Cardiac Poisons

DON Has A Queen

Digitalis

Oleander

Nicotinum

Hydrocyanic acid

Quinine

Included

Nicotine, nornicotine, anabasine @NAN

Nicotinum tobaccum active principles

All except ripe seeds

Toxic parts of tobacco

15-20 mg of nicotine

1 cigarette how many gm of nicotine

Acts on nicotine receptors present in autonomic nervous system, adrenal medulla, central nervous system, spinal cord, neuromuscular junction and chemoreceptors of carotid and aortic bodies.

Acts on the somatic NMJ and afferent fibres from sensory receptors

Suppresses appetite while increasing basal energy expenditure,leading to weight loss.

MOA of nicotine

1-2mg

Amount of nicotine absorbed from one cigarette

60-100mg of nicotine

tobacco -15-30gm

Toxic dose of nicotine

Inversine-(mec-amyl-amine)—— nicotine antagonist

Antidote for tobacco poisoning

• Gastric lavage with potassium permanganate & then use activated charcoal.

• Nicotine is completely eliminated from the body in 16 hours – if a person survives this period.

• Mec-amyl-amine is the antidote of choice – nicotine antagonist.  

• For chronic users – Nicotine Replacement Therapy

• Which includes nicotine gum, nicotine patch, nicotine nasal spray, & nicotine inhaler.

treatment of tobacco poisoning

Brownish stains present over the skin

Brownish froth present over the nose and mouth

Tobacco smell

SIgns of asphyxia

Pulmonary edema

Brownish discoloration of esophagus and stomach mucosa

PM findings of tobacco poisoning

5-15 minute

Fatal period of tobacco poisoning

Yellow oleander

Lucky nut

Cerebra thevetia other name

Cerebrin

Thevetin

Thevotoxin

Peruvoside

Neriifolin

Active principles of yellow oleander

Peripheral circulatory failure

Cause of death in yellow oleanders

8-10 seeds

root-15-20gm

Fatal dose of yellow oleadnder

2-3hours

Fatap period

1. Gastric lavage & activated charcoal as usual;

2. IV fluids;

3. Atropine for sinus bradycardia & A-V block;

4. Antiarrhythmics e.g. Lignocaine

5. Digoxin – specific Fab fragment therapy is said to be effective.

Treatment for yellow oleander poisoning

White oleander

Common oleander

Kaner

All part of the plant is toxic

Nerium odorum other names

Nerin

Oleandrin

Karabin

Folinerin

Toxic principle of nerium odorum

Blocks Na k atpase

Mechanism of action of nerium

Petechial hemorrhage

charateristic feature of nerium odorum in heart on PM finding

Root-15-20gm

Leaves-5-15gm

Fatal period 24 hours.

Fatal dose and fatal period of nerium odorum

Monkhood

Blue rocket

Devil’s helmet

Mitha Zaher, BIsh, Sweet poison, Wolf bane

Aconite other names

Aconitine

Pseudo-aconitine

Indaconite

Picraconite ,aconine

Active principles of aconite

Opens Na+ channel in nerve axons

Inhibits complete reploarization of the membrane in myocardial tissued due to repeated firing

Stimulates vagal medullary centre

MOA of aconite

Nausea, vomitting, diarrhoea, bradycardia, sinus tachycardia, ventricular arrhythmia, tingling and numbness sensation around the lips and mouth,slow irregular feeble pulse, slow laboured and shallow breathing, hippus.

Signs of aconite poisoning

Atropine

Major physiological antidote in aconite poisoning

Root-1-2gm

Aconitine-2-5mg

Fatal period-2-6hours

Fatal dose and fatal period

DVT-Deafness, vertigo, tinnitus

BDS-Blindnessm Diplopiam scotoma

SKinrash

Hypoglycemia

Cardiac arrhythmias

Features of cinchonism and quninism