Poisoning of some Drugs
1. Poisoning with muscarine:
Symptoms:
- miosis,
- blurred vision,
- increased salivation,
- excessive sweating,
- lacrimation,
- bronchial secretions,
- bronchoconstriction,
- bradycardia,
- abdominal cramping,
- increased gastric acid secretion,
- diarrhea and polyuria (it might cause also tremor, convulsions and hypothermia).
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| Miosis |
Treatment:
The drug of choice is Atropine.
Atropine (antidote), also can be used as muscarinic antagonists scopolamine and pirenzepine.
Prescription
Rp.: Sol. Atropine sulfatis 0,1%-1 ml
Da Tales Doses Numero-10 in amp.
Signa .To introduce 1ml IM during poisoning by muscarine.
2. Poisoning with organophosphates:
Symptoms:
- hypersalivation,
- nausea,
- vomiting,
- spasm of bronchi,
- edema of the lungs,
- convulsions,
- unconsciousness.
Treatment:
introduce IM atropine and reactivators of cholinesterase –dipyroxime, alloxim, izonitrozin.
Prescription
Rp.: Sol. Atropini sulfatis 0,1%-1ml
Da Tales doses numero 10 in ampules
Signa. introduce IM 1 ml
3. Poisoning with Belladonna:
Symptoms:
- restlessness,
- disorientation,
- hallucinations,
- delirium,
- coma,
- midriasis,
- dryness of skin and mucous membrane,
- dysphagia,
- retention of urine,
- hyperemia,
- elevated body temp.
Treatment:
neostigmine (anticholinesterases) –cause accumulation of the acetylcholine in synapses what leads to releasing atropine(belladonna) from receptors,
chlorpromazine to decrease psychotic disorders,
barbiturates to decrease seizures.
Prescription
Rp .: Tab. Neostigmini methylsulfatis 0,015 N 10
DS: inside 1 tab. 30 minutes before meals 3 times a day.
4. ANTICOAGULANTS OF INDIRECT ACTION: (Warfarin)
Symptoms:
- hemorrhage,
- diarrhea,
- alopecia,
- urticarial,
- skin necrosis,
- dermatitis.
Antidote: Vikasolum ,Vitamin K
Prescription:
Rp: Vikasoli 0.015
D.t.d No 20 in tab
Signa. To introduce 1 tab PO 2t/d after meal.
4.b : ANTICOAGULANTS OF DIRECT ACTION: (Heparin)
Symptoms:
- Hemorrhage,
- Subdural hematoma,
- hemarthrosis,
- ostealgia,
- osteoporosis
Antidote: Protamine sulfate
Prescription
Rp. Protamini sulfatis 10ml
D.S. Introduce 25ml IV
5.Myorelaxants Depolarising and Non-Polarising type of Action:
Depolarizing-- Dithyline (Succinylcholine) is a double Ach molecule, Depolarizing agents,
myorelaxants, acts on end plate Ncholinoreceptors, stimulates them and causes depolarization of postsynaptic membrane, administred IV, has short duration of action.
Sings of poisoning: May cause fibrillation of skeletal muscles at the start of action, hyperkalemia, cardiac arrhythmia, an increase of intraocular pressure, pain in skeletal muscles after the surgery, long lasting apnea in patients deficient on butiryl cholinesterase
Intoxication treatment: In case of Dithyline poisoning emergency help is hemotransfusion and artificial lung ventilation.
Non- depolarizing: Tubocurarine
Non- depolarizing Symptoms- Hypotension,Spasm of bronchi,urticarial. Antidote : Proserini and Galantamine hydrobromide
Prescription
Rp: Sol. Proserini 0.05% - 1 ml
D. td N 6 in ampull.
S. 1 ml 1-2 times a day
6. Acute poisoning with etanol:
Etanol is a water and lipid soluble liquid with a specific odor.
Effects:
- an antiseptic,
- a disinfective action,
- an irritating action,
- a tannic effect,
- an antifoam action,
- an anxiolytic action,
- an anti-shock action,
- an increase in BP,
- an increase in heat irradiation.
Sings of poisoning:
- specific odor;
- excitement,
- then sleeping and coma;
- hyperemia of the face,
- then paleness;
- a decrease in BP;
- suppression of respiration;
- hyporeflexia;
- hypothermia;
- involuntary urination
- defecation
Intoxication treatment: Lavage of the stomach with the solution of potassium permanganate, Analeptics (Bemegridum), Glucose, insulin and vitamins preparation, IV, Nootrops (Piracetam, IV)
Prescription 1
Rp.: Sol. Pyracetami 20% 5 ml
D. t. d. No10 in ampulis
S. 5 ml IV once a day
Prescription 1
Rp.: Sol. Bemegridi 0.5% 10 ml
D. t. d. N. 10 in ampulis
S. Intravenously (slowly) 5 ml 1 time per day
7. Chronic poisoning with ethanol:
Symptoms:
- alcohol encephalopathy,
- alcohol polyneuritis,
- alcohol myocardiopathy,
- alcohol cirrhosis,
- hypoacidic gastritis,
- impotency in men,
- negative influence on fetus in pregnant women
Treatment: Emetine chydrochloride, Teturam(Disulfiram)
Prescription 1
Rp. Disulfiramini 500,0
D.t.d No 20 in tab.
S. Introduce PO 1 tablet 2 times a day
8. Poisonings with Barbiturates:
Symptoms:
- sleep,
- coma,
- hyporeflexia,
- a decrease of muscle tone,
- suppression of respiration,
- hypotension,
- hypothermia,
Treatment:
- benzodiazepine derivatives (Nitrazepam),
- Chloral hydrate,
- Bromisovalum,
- Zolpidem,
- Zopiclone
Emergency help:
- lavage of stomach,
- activated charcoal,
- laxatives (magnesium sulfide),
- hemodilution and forced diuresis,
- hemodialysis,
- alaleptic Bemegridum (antagonist of barbiturates)
Prescription
Rp: Carbonis activatis 0,5(30,0)
D.t.d: № 10 in tab.
S. Take 2 tablets after oral poisoning for absorption of the poison.
9. Treatment of poisonings with Opioid Analgesics:
Signs:
- state of sleep,
- unconsciousness,
- presence of reflexes,
- normal muscular tone,
- miosis,
- bradycardia,
- Chain-Stocks breath,
- the retention of urination,
- spasm of the intestine and bowel
Emergency help:
- the lavage of the stomach by 0,5% solution of potassium permanganate,
- Naloxone IV (an antagonist of narcotic analgesics),
- Atropine (for a decrease in vagal action of morphine)
Prescription
Rp: Sol. Naloxoni hydrochloridi 0.04%-1ml
D.t.d: N 10 in amp.
S. Inject 1 ml SC
10. Poisoning with salicylic acid derivatives:
Symptoms:
- Nausea,
- vomiting,
- ringing in the ears,
- headache,
- confusion,
- hyperventilation,
- tachycardia,
- fever,
- Delirium,
- hallucinations,
- seizures,
- coma,
- respiratory arrest
Emergency help :
- Activated charcoal and sodium bicarbonate,
- lavage of stomach with cold water,
- narcotic analgesics for a decrease in pain,
- the administration of astringents into the stomach.
Treatment:
Rp: Carbonis activatis 0,5(30,0)
D.t.d: № 10 in tab.
S. Take 2 tablets after oral poisoning for absorption of the poison.
11. Cardiac Glycosides
Treatment:
- abolishing of cardiac glycosides,
- drugs containing potassium(panangin ,potassium chloride),
- digoxin antibodies(digibind),
- S-H group donator(Unithiol).
Symptoms:
- Bradycardia,
- anorexia,
- nausea,
- vomiting,
- arrhythmia
Antidote: Unithiol
Prescription
Rp. Sol. Unithioli 5%-5ml
D.t.d No 15 in amp
S. Introduce 5ml IV
12.Poisoning with paracetamolum:
Specific signs:
- yellowing of the skin and the whites of the eyes (jaundice),
- loss of co-ordination,
- low blood sugar (hypoglycaemia),
- which can cause symptoms including sweating, trembling and irritability.
Treatment:
- Acetylcysteine, also called N-acetylcysteine or NAC, works to reduce paracetamol toxicity by replenishing body stores of the antioxidant glutathione.
Gastric decontamination:
In adults, the initial treatment for paracetamol overdose is gastrointestinal decontamination. Paracetamol absorption from the gastrointestinal tract is complete within two hours under normal circumstances, so decontamination is most helpful if performed within this timeframe. Gastric lavage, better known as stomach pumping, may be considered if the amount ingested is potentially life-threatening and the procedure can be performed within 60 minutes of ingestion. Activated charcoal is the most common gastrointestinal decontamination procedure as it adsorbs paracetamol, reducing its gastrointestinal absorption. Administering activated charcoal also poses less risk
of aspiration than gastric lavage.
Liver transplant:
In people who develop acute liver failure or who are otherwise expected to die from liver failure, the mainstay of management is liver transplantation.
Prescription
Rp.: Sol. Acetylcysteini 2,0 - 100 ml
D.S.in case of poisoning by paracetamolum Intravenous acetylcysteine is given as a continuous infusion over 20 hours for a total dose 300 mg/kg. Recommended administration involves infusion of a 150 mg/kg loading dose over 15 to 60 minutes, followed by a 50 mg/kg infusion over four hours; the last 100 mg/kg are infused over the remaining 16 hours of the protocol
13. Caffeine sodium benzoate:
Symptoms:
- fever,
- tachypnea,
- jitteriness,
- insomnia,
- seizures,
- fine tremor of the extremities,
- hypertonia,
- tonic-clonic movements,
- non-purposeful jaw and lip movements,
- vomiting,
- hyperglycemia,
- elevated blood urea nitrogen.
Treatment:
- intravenous administration of diazepam or a barbiturate such as pentobarbital sodium
Antidote: Diazepam
Prescription
Rp: Tab. Diazepami 0,005
D.t.d: №100 in tab.
S: introduce PO 1 tablet 2 times a day
14. Bromides:
Bromides are sedative drugs. The action of bromides depends on the type of nervous system: in the case of a “weak” type the action is increased one and an in a “strong”—the contrary type. That is why the doses of bromides have to be determined individually. The bromides are excreted from the organism rather slowly (50-60 days).
Sings of poisoning: Bromides may be accumulated and cause the signs of chronic poisoning (bromism) which is manifested in weakness, sleepiness, apathy, decrease of memory, and acne- form eruption on the skin (bromide acne). The irritative action of bromides leads to inflammation of the mucous membranes, which is accompanied by cough, rhinitis, conjunctivitis, and diarrhea.
Iintoxication: The treatment of bromism is carried out by interrupting to take bromides and speeding up their excretion. The excretion of bromides with the urine may be increased by indication of high amounts of sodium chloride, water, and diuretics.
Prescription
Rp. Sol. Natrii Chloridii 0,9%-500ml
D.S. IV, twice a day
Rp.: Sol. Furosemidi 0,01% –2 ml
D.t.d. N 10 in ampulis
S. For IM injection, 2ml, twice a day
15. Neuroleptics:
Symptoms:
- Coma,
- seizures,
- hypotension,
- dysrhythmia.
Treatment: Treatment is with activated charcoal and this should Be done as soon as possible.
Antidote: Carbonis activatis
Prescription
Rp: Carbonis activatis 30.0
D.S. To mix with water and introduce orally or Via tube if the patient is in coma
16. Methyl Alcohol poisoning:
Symptoms:
- metabolic acidosis with rapid shallow breathing, (tachypnea.)
- Visual disturbances,
- severe abdominal pain,
- GI disturbances,
- retinal edema,
- Coma in severe cases may lead to death due to respiratory Failure.
Treatment:
- fomepizole and ethanol, both drugs act to reduce The action of alcohol dehydrogenase.
- Also Gastric lavage with sodium bicarbonate and glucose solution.
Antidote: Ethanol , fomepizole
Prescription
Rp: Sol. Ethanol 95%-50ml
D.t.d No 1 in amp
S. To introduce IV slowly in drops.
17. Salts of heavy metals:
Acute poisoning:
Symptoms –
- vomiting and diarrhea with admixtures of blood.
- Metal after taste,
- Hyper salivation,
- bleeding gum ,
- 2-3 days after – acute renal failure,
- Hypochromic anemia.
Emergency help: lavage of the stomach, Administration of charcoal and astringents in The stomach, Atropine for a decrease in spasm of GI tract, Hemodialysis.
Antidote: Unithiol and Sodium thiosulfate
Prescription
Rp: Sol. Unitholi 5%-5ml
D.t.d No 5 in ampullis
S. To introduce 2ml in during poisoning with heavy metals.
Chronic poisoning:
Symptoms-
- headache,
- Weakness and tiredness,
- Achy joints and muscles ,
- Constipation
Prescription
Rp: Sol. Natrii thiosulfatis 30%-10ml
D.t.d N 10 in amp
S. To introduce 2ml in during poisoning with heavy metals.
18. Cyanides poisoning:
Symptoms:
- coma with seizures,
- apnea,
- and cardiac arrest,
Antidote :
Rp: Sol. Natrii thiosulfatis 30%-10ml
D.t.d N 10 in amp
S. To introduce IV
19. Nitrates and Nitrites poisoning:
Symptoms :
- Bluish skin from lack of oxygen(around mouth and lips),
- Difficulty breathing,
- nausea,
- diarrhea,
- Vomiting,
- dehydration,
- fast pulse,
- dizziness and CNS depression.
Emergency help:
- Methylene blue- which converts hemoglobin into methhemoglobinThis interacts with cyanides and transforms them into non-toxic compounds.
Antidote: Methylene blue R.p: Rp: Sol. Methyleni coerulei 1%-50ml
Prescription
D.t.d No 5 in amp
S. To introduce IV,after it has been prepared on 25% glucose. In case of poisoning by nitrates.
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