lecture by DR MASOOD AHMED UNAR

2. POISONING OF CNS STIMULANTS
 AMPHETAMINES
 COCAINE
 CHRONIC COCAINE POISONING

3. AMPHETAMINE

4. POISONING OF CNS STIMULANTS
 These are drugs which stimulate the central nervous
system and produce a false sense of euphoria which
is followed by depression.
 Commonly abused preparations are amphetamines
and cocaine.

5. POISONING OF AMPHETAMINE
INDTRODUCTION
 Amphetamine (contracted from alpha-methyl-
phen-ethylamine) is a potent central nervous
system (CNS) stimulant that is used in the
treatment of attention deficit hyperactivity
disorder (ADHD), narcolepsy, and obesity.

6.  Amphetamine was discovered in 1887 and exists as two
enantiomers levoamphetamine and
dextroamphetamine.
 Historically, it has been used to treat nasal congestion
and depression.

7.  Amphetamine is also used as an athletic performance
enhancer and cognitive enhancer, and recreationally
as an aphrodisiac and euphoriant.
 It is a prescription drug in many countries, and
unauthorized possession and distribution of
amphetamine are often tightly controlled due to the
significant health risks associated with recreational
use.

8. Mode of Action
 it stimulate both alpha and beta
adrenoceptors thru an indirect mechanism
(ie.by release of intracellular cetacholamine
and Mono Amine Oxidase blockade.
 It stimulates cerebral cortex reticular activating
system, medullary centers and spinal cords.

9. SIGNS AND SYMPTOMS
 Toxic effects manifest as euphoria
 Talkativeness
 Restlessness
 Insominia
 Tremors
 Dry mouth
 Nausea,vomiting
 Diarrhoea,abdominal cramps
 Palpitations and tachycardia.

10. S&S conti:
 Mania and delirium with hallucinations,mainly auditory, results
from larger doses.
 Convulsions and coma are characteristics features of severe
poisoning.
 Addiction occurs after long use.
 Amphentamine psychosis.

11. Fatal dose and fatal period
 The fatal dose is 120-200mg .
 Death has followed five days after ingestion of 140mg.

12. Treatment
 The patient should be kept in a darken room
 Gastric lavage with tap water and activated charcoal.
 Sedation with chlorpromazine is recommended.
 The peripheral symptomatic actions of amphetamines
may be antagonized by β-adrenergic blocking drugs.
 Acidification of urine for elimination of amphetamine.
 Symptomatic treatment

13. POSTMORTEM APPEARANCES
 Particles of un absorbed drugs may be found in
stomach.
 Reddish blotches on the skin.
 Generalized edema of the lungs and pulmonary
petechial hemorrhages are common
 The adrenal may show hemorrhagic reaction

14. MEDICOLEGAL ASPECTS
 Over dosage is common.
 Amphetamines are drugs of addiction.
 Suicide is sometimes triggered by the prolonged
depression and errors of judgment which intense
stimulation from continued high dosage.

15. LIQUID GOLD
 Is the term associated with amphetamines abuse
because of the fact that metabolites of this
compound which are excreted in the urine are
themselves addictive and ,people used to sell their
urine in weekly market receiving high prices, hence
the term.

16. (2)COCAINE

17. Cocaine poisoning
COCAINE INTRODUCTION
 Cocaine is an alkaloid obtained from the leaves of
coca tree, of which there are two important species
Erythroxylon coca and E.novogranatense.
 They grow well in South America, Indonesia and
India.

18.  In 1884 it was first time available commercially.
 Increased numbers of drug users,over doses
deaths,crime and the images of crack babies
damages in utero by cocaine-using pregnant women
gave national visibility to the drug problem,
particularly to cocaine use.

19. Common routes of Administration
 Can be taken orally.
 Injection
 Absorption via nasal and buccal membranes.
 Inhalation
 Cocaine hydrochloride the water-soluble form typically used
for snorting.
 Freebase cocaine is inhaled.
 Smoked (crack cocaine is an alkaloid form)

20. Mode of Action
 (1) it causes blockade of nor-
epinephrine,serotonin,dopamine reuptake.so increase
catecholamine actions.
 (2).prolong dopamine action on limbic system
euprhoria initially but chronically results in severe
depression due to depletion of dopamine in these
neurons craving for cocaine to relieve depression.
 (3).it also causes Na channel blockade local
anesthetic effects.

21. SIGNS AND SYMPTOMS
 First it act as stimulant and then a depressant of the
nervous system.
 The psychoactive effects are due to its actions on
dopamine and which goes to pleasure centre of the
brain.
 In stimulant stage it shows following characteristics.
 Dryness of mouth.
 Bitter taste.

22.  Euphoria.
 Increased physical and mental energy.
 Stimulation of libido.
 Restlessness and delirium.

23. s/s conti:
 Flushed face
 Dilated pupils
 Blurred vision
 tachycardia., hyperthermia.
 And an increased respiratory rate.
Pt may become maniacal and hallucination may occur.

24. POISONING OF CNS STIMULANTS
 Cocaine is often mixed with heroin to decrease its harsh
effects.
 This combination is called speedball and can be deadly.

25. Fatal dose and fatal period
 Fatal dose is 1 gm. Orally. 20 mg I/v.
 Fatal dose after application to mucous membrane is
30mg.
 Fatal period
 Death usually occurs in about two hours.

26. DIAGNOSIS
 Qualitative toxicological analysis of blood and urine.
 Finding cocaine and metabolites in the urine
supports the diagnosis.
 But can be detected in urine after 2-4 days of
exposure.

27. Treatment of cocaine poisoning
 If it is injected,absorption should be limited
from the injection site by tourniquet.
 If applied locally to the nose or throat then
removed by washing.
 If swollowed then stomach wash with dilute
solution of potassium permanganate.

28.  Medicinal charcoal may be employed.
 Exitement should be controlled by barbiturates or
diazepam.
 Artificial respiration in severe cases.

29. POST MORTEM APPERANCE
 Death being due to asphyxia or cardiac failure.
 The signs are less likely to be found.
 Cocaine is largely destroyed in body and it is difficult
to detect it by chemical analysis.

30. Chronic Cocaine Poisoning.
 Also called as cocainism
 Cocainophagia.
 Cocainomania.
 The sense of well being experienced on
administration of cocaine causes a number of
persons to drift into addiction.

31. Signs and symptoms of chronic
cocaine poisoning
 The tongue and teeth of habitual eater of cocaine are black.
 Ulceration of nasal mucosa occurs after chronic insufflation.
 Impotense
 Loss of appetite,weight
 Weakness,tremors
 Moral deterioration and insanity

32.  Increased erotic tension in women and nymphomania.
 In men,the condition leads to many sexual perversions
manly homosexuality.
 Insanity is characterized by many delusions of persecution
and hallucinations.
 Chiefly tactile and visual.
 MAGNAN’S SYMPTOMS: The feeling as if grains of sand
are lying under the skin or small insects (cocaine bugs) are
creeping on the skin (formication).

33. Medico legal Aspects
 It is rarely used for homicide or suicide.
 Cocaine is a drug of addiction and produces
physical and psychological dependence.
 Used as recreational drug
 Anesthetic or an aphrodisiac.

34.  Used locally on glans to increase the duration
of the sexual act.
 it is injected in vagina by women for increasing
the sexual pleasure gives sense of local
constriction.
 Smugglers hide cocaine in different body
orifices on plastic packing.if leaked can be
fatal.