‫بسم الله توكلت على الله ولحول ول قوة إل بالله العلي العظيم‬ ‫النهاردة هناخد النباتات‬ ‫عندنا كام

واحد‬ 1. Atropine 2-Strychnine 3-Nicotine 4- Aconite 5-Ergot 6- Digitalis 7-Cocaine 8- Opium 10-Hashish 11- lSD. 12.mescaline 13.nutmeg 14.amphetamine 15.DMT-DET-DPT ‫الله المستعان‬

Drug 1. Atropine

Fatal dose 5mg (Atropin &hyoscamine) 8mg==hyoscine 15-30mg 40-60mg(1 drop ) contained in 2-4 gm of tobacco in GIT 15-30 mg (In 2 hrs) 1 gm of the plant 5 ml of the tincture 1-2 mg of aconitine 5mg digitoxine 3mg digoxine 30mg pure IV 1gm by snuffing(20mg in one line) 2-5 gm of opium 100-500gm of morphine period 6-12 hours 35μg is hallucinogenic but street dose need to be 200μg ‫خللي بالك ميكرو جرام‬ 5mg/kg ==sensory hallucination 50mg/kg ==sever hypotension&Resp.depres sion 10-15mg i.e (2-3 nutmegs)

2. Nicotine 3. Strychnine 4. Aconitine (fatal period 1-4 hrs) 5. Digitalis 6. Cocaine ‫يعني محتاج خمس‬ ‫خطوط علشان يدخل‬ ‫في التسمم‬ 7. Opium Acute poisoning 8. lSD

9.mescaline

10.nutmeg

‫هنبدأ بال‬ Atropine ‫عندنا تلت نباتات فيهم تلت مواد فعالة‬ Atropa pelladona Hyoscyames Dtura ‫بيقول لك ايه إن كل جزء من النبات (يعني جذر ساق أوراق بذور )بيحتوي‬ ‫على أي من التلت مواداللي هما‬ Atropin ,Hyoscine &Hyoscyamine Site of action Postganglionic cholinergic neve endings Mechanism of action: Stimulation followed by depression ‫السطر اللي فات مش بيفكركم بحاجة‬ ‫اللي قلناه المرة اللي قبل فاتت‬ Stimulation followed by depression ‫وعلشان نتفق بعد كده أي حاجة هتلقي فيها‬ Stimulation on CNS ‫هنقول‬ Irritability, Restlessness, Anxiety Agitation, Hallucinations, Convulsions ‫وأي حاجة فيها‬ Depression ‫هنقول‬ Lethargy, Apathy, Somnolence, Confusion, Sleep, stupor, Coma ‫وبالمرة هيكون سبب الوفاة‬ Circulatory collapse, Resp. Failure )RC depression( ‫لنها هتتكرر بعد كده كتير فمش كل شوية هنقعد نقول كلم مش شكل‬ ‫(بعضه(زي ما بقول لك كده هنحط الكلمتين دول وهيطلعو صح‬ Hyoscine==depression from the start ‫فاضل بس ال‬ Peripheral action Eye==Mydriasis==Dilated fixed pupil )irreactive(

Face==fever ==hyperpyrexia due decreased sweating &Not due to heat regulating centre affection Trachea==decreased bronchial secretions GIT== colic &constipation Urinary ==urine retention )need catherization( ‫وبعدين كلم اهبل كده يقول لك ايه‬ ‫سخن زي الرنب و أعمى زي الخفاش وناشف زي العظمةوأحمر زي‬ ‫)البنجر ومجنون زي الفرخة‬beet( ‫بعد كده‬ Management As we said before )diagnosis+ttt( Diagnosis=C/P +investigations ‫مش احنا قلنا إن عنده‬ Urine retention Tachycardia ‫ماقلناهاش دي‬ Convulsions Hyperpyrexia ‫بسيطة هنعمل ايه‬ ‫الول الخطوات السبعة بتوعنا بس مش هعيدهم تالت‬ Urine retentionCatherization +fluids by mouth or IV to maintain urine output Tachycardia Monitor E .C.G. Convulsionsanticonvulsant e.g diazepam HyperpyrexiaCold fomentations &reduce rectal body temperature to 38 Physiological antidote is Physostigmine ==Act centrally &peripherally 1-5 mg ml is given Slowly IV according to age &severity of the case ‫وما ننساش غسيل المعدة بإيه؟‬ K permanganate oxidize alkaloid Tannic acid ppt alkaloid Alkalies)Na HCO3 2%(ppt alkaloid Activated charcoal Adsorption of alkaloid Strychnine Strychnus nux vomica seeds ‫اسم النبات ستركنس نكس فوميكا‬

‫خلي بالك الجزء الفعال هو البذرة وهي عاملة زي الزرار وناشفة جدا ولو‬ ‫حد بلعها عادي مش هيحصل حاجة إنما التسمم لما تكون مطحونة‬ ‫موجود معاه مادة تانية أقل منه شوية بعشرين مرة بس‬Sterychnine ‫وال‬ ‫== اسمها ايه‬ Brucine ‫بس لحظو حاجة إن طعمه لذع فمش هينفع في القتل‬ Mechanism of action ‫مهمة‬ Strychnine inhibit inhibitory chemical transmitter)Glycine( in the spinal cord=stimulation leading to Any sensory stimulus passing along synapses will reach post.horn cells leading to stimulation of all muscles of the body simultaneously =The character of movement will be governed by relative strength of the different muscles ==Extensors are stronger ‫افتكرها لن النسان بيبقى واقف على رجليه وفارد ظهره ودي شغلة ال‬ ‫وهي أقوى‬Extensors )‫فاللي بيحصل ايه (كده دخلنا في الكلينيكال بكتشر‬ Stiffness of the muscles of the head &neck, .1 restlessness, tremors in limbs =replaced by Painful convulsions Face ==all muscles are contracted ==Bitter smile = .2 called Risus sardonicus due to contraction of oricularis muscle ‫وتنطق ري سس ساردونيكس‬ All extensor muscles of the body are more powerful than .3 flexors )Arching of the back, Overextension of the limbs called Opisthotonus position ‫وتنطق أوبي ستوتونس‬ During convulsion In between

*All ms contracted Abd.&Resp.ms are* involved==stoppage of resp. movement No heart beat* No arrhythmia* Hypertension* Eye==bulges* pupil==dilated* face, lips are *cyanosed patient is suffering from peripheral *asphyxia

*All ms relaxed *Resp resumed

*Heart beats again

eye== ball retract* pupil== contract* again cyanosis disappear*

The patient is exhausted in between attack &anxious about a recurrence of spasm Any stimulus either visual ,Auditory or tactile will induce convulsions Death occurs after 5 covulsions Either during convulsions ==prolonged spasm of resp. -1 muscles death is due to Asphyxia )During interval ==Death due to exhaustion )syncope-2 ttt ‫اهم حاجة ما ننساش إن المريض ده أي لمس أو نور أو صوت هيدخله في‬ ‫تشنجات من جديد أمال إيه الحل؟‬ ‫ يقوم يريلكس وتتعامل معاه بقه‬ether ‫أول حاجة تشممه‬ Ether inhalation then followed by IV pentothal )General-1 )anaesthetic Artificial respiration with O2-2 Anticonvulasnt ==diazepam slow IV &repeat every 30-3 min if necessary OR Succinylcholine chloride IV Mephensin 1gm IV drip is the physiological antidote of -4 strychnine Gastric lavage using activated charcoal &K-5 parmenganate 1/1000 Acid diuresis by means of furosemide &ascorbic acid-6

It is VIP to keep patient in dark room, quit with -7 absence of stimuli Nicotine poisoning Plant name: Nicotiana Tabacum Active substance Nicotine :Forms
Nicotine ==volatile liquid found in the dry leaves &stem of-1 the plant dried leaves of tobacco contain about 2-6%of nicotine -2 ==used for smoking &chewing Decoction as insecticide 1% or more of nicotine-3 For spraying trees (‫منقوع)دي كوكشن‬ ‫طريقة التسمم طبعا دي حاجة نادرة جدا‬ Drinking the decoction of leaves or even drinking the -1 insecticide solution Inhalation of nicotine spray or dust during spraying trees-2 in agriculture NB nicotine us poorly absorbed from GIT but can be absorbed from intact skin

Nicotine act on parasympathetic ganglia ‫ في الجهاز العصبي‬A.Ch ‫أماكن وجود ال‬ CNS-1 Autonomic ganglia-2 spinal cord-3 Myoneural junction-4 Action Central Stimulation followed by depression Same mentioned before Peripheral Paralysis of cells of peripheral autonomic ganglia, myoneural junction &spinal cord, skeletal muscles )including the diaphragm are paralyzed )curare like action Clinical picture Initially there is burning of the mouth,throat & stomach preceding to prostration ,convulsions ,Respiratory slowing ,cardiac irregularity ,coma &generalized paralysis .Death due to Resp. ms paralysis within few min Ttt Skin decontamination Gastric lavage

Artificial resp Atropine IV Anticonvulsants ==Diazepam Supportive care &IV fluids Aconitine poisoning Plant ==Aconitum napellus or aconitum columbianum ),Aconite )Mankshood All parts of the plant are poisonous Active substance ==Aconitine Action Direct cardiotoxic effect Arrhythemia irregular beats &fibrillation We must remember that other cardiotoxic poisons are Antimony,Tricyclic antidepressants,Carbolic acids ,Aconitine Central stimulation ===depression ‫معروفة‬ Sensory stimulation ===depression ) tigling ,numbness then anaesthesia( Motor stimulation ===depression Twitches ,tremors ==paralysis Ttt==Atropin+digitalis +O2 ‫مع عدم اغفال باقي الجوانب‬ Ergot ‫معلش ابقوا اقروه‬ Digitalis Mechanism of action ‫اكتبها لو مش مكتوبة‬ 1-Inhibit Na –K Atpase pump Ca entry &K outflux  hyperkalemia Ca influx improve myocardial contractility Lead to decreased size of the enlarged heart &improve venous return,Cop &renal blood flow stimulation of vagus nerve bradycardia -2 inhibition of S.A.node &Av.node -3

weak diuretic action improve coefficiency of the heart -4 We'll Quickly compare acute &chronic toxicity due to External factors upon me Acute Chronic Normal person take the drug He is non cardiac patient Nausea ,vomiting ,Abd pain Arrhythemia Say any type except sinus arrhythemia Hyperkalemia Hypokalemia because of diuretic use d with digitalis K sparing diuretic ==weak diuretic action Gynecomastia due to steroid ring Ttt of arrthemia Procainamide Lidocaine K bicarbonate Ttt of heart block ==Atropin Occur in cardiac patient Slow onset Visual yellow hallucinations Confusions Hallucinations All types of arrhythemia

‫يا رب يا منجي من المهالك‬
Cocaine Morphine

Acute

30mm Iv 1mg snuffing

mg -20 mg 15 therapeutic

Action

Euphoria )once )+forever increase in+ activity Mydriasis

Pupil Cvs

Euphoria with 1 st dose due to analgesia &sleepy== then dysphoria Pinpoint

Ttt

Tachycardia ,hypertension +increased pulse==increase myocardial activity without sufficient oxygen supply ==increase load on heart==circulator y failure Gastric lavage with activated charcoal ABCDs ‫والباقي معروف‬

Bradycardia +orthoststic hypotension Coma &death due to inhibition of RC

I can make GL at delayed time due to inhibition of gastric motility ABCDs Specific antidote We have 2 groups agonist* antagonist ==nalorfan =levalorphane if addict ==with drawl manifestations if not ==acute intoxication from the drug itself pure antagonist* numefin more potent &of longer duration than naloxone

‫يا خفي اللطاف نجنا مما نخاف‬ ‫سلم‬