It Includes the toxicity and treatment of narcotic and anti narcotic drugs,and also calcium channel blocker,digoxin

1. Presented By:
Maham Shafiq
M Phil Pharmaceutics
2013-2015
University College of pharmacy
Univeristy of the Punjab,Lahore Pakistan

2. Narcotic Analgesics Non-Narcotic
Analgesics
Morphine Paracetamol
Diamorphine (Heroin) Salicylate
Dihydrocodiene, codeine
Other anti inflammatory
drugs e.g. Ibuprofen
Methadone Mefenamic acid

3.  Metabolized by glucuronidation ,sulfation
 P450 mixed function oxidase system to a highly
toxic reactive intermediate.
 With acute overdose >150-200mg/kg, or 8-10 g in
an average adult, hepatocellular glutathione is
depleted and the reactive intermediate attacks other
proteins and causes necrosis.
 Hepatotoxicity(long term uses)

4. The diagnosis after acute overdose is based on
measurement of serum acetaminophen level.
•
Shortly After ingestion Nausea and vomiting
Sever poisoning Hepatic necrosis
jaundice,hepatic
encephalopathy,renal failure
and death

5. Activated charcoal Withing 1 -2 Hour
Antidote
N-acetylcysteine
intravenously.
N-acetylcysteine
Loading dose = 140mg/kg orally,
Maintance dose=70mg/kg every 4 hrs.
Dilute the solution 5% with water juice
or soda
If vomiting interfere

6.  An intentional overdose with aspirin is the
most common cause of salicylate
intoxication; overdose may be with
methylsalicylate.
 Poisoning may also occur as a result of
transdermal absorption from skin ointments
containing salicylate.

7. Gastric lavage Upto 12 hr
Activated charcoal
Mild
Severe (with plasma
salicylate concentration
above 1000 mg/liter)
50-100 g for every 4
hours until recovery
haemodialysis
haemoperfusion.

8. morphine codeine, oxycodone, fentanyl are
popular drugs of abuse and cause of frequent
hospitalization of overdose

9. Mild intoxication euphoria, drowsiness and
constricted pupils.
More severe intoxication hypotension, bradycardia,
hypothermia, coma and
respiratory arrest

10. In emergency Assist ventilation
Administer activated charcoal.
opioid antagonist/antidote Naloxone
Administer 0.4-2mg IV
and repeat as needed to awaken
the patient and maintain airway
protective reflexes and
spontaneous breathing

11.  Calcium channel blockers are used to
decrease Blood pressure in patients
with hypertension
 verapamil, diltiazem, nifedipine,
nicardipine, amlodipine etc.

12. Signs and symptoms Chest pain, Palpitations, Flushing,
Weakness, Confusion, Seizure,
dizziness. Headache. Nausea,
Vomiting
Physical examination findings Slow heart rate, Hypotension,
Depressed level of consciousness
Abnormal findings on blood tests Hyperglycemia, Hypokalemia
Acidosis
On ECG Bradycardia atrioventricular (AV)
block.

13. Emergency treatment: Stabilize patient airway,
breathing, and assist
ventilation.
Activated charcoal For ingested drugs
Treat bradycardia with atropine 0.5-2mg I/v,
isoproterinol2-20mcg/min
by I/v infusion, or a
transcutaneous or internal
cardiac pacemaker.
Sustained release product Whole bowelirrigation

14. Calcium Chloride 10% -10ml
Calcium gluconate 10% -20ml
Epinepherine 1-4mcg/min
Insulin 0.5-1 U/kg/IV bolus followed by
infusion of 05-1 U/kg/hr
Glucagon 5-10mg/iv

15.  Cardiac glycosides are derived from a
variety of plants and are widely used to treat
heart failure and supraventricular
arrhythmias
 digoxin, digitoxin are derived from digitalis.

16. Acute over dosage nausea, vomiting,
bradycardia,
hyperkalemia and AV
block frequently occur
Chronic toxicity Hypokalemic due to
concurrent diuretic
treatment and more
commonly present with
ventricular
arrhythmias.

17. In emergency administer Activated
charcoal
Increases GI elimination and
systemic clearance
Hemodialysis
Magnesium: 2 g IV initially,
consider maintenance
treat hyperkalemia, but is not
effective for reversal of
toxicity because of the
extensive tissue distribution of
digoxin