Treatment of poisoning_in_pharmacology

general principles of poisoning and their treatment in pharmacology

1. P.S.V COLLEGE OF PHARMACEUTICAL SCIENCE AND RESEARCH

2. PHARMACOLGY-Ill Subject staff: M.RAMASAMY,M.pharm (Pharmacology). Presentation by: T.ABISHEK.,B.Pharm, (III-year)

3. TOPIC: GENERAL PRINCIPLES OF TREATMENT OF POISONING

4. CONTENTS : 1.Introduction 2.Sources 3.Signs and symptoms 4.Diagnosis 5.Treatment

5. INTRODUCTION Toxicology: It is the science that deals with study of poisons,their source, properties, action,detection and treatment of poisoning.

6. POISON Poison may be defined as any substance which if administered or comes in contact with a living being, produces ill health, disease or death. *Every drug in a high dose can be poisonous

7. SOURCES: Venom, toxins and poisons may be originating from animals, microorganisms, plants or chemicals may be, 1.ACUTE: A single large dose or multiple small dose repeated at short intervals results in acute poisoning.

8. 2.CHRONIC: Small doses repeated over a long period result in chronic poisoning.signs and symptoms appear gradually. examples of chronic toxicity : Inhalation of certain acid vapours at concentrations may, over long periods of time, cause loss of tooth enamel, eventually leading to extensive tooth decay.

9. II.SIGNS AND SYMPTOMS: While signs and symptoms of poisoning can vary depending on the type and other factors, there are a few common symptoms to be aware of: Pain & headache, Vomiting, Dizziness, Trouble breathing, Disorientation, Feeling faint.

10. …,,, Generally symptoms like hypotension and dehydration due to diarrhoea and vomitting are common, cardiac arrhythmias can occur particularly from dugs like digitalis, theophylline, amphetamine, ephedrine and some antiarrhythmic drugs

11. DIAGNOSIS: 1.Consideration of poisoning in patients with altered consciousness or unexplained symptoms 2.History from all available sources 3.Selective, directed testing The first step of diagnosis of poisoning is to assess the overall status of the patient. Severe poisoning may require rapid intervention to treat airway compromise or cardiopulmonary collapse.

12. TREATMENT: No time should be lost in identifying the exact poison. Treatment should be started immediately with supportive measures. Steps in the treatment of poisoning include, 1.STOP THE SOURCE OF POISONS: The patient should be shifted away from the source of poison.

13. 2.LIMIT THE ABSORPTION OF POISON: This depends on the route of entry,If taken orally , vomitting may be induced or stomach wash may be given to prevent further absorption of poison Cathartics or Bowl irrigation system may also be used.

14. 3.SUPPORTIVE THERAPY: Emergency stabilization of the cardio- vascular and respiratory system is needed, ABC- (Airway, Breathing, Circulation) 1. Airway should be cleared of any mucus by suction to clear the air passages if needed.

15. …... 2.If breathing is depressed, artificial ventilat- ion should be given.oxygen may be needed. 3. circulation: Circulatory status should be assessed by pulse rate,blood pressure and urine output 4.If the patient is in coma,nothing should be given orally.If all comatose patient with signs of

16. ….. CNS depression administration of “coma cock tail” is recommended,it includes i.naloxone-2mg ii.thiamine-100mg iii.dextrose-50ml of 50% solution All are given intravenously.

17. 4.SPECIFIC THERAPY : Specific antidotes, antivenoms, antitoxins should be used,. Agent causing toxicity 1.Paracetamol. - 2.morphine and other - opioids 3.methanol. - 4.carbon monoxide. - Antidotes 1.N-acetyl cysteine 2.Naloxone. 3.ethanol 4.oxygen

18. 5.OTHER MEASURES: Forced diuresis, peritoneal dialysis,haemodialysis,haemoperfusion, exchange transfusion and such similar procedures are carried out in certain cases of poisoning, only if indicated

19. GENERAL MANAGEMENT: 1.GUT DECONTAMINATION: It is done by by following three ways ,they are emesis,stomach wash and purgatives . i.EMESIS: vomitting can be induced with 20 to 30 ml of ipecac.It acts within 15 mins. But if the poison is an corrosive agent or petroleum product or if the patient is in uncons-cious stage , vomitting should not be induced

20. ii.STOMACH WASH: Washing the stomach with large amount of water removes unabsorbed poison. Stomach wash is also carried out in concious patient only. Warm water or saline may be used for lavage. iii.PURGATIVES: It may help to speed up the excretion of drugs from gut.Saline purgatives are generally needed. eg: MgSO4 20-30gm given orally.

21. 2.MANAGEMENT OF RESPIRATORY FAILURE: It is necessary to maintain a clear airway .patient should be placed in semiprone position. Oxygen may be given if there is hypoxia or increased carbon dioxide on blood gas analysis. 3.MANAGEMENT OF CIRCULATORY FAILURE: In presence of hypotension, foot end of the bed should be elevated.Vassopressors like dopamine, phenylephrine or methoxamine may be used.

22. 4.ANTIDOTES: An antidote is the substance which antagonizes and overcomes the effect of poison.Unfortunately specific antidotes are available only for a few toxins. According to the mode of action antidotes are classified into three types, they are, I.PHYSICAL ANTIDOTES: Act by reducing the adsorption of poison. eg: activated charcoal adsorbs. Alkaloids

23. 2.CHEMICAL ANTIDOTES: These act by forming complex with poison. eg: acetic acid reacts with alkaline. 3.PHARMACOLOGICAL ANTIDOTES: These antidotes are compete for binding to the same receptors or sites where the toxins binds. eg: naloxone for morphine.

24. SNAKE BITE TREATMENT: All over the world snake bites are respons- -ible for 30,000 to 40,000 deaths every year.In,India 2 lakh people are bitten by snakes every year of which about 16,000 die.vipers, cobra and kraits are common poisonous snakes. SIGNS AND SYMPTOMS:. The signs and symptoms of systemic activity appear in about half an hour,..

25. Common symptoms: In all cases of snake bite,the patient is in,.. Semiconcious state, Cold, Clammy skin, feeble pulse, Rapid and shallow brearthing, pain, Swelling, Burning Discolouration of site,. Oozing blood,..etc,

26. …... 1.Elapid bite(cobra,kraits,.)- neurotoxic 2.Viper bite. -haemotoxic 3.Sea snakes. -hydrophids/myotoxic TREATMENT: I.FIRST AID: 1.Reassurance 2.Immobilise the bitten part.Measures like local incision,suction,application of ice are all found to be harmful and no more recommended.

27. 2.SPECIFIC THERAPY: Antisnake venom(ASV) is indicated in presece of signs of systemic envenomisation.Dose of antivenom varies, i.Mild envenomisation - 3 to 5 vials ii.moderate envenomisation -5 to 10 vials iii.severe envenomisation -10 to 20 vials Infusion should be done after test dose.clean the bite site with providence iodine.

28. FOOD POISONING: Food poisoning can occur on consumption of food that is contaminated with microorganisms,toxins or chemicals. CAUSES FOR FOOD POISONING: 1.Microorganisms: Bacteria,fungi,protozoa and viruses 2.Toxins: in certsin fish, plants & mushrooms. 3.Chemicals.

29. SIGNS AND SYMPTOMS: Nausea Vomitting Abdominal pain Fever Weakness and Diarrhoea are the common symptoms Other symptom depends on causative agent.

30. REFERENCES: 1.Book;Phamacology, Author;Padmaja udayakumar 2. https://www.msdmanuals.com/professional/ injuries-poisoning/poisoning/general-principles-of-poisoning

31. THANK YOU