Plant Poisons and Their Effects

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Questions and Answers

Which of the following plants is NOT a source of Atropine, Hyosine, or Hyoscyamine?

Datura Fastiosa

Solanum Tuberosum (correct)

Hyoscyamus Muticus

Atropa Belladona

What is a primary medical use of Atropine?

Antispasmodic for GIT (correct)

Truth serum

Stimulation in mania

CNS depression

What is a notable symptom of Atropinism?

Increased gastrointestinal motility

Flushed skin (correct)

Excessive sweating

Decreased heart rate

Which mechanism best describes the action of Atropine and Hyoscyamine?

Block muscarinic action of acetylcholine (D) Signup and view all the answers

What is one of the major considerations in the toxicology of Atropine?

Respiratory depression (B) Signup and view all the answers

Which treatment option is recommended for managing poisoning from Atropine, Hyosine, and Hyoscyamine?

Gastric lavage (B) Signup and view all the answers

In which situation is Hyosine used as a therapeutic agent?

Induction of twilight sleep (A) Signup and view all the answers

What is a common cause of accidental poisoning with Atropine and its derivatives?

Incorrect use of prescription medications (A) Signup and view all the answers

Which classification of opioids includes both morphine and codeine?

Natural opium derivatives (D) Signup and view all the answers

What is the main mechanism of action for opioids in the central nervous system?

Interaction with specific opioid receptors (D) Signup and view all the answers

Which of the following is NOT a symptom commonly associated with opioid overdose?

Fever (A) Signup and view all the answers

Which of the following opioids is classified as a semisynthetic agent?

Heroin (D) Signup and view all the answers

Which investigation is most appropriate for diagnosing non-cardiogenic pulmonary edema associated with opioid use?

Chest X-ray (A) Signup and view all the answers

Which physiological antidote is used to counteract opioid effects?

Naloxone (B) Signup and view all the answers

What is a common cause of death in opioid overdose patients?

Pulmonary edema (B) Signup and view all the answers

What symptom might be expected to develop due to opioid-induced respiratory depression?

Cyanosis (B) Signup and view all the answers

Study Notes

Plant Poisons

Plant poisons include atropine, hyoscyamine, and hyoscine
Sources of these plant poisons include:
- Datura Fastiosa & Stramonium (Thorn apple)
- Atropa Belladona (Black berry)
- Hyoscyamus Muticus
Active principles are atropine & hyoscyamine (isomers) and hyoscine
Medical uses:
- Atropine:
  - Ophthalmology: Mydriatic
  - Chest: Bronchodilator (Asthma)
  - Gastrointestinal Tract (GIT): Antispasmodic
  - Urology: Urinary incontinence
  - Toxicology: Antagonist in (morphine, digitalis, organophosphorus)
- Hyoscine:
  - Used as a truth serum
  - In mania, combats excitement and induces twilight sleep

Conditions of Poisoning

Accidental:
- Children
- Therapeutic overdose
- Addicts
Homicidal: to facilitate rape & robbery
Suicidal: overdose of anticholinergic medication

Mechanism of Action

Atropine & Hyoscyamine:
- Anticholinergic:
  - Central: block Ach release (CNS↑ then↓)
  - Peripheral: block muscarinic action of Ach.
Hyoscine:
- Central: CNS↓
- Peripheral: weak

Clinical Presentation (Peripheral)

Atropinism:
- Dysphagia, Horse voice
- Constipation & urine retention (GIT & urinary motility)
- Dilated fixed pupil
- Flushed skin (due to dilation of blood vessels)
- Tachycardia + Tachypnea
- Atropine fever (inhibiting sweating & altering temperature)
Central stimulation:
- Restlessness, agitation
- Disorientation
- Euphoria, talk
- Visual hallucination
- Occupational delirium
- Staggering gait
Depression:
- Drowsiness, sleep
- Stupor
- Coma
- Cyanosis

Cause of Death

Respiratory depression

Investigations

Routine: CBC, ABG, electrolytes
ECG: sinus tachycardia
Chemical analysis (Tropin & Tropic acid)

Treatment

Supportive measures (ABCs)
GIT decontamination
Local antidote:
- Acetylcholine (A.C.)
- Hydrogen Peroxide (H₂O₂)
- Sodium bicarbonate (NaHCO₃)
Physiological antidote:
- Pilocarpine
- Physostigmine
Symptomatic treatment

Opium: Heroin

Opiates: naturally occurring opium
Opioids: Alkaloids with opium or morphine-like activity
Plant: Papaversomniferum
Opium contains:
- More than 20 alkaloids (morphine, papaverine, thebaine, codeine)
Ingested or smoked; has a meconic acid smell (unless injected, in which case it has no smell)

Classification of Opioids

Natural: codeine, morphine
Semisynthetic: diacetylmorphine ("heroin"), more potent than morphine, stadol, hydrocodone
Synthetic:
- Meperidine and related (lomotil, Imodium, fentanyl, mepridine/pethidine)
- Methadone and related (methadone, propoxyphene)
- Other (pentazocine)

Uses of Morphine

Pain killer (burns, metals, acute myocardial infarction, corrosive poisoning)
Treatment of opiate addicts (gradual withdrawal)

Mechanism of Action (Opium/Heroin)

Opioids interact with specific opioid receptors (mu, kappa, delta) in the CNS
These receptors mediate analgesia
Sigma is not an opioid receptor (not antagonized by naloxone)

Clinical Presentation (Opium/Heroin)

Euphoria or dysphoria (distress & fear)
- Sleep, stupor, coma
Non-cardiogenic pulmonary edema (dyspnea & cyanosis)
Constipation, diminished bowel sounds
Respiratory depression with cyanosis & characteristic smell in the breath (if opium).
Hypothermia
Circulatory collapse
Miosis (pinpoint pupil), fixed pupil
Skin boils, cellulitis, needle tracks (in IV drug addicts)

Cause of Death (Opium/Heroin)

Respiratory depression (central asphyxia)
Pulmonary edema
Arrhythmias
Irreversible brain damage secondary to prolonged hypoxia

Investigations (Opium/Heroin)

Routine CBC, ABG, serum electrolytes
Chemical analysis (morphine + meconic acid)
Chest X-ray (pulmonary edema)
ECG (hypoxic effects & arrhythmias)

Treatment (Opium/Heroin)

Supportive measures (ABCs):
- Treat respiratory depression, coma, seizures, hypotension, non-cardiogenic pulmonary edema
GIT decontamination: gastric lavage (cuffed endotracheal tube)
Local antidotes: alkaloidal antidotes or activated charcoal
Physiological antidote: Antagonists: atropine (1mL IV) ≠vagal stimulation & HR); Competitors (Agonist antagonist, pure agonist)

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Description

Explore the world of plant poisons including atropine, hyoscyamine, and hyoscine. Learn about their sources, medical uses, and the conditions of poisoning they can cause. This quiz will test your knowledge on the mechanisms of action and the impact of these natural substances.