosides, their mechanisms of action, and the risks associated with digitalis. Test your knowledge on how these substances affect heart conditions and their origins in various plants.