Drugs used in GIT Poisoning and Emetics PPT2.pptx

Drugs Used to management patients of poisoning

1. Drugs used in GIT Poisoning and Emetics By Dr Peter Mukhama kiondo b.pharm . Msc . Pharmacology Iaea fellow radiopharmacy

2. By definition: A Drug is a carefully used Poison. A Poison is a misused Drug

3. PLAN To remove or reduce the poison from the GIT by the following methods 1. to cause emesis 2. Diarrhea 3. Absorption

4. Treatment for GIT poisoning involves drugs like emetics, anti-emetics, adsorbents, cathartics, antacids, prokinetics , antibiotics, and specific antidotes, along with supportive care and consultation with a healthcare professional or poison control center. Drugs used in GIT poisoning The emetic reflex is the body’s protective mechanism to prevent the absorption or delivery of substances that are perceived as toxic to the small intestine and ultimately the blood stream (Andrews and Horn, 2006

5. EMETICS

6. TO NOTE Ipecac syrup (no longer recommended due to potential for abuse ) - Stimulates vomiting by irritating the gastric mucosa and activating the chemoreceptor trigger zone (CTZ) in the brain . - Increases gastrointestinal motility. Also Apomorphine is rarely used. -   It Activates dopamine receptors in the CTZ, inducing vomiting .  

7. Important notes 1. Treatment should be guided by the specific type of poisoning and severity of symptoms. 2. Activated charcoal is often the first line of treatment. 3. Ipecac syrup is no longer recommended due to potential for abuse. 4. Antibiotics should only be used if bacterial poisoning is confirmed. 5. Consult a healthcare professional or poison control center for guidance

8. Adsorbents (to bind toxins )   1. Activated charcoal (single or multiple doses ) - Binds to toxins, reducing absorption and enhancing elimination. - Interferes with toxin-receptor interactions. 2. Kaolin-pectin combination - they work together synergistically to adsorb toxins, chemicals and bacteria, reducing their adsorption into the blood stream - Kaolin forms a protective barrier on the GIT mucosa, while pectin helps sooth and calm irritation. - Pectin’s soluble fiber helps create a soothing film on mucus membranes ,reducing inflammation and discomfort

9. Cathartics (to evacuate bowel)   1. Magnesium hydroxide (milk of magnesia) - Increases water absorption, softening stool and promoting bowel movement. - Neutralizes stomach acid. 2. Magnesium citrate - Increases water absorption, softening stool and promoting bowel movement. - Helps eliminate toxins.

10. 3. Sorbitol - It is poorly absorbed by the small intestines thus remaining in the GIT - It retains water in the intestines causing the increase of water content in stool - Water content increases intestinal pressure and stimulates bowel movements - It inhibits water absorption in the colon leading to stool softness

11. Antacids (to neutralize stomach acid ) 1 . Aluminum hydroxide gel - - Neutralizes stomach acid , reducing gastric irritation. - Binds to toxins, reducing absorption . 2 . Magnesium hydroxide -It reacts with hydrochloric acid in the stomach to form water, Mgcl2 and CO2. 3. Calcium carbonate - Neutralizes stomach acid, reducing gastric irritation.

12. Prokinetics (to enhance gut motility )   1. Metoclopramide (Reglan ) and 2. Domperidone ( Motilium ): - Enhances gastrointestinal motility. - Accelerates gastric emptying. 3. Erythromycin (off-label use ) - It binds to motilin receptors in the GIT thus stimulating the GIT motility - It enhances Ach release from enteric neurons , increasing smooth muscle contractions - It accelerates gastric empting by increasing antral contractions and also enhances intestinal motility and thus ,reduction of transit time

13. Food Poisoning Bacillus cereus (bacterium) Campylobacter (bacterium) Clostridium botulinum (bacterium) Clostridium perfringens (bacterium) Escherichia coli, commonly called E. coli (bacterium) Giardia lamblia (parasite) Hepatitis A (virus) Listeria (bacterium) Norovirus (virus) Rotavirus (virus) Salmonella (bacterium) Shellfish poisoning (toxin) Shigella (bacterium) Staphylococcus aureus (bacterium) Vibrio (bacterium)

14. Antibiotics (for bacterial poisoning )   1. Ciprofloxacin ( Cipro ) - Inhibits bacterial DNA gyrase and topoisomerase IV. - Effective against gram-negative bacteria. 2 . Azithromycin (Zithromax ) - Inhibits bacterial protein synthesis. - Effective against gram-positive and gram-negative bacteria.   3 . Metronidazole ( Flagyl ) -It inhibits the bacteria DNA synthesis and repair.

15. SPECIFIC ANTIDOTES COMMON SUBSTANCES USED FOR POISONING Organophosphorus poisoning • Organochlorides – Endosulphan poisoning • Rat poisons • Aluminum phosphide poisoning • Oduvanthalai poisoning • Oleander poisoning • Acetaminophen overdose • Barbiturate

16. FIVE GOLDEN RULES 1. Correct immediate life-threatening , Breathing and Circulation 2. Many poisoned patients will recover with simple supportive measures . 3. Alleviate the anxiety of the patient and the family members. 4 . Assess the condition of the patient frequently 5.Encourage the family member (s)/ friend (s) to bring the remaining materials of the poison consumed/ tablet taken and any other note left by the patient for identification of the poisonous agent and to decide on appropriate antidote

17. Specific antidotes   1 . Atropine (for organophosphate poisoning ) - Blocks acetylcholine receptors, reversing muscarinic effects. - Reduces salivation, sweating, and bronchial secretions. 2 . Pralidoxime (2-PAM) (for organophosphate poisoning ) - Reactivates acetylcholinesterase , reversing neuromuscular blockade . 3 . N- acetylcysteine ( Mucomyst ) (for acetaminophen overdose - Replenishes glutathione stores. - Enhances acetaminophen conjugation and elimination

18. Supportive care   1. Fluid replacement - Replenishes lost fluids and electrolytes. - Maintains hydration 2 . Electrolyte management - Replenishes lost electrolytes. - Maintains acid-base balance 3. Monitoring of vital signs 4. Rest and hydration

19. Please note that this is not an exhaustive list, and treatment should always be guided by a healthcare professional or poison control center.  

20. Thank you