Datura And Opiates (Atropine, Hyosine, Hyosciamine & Heroin) Flashcards
What are the sources of atropine, hyosine and hyoscyamine?
Datura fastiosa plant (thorn apple)
Atropa bellanoda plant (black berry)
HM plant
What are the 5 medical uses of atropine?
-Antidote for organophosphorus compounds and digoxin
- Urinary: urinary incontinence
- Eye: mydriasis
-GIT: antispasmodic
-Chest: bronchodilator
2 uses of hyosine….
Truth serum
Treatment of mania cuz it depresses CNS without initial increase (unlike atropine & hyoscyamine
MOA of atropine, hyosine & hyoscyamine peripheral and central…
-Atropine & hyoscyamine:
>central: CNS depressant due to anticholinergic (antimuscarinic specifically) which blocks ach release but has initial stimulation cuz when ach. blocked, epinephrine take over which cause stimulation
>peripheral: block muscarinic actions
- Hyosine:
>central: CNS depression
>peripheral: weak
Clinical picture of datura poisoning…
-Fixed pupil dilation
-Urinary retention & constipation
-Flushing due to vasodilation ( same as alcohol)
-horse voice and dysphagia
-Atropine sweating
-tachycardia and tachypnea (cuz Ach usually decreases stuff)
-CNS stimulation first causing agetation, euphoria and staggering gate (like in alcohil)
-CNS depression after
Cause of death in datura poisoning is…
Respiratory depression
3 investigations done for diagnosis of datura…
CBC & electrolytes
ECG: sinus tachycardia
Tropin and tropic acid levels
Differential diagnosis of datura poisoning is…. bcz….
Alcohol intoxication
Cuz of staggering gate and bcz it causes CNS stimulation then inhibition like the stages in alcohol intoxification
5 treatment methods of datura poisoning…
Supportive: ABCs
GI decontamination
Local antidote: activated charcoal, sodium bicarbonate & hydrogen peroxide
Physiological antidote: Pilocarpine and Physostigmine (3Ps in datura)
What is the source of heroin?
Papaversomniferum plant
Routes of administration of heroin is…
Smoking
Ingestion
Route of administration of morphine is…
Injection
3 classifications of opioids are…
Natural: morphine
Semisynthetic: heroin
Synthetic: جلا
Other name for heroin is…
Diacetylmorphine
2 uses of morphine include…
Painkiller (analgesic)
Treatment of opioid addicts (gradual withdrawal)
MOA of opioids is…
Cause analgesic effect by binding to Mu, Delta & kappa receptors in brain. Sigma used to be a 4th receptor but not anymore cuz doesnt respind to naloxone
Clinical presentation of opioid toxicity…
- euphoria or dysphoria ( وات زا هل)
- non cardiogenic pulmonary edema
- respiratory depression and cyanosis
- constipation and decreased bowel sound
-hypothermia - fixed pin point pupil
-Needle tracks in IV addicts - circulatory collapse
- MECONIC ACID BREATH (iconic hero)
4 Causes of death in opioid toxicity…
Central asphyxia
Pulmonary edema
Arrhythmia
Irriverisble brain damage due to prolonged hypoxia
Investigations done for opioid toxicity is…
-CBC, arterial blood gas, serum electrolyte
- Morphine and meconic acid levels in serum
- ECG
- chest x ray for pulmonary edema
How do you treat opioid poisoning?
-Supportive: ABC
-GI decontamination: gastric lavage and activated charcoal local antidote, endotracheal tube also..
-Physiological antidote: atropine (cuz there is miosis and atropine cause mydriasis
-Agonist antagonist (act as agonist when there is no opioid, and antagonost when there is):
- levallorphane & nalorphine (half half of morphine)
-Pure antagonist: Naloxone Nalmefene Naltrxone (Nal=null= no agonist effect)
