Plant & Opium Poisons PDF

Atropine, Hyosine &Hyoscyamine Source: All parts of the following plants  Datura Fastiosa & Stramonium (Thorn apple)  Atropa Belladona (Black berry)  Hyoscyamus Muticus Active principles:  Atropine & Hyoscyamine (isomers)  Hyosine Atropine, Hyosine...

Atropine, Hyosine &Hyoscyamine Source: All parts of the following plants  Datura Fastiosa & Stramonium (Thorn apple)  Atropa Belladona (Black berry)  Hyoscyamus Muticus Active principles:  Atropine & Hyoscyamine (isomers)  Hyosine Atropine, Hyosine &Hyoscyamine Medical uses: Atropine  Ophthalmology – Mydriatic  Chest – Bronchodilator (Asthma)  GIT – Antispasmodic  Urology – Urinary incontinence  Toxicology – Antagonist in:  ( morphine, digitalis and organophosphorus) Hyosine  Used as Truth Serum  In mania as it CNS without initial , thus it combats excitement and induces twilight sleep Atropine, Hyosine &Hyoscyamine Conditions of Poisoning: Accidental:  Children  Therapeutic overdose  Addicts Homicidal: to facilitate rape & robbery Suicidal: overdose of anticholinergic medication Atropine, Hyosine &Hyoscyamine Mechanism of action:  Atropine & Hyoscyamine are ANTICHOLINERGIC - Central: block Ach. release (CNS then ) - Peripheral: block muscarinic action of Ach.  Hyosine - Central: CNS - Peripheral: weak Atropine, Hyosine &Hyoscyamine C.P.:  Peripheral: (Atropinism)  Dysphagia, Horse voice  Constipation & urine retention (GIT & urinary motility)  Dilated fixed pupil  Flushed skin (Atropine flush) due to D of B.V.  Tachycardia + Tachypnea  Atropine fever (inhibit sweating & alterate T.R.C.)  Central: (stimulation)  Restlessness, agitation, disorientation, euphoria, talk & visual hallucination  Occupational delerium  Staggering gait (depression)  Drowsiness, sleep, stupor, coma & cyanosis Atropine, Hyosine &Hyoscyamine Cause of Death: Respiratory depression Investigations: Routine: CBC, ABG & Electrolyte ECG: sinus tachycardia Chemical analysis (Tropin & Tropic acid) D.D.: Alcohol Atropine, Hyosine &Hyoscyamine Treatment:  Supportive measures [ABCs]  GIT decontamination  Local antidote: - A.C. - H2O2 - Na HCO3  Physiological antidote: - Pilocarpine - Physiostigmine  Symptomatic Opium: Heroin Opiates: naturally occuring opium Opioids: Alkaloid compounds have opium or morphine like activity Plant: Papaversomniferum Alkaloid Opium contains, more than 20 alkaloids such as morphine papaverine, thebaine and codeine Opium is ingested or smoked & has a smell [meconic acid]. While morphine is injected only & has no smell Opium: Heroin Classification of opioids: 1. Natural opium derivatives: (codeine and morphine). 2. Semisynthetic agents: (diacetylmorphine “heroin” which is more potent than morphine, stadol, hydrocodone) 3. Synthetic agents:  Meperidine and related (lomotil, Imodium, fentanyl, mepridine” pethidine”)  Methadone and related (methadone, propoxyphene)  Other (pentazocine) Opium: Heroin Uses of Morphine: a) Pain killer [e.g. Burns, Metals, acute myocardial infarction. & corrosive poisoning] b) Treatment of opiate addicts [Gradual withdrawal]. Opium: Heroin Mechanism of action: The opioids exert their effects by interacting with specific opioid receptors in the CNS. The three main opioid receptor types are; mu, kappa and delta. All three mediate analgesia effects. A fourth receptor sigma is no longer considered to be an opioid receptor because it cannot be antagonized by naloxone Opium: Heroin Clinical presentation: 1) Euphoria or dysphoria [distress and fear] - Sleep, stupor —, coma 2) Non cardiogenic pulmonary edema {dyspnea & cyanosis] 3) Constipation and diminished bowel sounds. 4) Respiratory depression with cyanosis &characteristic smell in the breath [if opium]. Opium: Heroin Clinical presentation: 5) Hypothermia. 6) Circulatory collapse. 7) Miosis [pin point pupil] & fixed pupil. 8) Skin boils, cellulitis and needle tracks are observed in IV drug addicts. Opium: Heroin Cause of death: - Respiratory depression [central asphyxia] - Pulmonary edema. - Arrhythmias. - Irreversible brain damage secondary to prolonged hypoxia Opium: Heroin Investigations:  Routine CBC,ABG, serum electrolytes.  Chemical analysis [Morphine + meconic acid].  Chest X-ray to diagnose pulmonary edema.  ECG to detect hypoxic effect and arrhythmias. Opium: Heroin Treatment: I) Supportive measures [ABCs] - Mainly treat respiratory depression. - Treat coma, seizures, hypotension and non cardiogenic pulmonary edema if they occur. II) GIT Decontamination: by Gastric lavage: a) Using cuffed endotracheal tube even if alert (CNS depression) b) Even if the toxicity is by Morphine which is injected (morphine reexcreted in the stomach) Opium: Heroin Treatment: III) Local antidotes: Using one of alkaloidal antidotes or activated charcoal. IV) Physiological Antidote: A) Antagonists: Atropine 1 ml I.V (≠Vagal stimulation and ↑HR). B) Competitors:  Agonist antagonist  Pure agonist Opium: Heroin Competitors:  Agonist antagonist: [In absence of opiates, they act as agonists on receptors, but in presence of opiates, they act as antagonist]. a) Levallorphane 1mg b) Nalorphine 10mg.  Pure Antagonist: a) Naloxone b) Nalmefene c) Naltrxone Thank you