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Cardiac poisons

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poisons, cardiac, heart , treatment

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Cardiac poisons

  1. 1. Dr Gopisankar.M.G.
  2. 2. Nicotiana Tabacum Digitalis Pupurea Nerium Odorum Cerebera thevetia Cerebera Odallam Cleistanthus Collinus Qunine Aconite
  3. 3. All parts are poisonous except ripe seeds Dried leaves  1-8% of nicotine Toxic alkaloids 1. Nicotine 2. Anabasine (equally toxic ) 3. Nornicotine (less toxic)
  4. 4. Agricultural , horticultural works Fumigation , spraying , insecticide , worm powder Each cigarette  15 – 20mg N 1-2 mg is absorbed by smoking 15 – 40 mg /cigar
  5. 5. Absorbed from  skin , mucous membrane , lungs 90% is metabolised by liver Some metabolised by lungs and kidneys Excreted by kidneys
  6. 6. Acts on Autonomic ganglia stimulated first and then depressed and blocked Also acts on somatic neuromuscular junction and afferent fibers from sensory receptors
  7. 7. GIT Cardiopulmonary  arrhythmias CNS  mydriasis Death  respiratory failure
  8. 8. Amblyopia
  9. 9. A short period of 6 to 12 weeks of maintenance often followed by a gradual reduction in 6 – 12 weeks is done NRT FD 50 – 100 mg of nicotine 15 – 30 mg of crude tobacco
  10. 10. Stomach wash Colonic washout Inversine /Mecamylamine  specific antidote Atropine / hexamethonium chloride VD Oxygen
  11. 11. Asphyxia
  12. 12. Entire plant is toxic Over 30 cardiac and steroidal glucosides Roots , leaves ,seeds 1. Digitoxin 2. Digoxin 3. Digitalin 4. Digitonin
  13. 13. GIT Cardiac arrhythmias , block Endocrine  gynaecomastia Visual  transient amblyopia , scotomata, colour aberration , halos Skin  urticaria CNS  nueropsychiatric , delerium , hallucinations , trigeminal nueralgia
  14. 14. Death occurs from cardiovascular collapse FD 2 gm leaf 15 – 30 mg digitalin 10 mg digoxin 4 mg digitoxin FP 1 – 24 hours
  15. 15. Stomach wash with tannic acid Bowel wash Activated charcoal Digoxin specific antibody fragments (Fab) one vial IV over 30 min 1 vial = 38 mg Fab Total 10 – 20 vials Phenytoin
  16. 16. Specific antidote for digitalis induced cardiac arrhythmias  lignocaine 100 mg ,Dilantin , Propanalol Trisodium EDTA  to lower s. calcium Potassium suppliment Atropine if brady
  17. 17. White oleander or kaner All parts except roots , including nectar are poisonous Cardiac glycosides 1. Oleandroside(oleandrin)digitalis in action 2. Nerioside(nerin) digitalis in action 3. Folinerin 4. Rosagenin
  18. 18.  Contact dermatitis  Emenations Headache, dizziness, respiratpry difficulty, Nausea  Ingestion difficulty in swallowing and articulation , V, profuse frothy salivation and diarrhoea , abdominal pain  Pulse is first slow and later rapid and weak  Arrhythmias , block  Mydriasis , tetanic spasm, lock jaw ,  Death usually results from cardiac failure
  19. 19. FD 15 – 20 g of root 5 to 15 leaves FP 20 – 36 hours Treatment  symtpomatic PMA -
  20. 20. Root  abortifacient , veneral disease Cattle poison  into anus of cattle Smoke from the burning plant is toxic When plant material is used to roast food over a fire , the poisonous sap transferred to the food may be lethal
  21. 21.  Yellow oliander / pila kaner  All parts are poisonous  Seeds (A) 4% thevetin  which is 1/8th as potent as ouabain  Similar to digitalis in action  (B) thevetoxin  ( C) nerifolin  (D) Peruvoside  (E) Ruvoside  (F) Cereberin
  22. 22. And a bitter principle that act on CNS to produce tetanic convulsions All active principles are glycosides Milky juice exudes from all parts of the plant
  23. 23. Contact dermatitis Chewing bark /seed numbing sensation , feeling of heat in the mouth Mydriasis Heart block Death due to peripheral circulatory failure
  24. 24. FD 8 – 10 seeds 15 – 20 g of root 5 – 10 leaves FP  2- 3 hours
  25. 25. Stomach wash Sodium Molar lactate solution with glucose and 1 mg atropine , 2 ml adrenaline, 2 mg noradrenaline PMA Circumstances  criminal abortion , cattle poison
  26. 26. Pilikirbir Contains glycosides 1. Cerberin 2. Cerberoside 3. Odollin 4. Odolotoxin 5. Thevetin 6. Cerapain
  27. 27. Milky acrid juice (toxic) from all parts of the plant
  28. 28. Within 1 hour GI Cardiac  3 hours  brady , AF , Irregular respiration Death from heart failure Hyperkalemia and depression of transaminase activity are chief biochemical changes
  29. 29. FD Kernal of 1 fruit FP  1-2 days or more PMA asphyxia Sub epi, endo , plueral ptecheal bleed
  30. 30. Stomach wash Atropine Correct hyperkalemia Circumstances
  31. 31. Odovan , karlajuri , karada, garari All parts of the plant are poisonous Toxic principle  Oduvin  glucoside MOA blocks nueromuscular transmission , and cardiac conductive system
  32. 32. FD  200 – 400 gm of leaves FP  1 – 3 days
  33. 33. Mydriasis Hyperpyrexia Cardiac conductive
  34. 34. Species of cinchona plants Quinine Cinchonidine Alkaloids
  35. 35. It is a strong protoplasmic poison Anaesthetic Sclerosing action It stimulates and depresses CNS
  36. 36. Starts in 15 – 30 min Partial deafness, disorders of vision , pupils fixed dilated Rash Methhaemoglobinemia Death occurs due to respiratory failure Large doses cause hemolysis Renal tubule block  uremia
  37. 37. Repeated therapeutic doses or over dose Tinnitus, vertigo , deafness, diplopia , scotomata, blindness, skin rash , hypoglycemia , and cardiac arrhythmias
  38. 38. FD 8 – 15 g FP  6 hours Quinidine  4 – 6 g
  39. 39. Gastric lavage Concentrated solution of magnesium sulphate left in stomach for rapid elimination of poison Activated charcoal +MgSo4 until stool looks black Forced acid diuresis Bilateral Stellate ganglion block cause immediate return of vision
  40. 40. Hemolysis Renal tubules blocked with Hb Circumstances abortifacient
  41. 41. Monk’s hood Blue rocket Mitha zaher Bish Bikh
  42. 42. Aconitum napellus Aconitum ferox Roots are used All varieties and all parts are poisonous Most when seeds ripen and bloom
  43. 43.  Roots and seeds are most potent  Contains 1. Aconitin 2. Pseudo aconitine 3. Indaconitine 4. Bikhaconitine 5. Picraconitine 6. Aconine 7. Mesaconitine 8. Jesaconitine
  44. 44. Contact  tingling and numbness Odour has narcotic action Pollen causes pain and swelling of the eyes Symptoms immediately or within min GI Salivation  dry and difficulty in swallowing Limbs weak , paraestheisa, ataxia, slurred speech
  45. 45. The pupils alternate contract and dilate  Hippus …but remain dilated in later stages Diplopia Dim vision  cardiac arrhythmia , blocks Mind clear =+/_ hallucinations Death  paralysis of cardiac or respiratory centres or both
  46. 46. FD 1 g root 2 – 5 mg Aconitine 250 mg extract 2 – 30 ml tincture FP  2 – 6 hours
  47. 47. Gastric lavage Weak solution of iodine , in KI , or tannic acid to precipitate alkaloid Animal charcoal Cathartic Atropine Eliminated mainly by urine

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