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Y3R2 - Toxicology ☠️ > L8: Plant Poisons > Flashcards

L8: Plant Poisons Flashcards

1
Q

Source of Atropine

A

Datura plant which is known also as thorn apple.

Two otber plant families haye the same active ingredients:

  • Atropa belladona plant & Hyoscyamus muticus plant.
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2
Q

in which part of datura plant is Atropine found?

A

Every part of Datura plants (leaves, fruits, flowers and seeds)

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3
Q

what are the alkaloids found in datura plant?

A
  • contains three alkaloids (Atropine, hyoscine and hyoscyamine).
  • The three alkaloids together referred to as (Belladona alkaloids).
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4
Q

where is the highest concentration of alkaloids found in datura plants?

A

Seeds

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5
Q

Toxic action of Atropine

A
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6
Q

Characteristcs of Hyoscyamine

A
  • similar to atropine but more potent.
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7
Q

Characters of Hyoscine

A
  • similar to atropine but it is a CNS depressant from the start
  • (No initial stimulatory phase) even at therapeutic doses.
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8
Q

Peripheral and central manifestations of atropine start ….. after ingestion, Can last for ……..

A
  • Peripheral and central manifestations start 30-60 min after ingestion, Can last for 24-48 hours.
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9
Q

CP of Atropine Toxicity

A

Peripheral effects manifestations:
- Dry as a Bone
- Red as a beet
- hot as a hare
- Blind as a bat
- Flappy as a bird
- Urinary retention and decreased intestinal sounds

Central effects manifestations
- Initial stimulatory stage
- Second inhibitory stage (depressant)

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10
Q

Dry as a bone Atropine Toxicity

A

Due to inhibition of salivation:

  • Dryness of mouth and throat.
  • Difficulty in swallowing (dysphagia) and speech (dysphonia).
  • Bitter taste in the mouth.
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10
Q

Red as a beet Atropine Toxicity

A
  • Dilatation of cutaneous blood vessels causes atropine flush: Dry, hot and red flushed face
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11
Q

Hot as a hare Atropine Toxicity

A
  • Body temperature is raised (atropine fever)

Where the skin is hot and dry due to:
- Inhibition of sweat secretion.
- Stimulation of heat regulating center (central).

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12
Q

Blind as a bat Atropine Toxicity

A
  • Pupils are dilated and fixed (insensitive to light) leading to blurred
  • The power of accommodation is paralyzed
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13
Q

Flappy as a bird Atropine Toxicity

A
  • Tachycardia (120-140 /min)
  • Hyperpnea.
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14
Q

Central manifestations of Atropine Toxicity

A
  • Initial stimulatory stage
  • Second inhibitory stage (depressant)
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15
Q

Initial stimulatory stage of Atropine Toxicity

A

Staggering unsteady gait like a drunker

Irritability, restlessness and mental confusion
- (The mind is affected early).

Purposeless movements (occupational delirium) (Mad as a Hen):
- The person appears to grasp at imaginary objects, e.g., rolling a cigarette, threading a needle.

  • This usually accompanied by mutters in distinct words, visual and auditory hallucinations as well as failure to recognize relatives.

Convulsions are seen in severe cases.

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16
Q

Second inhibitory stage of Atropine Toxicity

A

The patient due to cortical depression becomes drowsy

  • then passes into stupor
  • followed by coma and death due to respiratory center paralysis.
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17
Q

DDx in Atropine Toxicity

A
  • Heat stroke
  • Alcohol Poisoning
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17
Q

Investigations in Atropine Toxicity

A
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18
Q

Compare between Atropine Toxicity & Alcohol Toxicity

A
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19
Q

TTT aspects of Atropine Toxicity

A
  • Emergency
  • Decontamination
  • Antidotes
  • Enhanced Elimination
  • Symptomatic TTT
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20
Q

Emergency TTT of Atropine Toxicity

A
  • Care ABCDE
  • Treat coma and convulsions if occur.
  • Monitor ECG, blood pressure and temperature.
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21
Q

Decontamination in Atropine Toxicity

A
  • Gastric lavage
  • Activated Charcoal
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22
Q

Gastric Labage in Atropine Toxicity

A
  • To remove remnants of crushed seeds.
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23
Q

Activated Charcoal in Atropine Toxicity

A
  • Give with cathartic even after 24 hours from ingestion of datura seeds (intestinal motility is decreased),
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24
Q

Antidote in Atropine Toxicity

A

Physostigmine:

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25
Q

Indications of Physostigmine

A

Indicated only in severe toxicity

(Eg, severe hypertension, severe delirium, arrhythmia, coma and convulsion).

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26
Q

Mechanism of Physostigmine

A
  • It antagonizes peripheral and central effects as it crosses BBB
27
Q

SE of Physostigmine

A

Patient needs monitoring as it may cause seizures, bradycardia or asystole.

28
Q

Pilocarpine, Pyridostigmine & Neostigmine in Atropine Toxicity

A
  • They are not effective in treating central atropine toxicity as not pass BBB.
  • Neostigmine can be used for treating anticholinergic-induced ileus.
29
Q

Enhanced Elimination in Atropine Toxicity

A
30
Q

Symptomatic TTT in Atropine Toxicity

A
31
Q

Cultivation of Opiates in egypt

A

forbidden by law in Egypt

32
Q

Sources of Opiates

A
  • Opiates are a group of naturally occurring compounds that present in “Crude opium”
  • which is obtained from capsule of “Papaver Somniferum” plant (Poppy or Khash Khash).
33
Q

what do Opiates contain?

A
  • Actually, opium contains more than 20 alkaloids (e.g., Morphine, Codeine, Narceine, Narcotine, Papaverine, Thebaine)
  • but it owes its action chiefly to its alkaloid morphine
34
Q

what do Opiates inhibit?

A
35
Q

Toxic action of Opiates

A
  • Inhibition
  • Stimulation
  • Other Actions
36
Q

What do Opiates stimulate?

A
37
Q

Other actions of Opiates

A
38
Q

Onset of manifestations in Opiates Toxicity

A

½-1 hour (if morphine ingested)

Within few minutes (if injected).

39
Q

What causes morphine coma?

A

With high doses of opiods

40
Q

CP of Opiates Toxicity

A

Morphine coma

41
Q

Describe morphine coma

A
42
Q

DDx of Opiates Toxicity

A
43
Q

Dx of Opiates Toxicity

A
44
Q

Investigations in Opiates Toxicity

A
45
Q

TTT aspects of Opiates Toxicity

A
  • Emergency and supportive measures
  • Antidotes
  • Decontamination
  • Enhanced Elimination
  • Symptomatic treatment
46
Q

Emergency TTT of Opiates Toxicity

A
  • Maintain an open airway and administer supplemental oxygen.
  • Assist ventilation if necessary
  • Continuous cardiac monitoring and treatment of hypotension.
  • IV diazepam for controlling resistant soizures.
47
Q

Antidote of Opiates Toxicity

A

Naloxone (N-Allyloxymorphine)

48
Q

Indications of Naloxone

A
  • It is pure opioid antagonist
  • It is a diagnostic and therapeutic antidote
49
Q

Dose of Naloxone

A

0.1-0.4 mg IV.

  • Repeat doses every 2-3 minutes, if there is no response, up to a total dose of 10-20 mg.
50
Q

Titrable dose of Naloxone

A
  • If an opioid overdose is strongly suspected.
  • “Titrate the dose to reach the desirable effect → without induction of withdrawal manifestation in addict”
51
Q

Cautions during adminstration of Naloxone

A
  • The duration of effect of naloxone (1-2 hours) is shorter than that of many opioids.
  • If repeated dosing is required, the patient should be admitted to intensive care unit (ICU) under observation.
52
Q

Nalmefene as an antidote for Opiate Toxicity

A

may be substituted for naloxone if prolonged antagonism is desired duration of action is (3-5h).

53
Q

Decontamination in Opiate Toxicity

A
54
Q

Is enhanced eliminatation effective in Opiate Toxicity?

A
55
Q

Sources of Cannabis

A
  • Indian hemp plant “Cannabis sativa plant”
  • All parts of the plant are poisonous.
  • Its cultivation is prohibited in Egypt.
55
Q

Symptomatic TTT in Opiate Toxicity

A

Hypothermia: Maintain body warmth by blankets and warm water bottles.

56
Q

Cannabis names

A
57
Q

Toxic action of Cannabis

A
57
Q

CP of Cannabis Toxicity

A
58
Q

Dx of Cannabis Toxicity

A

History: of addiction and or cannabis smoking.

Clinical presentation: of previous typical physical findings.

59
Q

Investigations in Cannabis Toxicity

A

Toxicological Screen:
For cannabinoid metabolites may be detected in the urine up to

  • Several days after a single acute exposure
  • Weeks after chronic THC exposure
60
Q

Emergency TTT in Cannabis Toxicity

A
61
Q

antidote in Cannabis Toxicity

A

There is no specific antidote.

62
Q

Decontamination in Cannabis Toxicity

A

Gastric lavage & Activated charcoal.

63
Q

Enhanced Elimination in Cannabis Toxicity

A

No Role

“Due to large volume of distribution of cannabinoids”.

64
Q

Symptomatic TTT in Cannabis Toxicity

A

Psychiatric consultation for exaggerated psychic illness

Y3R2 - Toxicology ☠️ (15 decks)

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