Reorientation training programme

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Re-orientation training programme
WELCOME

• SIGNIFICANCE OF TOXICOLOGY
• FOR
• HOMOEOPATHIC PHARMACOLOGY

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Dr. Srinath Rao B.H.M.S., M.D (Hom)

• VICE PRINCIPAL
• HEAD OF DEPARTMENT
• DEPT. OF HOMOEOPATHIC MATERIA MEDICA
• FR. MULLER HOMOEOPATHIC MEDICAL
• COLLEGE HOSPITAL
• DERLAKATTE, MANGALORE

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PHARMACOLOGY

• The science or study of drugs
• their preparation and properties
• (origin,nature,chemistry)
• and
• uses and effects.

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The word Pharmacology

• Greek pharmakon meaning drug, and logos,
  knowledge".
• Early pharmacologists focused on natural
  substances, mainly plant extracts.
• Pharmacology developed in the 19th century as a
  new biomedical science that applied the
  principles of scientific experimentation to
  therapeutic contexts.

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• Pharmacology deals with all aspects of the
  actions of drugs on living tissues, particularly
  their effects on man.
• Drugs' actions, both at the molecular level
  (interaction of drug molecules with receptors)
  and also at the macroscopic or whole-body level
  (such as drug effects on the cardiovascular
  system), are considered.
• The subject can be divided into two main
  sections pharmacodynamics and pharmacokinetics.
• The first is concerned with how the effects of a
  drug are generated, while the second is concerned
  with how drugs are distributed around the body,
  how they are metabolized, and how they are
  finally excreted or eliminated from the body.
  Discovery of new drugs proceeds by considering
  how chemical agents can be used to potentiate,
  inhibit, or modify some cellular or bodily
  process.

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Subdisciplines

• Clinical Pharmacology - the medical field of
  medication effects on humans
• Neuro and Psychopharmacology - effects of
  medication on behavior and nervous system
  functioning
• Pharmacogenetics - clinical testing of genetic
  variation that gives rise to differing response
  to drugs
• Pharmacogenomics - application of genomic
  technologies to new drug discovery and further
  characterization of older drugs
• Pharmacoepidemiology - study of effects of drugs
  in large numbers of people
• Toxicology - study of the effects of poisons
• Theoretical Pharmacology
• Posology - how medicines are dosed
• Pharmacognosy - deriving medicines from plants

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Pharmacodynamics

• Pharmacodynamics is the study of the biochemical
  and physiological effects of drugs on the body or
  on microorganisms or parasites within or on the
  body and the mechanisms of drug action and the
  relationship between drug concentration and
  effect

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Pharmacokinetics

• Greek "pharmacon" meaning drug and "kinetikos"
  meaning putting in motion, the study of time
  dependency)
• Pharmacokinetics is a branch of pharmacology
  dedicated to the determination of the fate of
  substances administered externally to a living
  organism. In practice, this discipline is applied
  mainly to drug substances, though in principle it
  concerns itself with all manner of compounds
  ingested or otherwise delivered externally to an
  organism, such as nutrients, metabolites,
  hormones, toxins, etc.
• Pharmacokinetics is often divided into several
  areas including, but not limited to, the extent
  and rate of Absorption, Distribution, Metabolism
  and Excretion.

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PHARMACOLOGY

• The discipline of pharmacology is the study of
  the effects of drugs on living organisms where a
  drug can be broadly defined as any chemical
  substance, natural or synthetic, which affects a
  biological system.
• Pharmacology may involve how organisms handle
  drugs, mechanism of drug action, drug toxicity,
  the use of drugs as probes to delineate
  biological processes during health and disease,
  identification of new targets for drug action,
  and the design and development of new drugs.
  These investigations can occur at the molecular,
  subcellular, cellular, tissue or whole organism
  level.
• Pharmacology is an interdisciplinary science
  employing experimental approaches which may
  include biochemistry, physiology, immunology,
  molecular biology, genetics and cell biology.

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TOXICOLOGY

• Greek words toxicos and logos is the study of the
  adverse effects of chemicals on living organisms.
  
• It is the branch of medical science, which deals
  with poisons with special reference to their
  source, character, properties, symptoms they
  produce, and of remedial measures.

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Pharmacology Toxicology

• Pharmacology is the study of the actions and uses
  of therapeutic agents in the treatment of
  diseases.
• Toxicology is the study of the poisonous or
  harmful effects of drugs and chemical agents.

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• Pharmacologists, emphasizing the mechanisms by
  which drugs act, draw on the disciplines of
  physiology, pathology, biochemistry, biology, and
  microbiology to examine the actions of chemicals
  on living organisms.
• Toxicologists are engaged in the investigation of
  poisons, or toxins, from the standpoint of
  detection, isolation, identification, and
  determination of their effects on the human body.
  
• Pharmacologists and toxicologists work together
  as part of a multidisciplinary team, which may
  include synthetic chemists, cell and molecular
  biologists, clinicians, and experts in other
  related disciplines.

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Dose Toxicity

• Toxicology is the study of the relationship
  between dose and its effects on the living
  organism.
• The chief criterion regarding the toxicity of a
  chemical is the dose, i.e. the amount of exposure
  to the substance.
• Almost all substances are toxic under the right
  conditions as Paracelsus, the father of modern
  toxicology said, Sola dosis facit venenum (only
  dose makes the poison). Paracelsus, who lived in
  the 16th century, was the first person to explain
  the dose-response relationship of toxic
  substances.

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• Even a benign substance like water can cause harm
  in excessive amounts. "Dr. Adrian Cohen was
  saddened, but not surprised, to hear about the
  28-year-old woman who died earlier this month
  after drinking nearly two gallons of water to try
  to win a radio station contest."
• Toxicology is also known as science of poisons.
• There is evidence that early in the history of
  the human race people understood the potency of
  certain natural materials and used them in
  hunting and for their therapeutic values.
• Some familiar images from the past reinforce this
  belief.For example,the story of Socrates
  ingesting poison hemlock and the stereotype of
  the royal starters are in this tradition.
• As time went on, and especially following the
  scientific revolution,the understanding of how
  chemicals affect the human body fell into the
  domain of pharmacology.
• Both beneficial and adverse effects were studied
  under this general heading, and so toxicology was
  but a branch or subset of pharmacology.

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General aspects of poisoning

• Duties of doctor in cases of poisoning
• Medico-legal autopsy in poisoning
• Preservation and dispatch of viscera for chemical
  analysis
• Role of Forensic Science Laboratory in brief

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Types of poisons, diagnosis, principles of
therapy and medicolegal aspects of

• Corrosive poisons strong mineral acids and
  organic acids.
• Metallic poisons Lead, Arsenic, Mercury and
  Copper.
• Animal poisons Snake and scorpion bites.
• Deliriants Dhatura, Cannabis and Cocaine.
• Somniferous agents Opium, Morphine and other
  opiods
• Inebriants Methyl and ethyl alcohol.
• Asphyxiant poisons Carbon monoxide, Carbon
  dioxide,
• Methane and cyanides.

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• Anesthetic agents.
• Cardiac poisons Cerebra thevetia and Nerium
  odorum.
• Miscellaneous Aspirin, paracetamol,
  barbiturates, diazepam, antihistaminics,
  antidepressants and kerosene oil.
• Insecticides Organophosphorus compounds,
  Carbamates and Organochloro compounds.
• Food poisoning.
• Drug abuse and dependence.

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Desirable to know following poisonings

• Inorganic non metallic poisons Phosphorous.
• Organic vegetable irritants Abrus precatorious,
  Capsicum, Calotropis, Semicarpus anacardium,
  Croton.
• Cardiac Poisons Aconite,
• Convulsants Strychnine.
• Paralytic agents, Curare.
• War gases and Industrial gases.
• Chloral hydrate.
• Mechanical poisons.

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FORENSIC MEDICINE AND MEDICAL JURISPRUDENCE
INCLUDING TOXICOLOGY

• Goal
• The broad goal of teaching undergraduate students
  Forensic Medicine is to produce a physician who
  is well informed about Medico-legal
  responsibility during his/her practice of
  Medicine.
• He/She will also be capable of making
  observations and inferring conclusions by logical
  deductions to set enquiries on the right track in
  criminal matters and associated medico-legal
  problems.
• He/She acquires knowledge of law in relation to
  Medical practice, Medical negligence and respect
  for codes of Medical ethics.

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• Educational objectives(a) Knowledge
• i. Identify the basic Medico-legal aspects of
  hospital and general practice
• ii. Define the Medico-legal responsibilities of a
  general physician while rendering community
  service either in a rural primary health centre
  or an urban health centre
• iii. Appreciate the physicians responsibilities
  in criminal matters and respect for the codes of
  Medical ethics
• iv. Diagnose, manage and identify also legal
  aspect of common acute and chronic poisonings
• v. Describe the Medico-legal aspects and findings
  of post-mortem examination in cases of death due
  to common unnatural conditions and poisonings
• vi. Detect occupational and environmental
  poisoning, prevention and epidemiology of common
  poisoning and their legal aspects particularly
  pertaining to Workmens Compensation Act
• vii. Describe the general principles of
  analytical toxicology

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• (b) Skills
• i. Make observations and logical inferences in
  order to initiate enquiries in criminal matters
  and Medico-legal problemsa. to be able to carry
  on proper Medico-legal examination and
  documentation/Reporting of Injury and Ageb. to
  be able to conduct examination for
  intoxicationc. to be able to preserve relevant
  ancillary materials for medico - legal
  examinationd. to be able to identify important
  post-mortem findings in common unnatural deaths
• ii. Diagnose and treat common emergencies in
  poisoning and chronic toxicity
• iii. Make observations and interpret findings at
  post-mortem examination
• iv. Observe the principles of medical ethics in
  the practice of his profession

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CLASSIFICATION OF POISONS

• Corrosives
• Strong acids
• Mineral or inorganic acids Sulphuric, Nitric,
  Hydrochloric.
• Organic acids Carbolic, Oxalic, Acetic,
  Salicylic.
• Strong alkalies
• Hydrates and Carbonates of sodium,
• Potassium and Ammonia.
• Metallic Salts
• Zinc chloride , Ferric chloride , Copper sulphate
  , Silver nitrate , Potassium cyanide , Chromates
  and Bichromates.

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• Irritants
• Agricultural
• Inorganic
• Non metallic Phosphorus, iodine, chlorine,
  bromine, carbontetrachloride.
• Metallic Arsenic, antimony, copper, lead,
  mercury, silver, zinc.
• Mechanical Powered glass, diamond, dust, hair,
  etc.
• Organic
• Vegatable Abrus precatorius, castor, croton,
  calotropis, aloes.
• Animal Snake and insect venom, cantharides,
  ptomaine.

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• Systemic
• Cerebral
• CNS depressants Alcohols, General Anaesthetics,
  Opioid Analgesics , Hypnotics, Sedatives.
• CNS stimulants Cyclic Antidepressants,
  Amphetamine, Methylphenidate, Caffine.
• Deliriant Datura, Belladonna, Hyoscyamus,
  Cannabis, Cocaine, etc.
• Spinal  Nux vomica , Gelsemium .
• Peripheral Conium , Curare .
• Cardiovascular Aconite , Quinine , Oleander ,
  Tobacco , Hydrocyanic Acid, Digitalis
• Asphyxiants CO, CO2, Hydrogen Sulphide.

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Oxalic Acid

• Its prepared from pine saw dust by oxidizing
  with caustic alkali.
• They are white shiny crystals, which are
  strongly acidic and sour in taste.

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• Uses -
• To clean glass and metals
• For manufacturing straw hat
• For floor polishing
• For removing ink stain

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• Fatal dose
• 15 gm
• Fatal period
• 3-10 minutes
• Mode of action
• Locally as corrosive
• Systemic precipitation of ionized calcium from
• the body.

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• Signs and symptoms
• Immediate intense sour taste in mouth
• Burning pain in mouth, throat, stomach
• Retching, nausea, vomiting (Coffee ground
• appearance due to altered blood in vomitus
• till death.
• Oliguria and anuria.

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• During 1st 2 days
• Excess of albumin in urine
• Crystals of oxalate, hyaline casts in urine
• Hypocalcaemia tetany, convulsion, lock
• jaw, severe prostration with cold, clammy
• sweaty limbs, hurried respiration.
• COMA
• DEATH

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• PM findings
• Signs of corrosion in mouth, throat, oesophagus
• and stomach.
• Whitish mucous membrane turns greyish
• Blackish from altered blood
• Submucosal haemorrhages
• Submucosal blood vessels appear like
• black net work
• Shiny crystals of oxalic acid can be seen in
• mucous membrane.

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• Ammomia (NH3)
• Solution of ammomia is known as spirits of
  Harts Horn a colourless strongly alkaline
  pungent liquid.
• Uses
• As chemical
• As bleaching agents
• In medicines

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• Action
• Irritation of skin and corrodes mucous membrane
  produces soft necrotic areas on contact with
  tissues.
• Action is slow but long sustained.
• Intense stimulation of alkalis on absorption may
  cause reflex loss of vascular tone and cardiac
  inhibition.

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• Fatal Period
• Inhalation of ammonia vapour may cause death
  within 4 minutes from edema glottis and death
  within 1 week or more due to bronchopnenumonia.

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• Signs and symptoms
• Burning
• Mouth, throat, abdomen
• Acrid nauseous taste in mouth
• Excoriation and ulceration of mucous membrane
• Vomiting -vomitus contain altered blood
• Liquid stool containing blood and mucus
• Dysphagia and dyspnoea.
• Skin burned cold clammy
• Abdominal pain tender on pressure
• Pulse quick, weak, feeble.
• Eyes shrunken, pupils dilated
• Shock, collapse and death.

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• Treatment
• Neutralize with weak vegetable acids along with
  water.
• Demulcent milk, lemon, barely, white of egg.
• Stomach wash and emetic should not be tried
  causes perforation

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• Postmortem changes
• Marks of corrosion over lips, mouth, tongue,
  esophagus.
• Deep chocolate or dark brown discoloration
• Edema and inflammation of parts
• Stomach congested, blackish brown in colour dark
  shiny fluid present
• Sub-mucosal haemorrhage
• All visceras congested

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OPHIDIA

• Poisonous
• Elapid secreting neurotoxic venom.
• Vipers Vasculotoxic
• Sea snake- myotoxic
• Non Poisonous

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Elapid

• Cobra
• King Cobra
• Common krait.
• Banded krait.
• Coral.

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Characteristics Of Snake Venom

• In the fresh state it is a clear transparent
  amber tinted fluid and dries in to a yellow
  granular mass which retains its activity for many
  years. It contains toxalbumines and several
  toxic principles such as the followings .
• Fibrinolysins
• Proteolysin
• Neurotoxins prominent in elapid
  venom
• Cholinesterase

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s

• 5. Haemolysin prominent in Viper venom
• 6.Thromboplastin
• 7. Agglutinns
• 8. Cardiotoxins
• 9.Coagulase, Hyaluronidase, lecithinase, etc
• Elapid Neurotoxin
• Viper Venom- Vasculotoxin
• Sea snake - Myotoxin

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Elapid- Neurotoxic Venom

• It causes muscular weakness of the legs and
  paralysis of the muscles of the face, throat and
  respiration.
• Neurotoxin of cobra venom produces both
  convulsion and paralysis.
• Krait venom cause only muscular paralysis.
• Local symptoms at the site of the bite are
  minimum as compared to caused by vasculotoxic
  venom.

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Viper Venom -Vasculotoxic

• Its produces enzymatic destruction of cell wall
  and coagulations disorder. As a result the
  endothelium of blood vessels is destroyed, red
  cell are lysed and other tissue cells are
  destroyed.
• There is oozing of Hemolytic blood and spreading
  cellulitis.
• Hemorrhages from external orifices of the body
  are common.
• Other functional disturbances are related to the
  involved organs.. e.g.. Convulsion from
  Hemorrhage on the brain

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myotoxic Venom- Sea snake

• Produces generalized muscular pain followed by
  myoglobinuria 3 or 4 hrs later, ending of
  respiratory failure in fatal cases
• Toxic dose.

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Signs and Symptoms..

• Poisoning may occur from bite (injection) or
  absorption of venom through cuts or scratches
  (sucking).
• In some cases instant death may occur from shock
  due to fright.

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Degree of toxicity depends on.

• The size of the person bitten.
• The potency of venom.
• The main toxic principle it contains.
• The amount injected which in turn depends up on
  the age, size, sex and species of the snake
  whether it had recently taken a prey, whether the
  bite is on bare skin or through clothing.
• Season and time of bite.
• The type of fang whether canalized grooved.
• Nocturnal bites may be more severs than those
  occur during the day..

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• Bite From A Elapid Snake
• Burning pain at the site of the bite which is
  followed by.
• Giddiness
• Lethargy
• Muscular weakness
• Spreading Paralysis
• Salivation.
• Vomiting
• Weakness in the legs is manifested by
  staggering
• Difficulty in speaking and swallowing.
• Ptosis and paralysis of extra cellular
  muscle may occur.
• Breathing became slow and labored .
• Conscious but unable to speak.
• Respiratory causes with or with out
  convulsion and heart stops.

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• Bite From Viper
• Sever local symptoms and marked vascular toxic
  effects.
• Pain , swelling, ecchymosis and sever oozing of
  Hemolytic blood.
• Serous and serosanguinous blister sometimes
  appears.
• Nausea and vomiting occur..
• Intra vascular Haemolysis may leads to
  hemoglobinuric nephritis.
• Petechial hemorrhage.
• Bleedings from gums, Haemoptysis, bleeding from
  the mucus membrane of the rectum and other
  orifices of the body are common.
• Collapse set in with clammy skin, rapid feeble
  pulse and dilated pupil, insensitive to light,
  followed coma and death.

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• A Bite From A Sea Snake
• Felt as a sharp initial prick, becoming painless
  later.
• 1-2 hrs after- generalized muscular pain and
  stiffness develops.
• Starting in the neck and limb gradually
• Myoglobinuria causes a characteristic brown
  colour urine.
• Serum transaminase become elevated.
• Hyperkalamia resulting from leakage of cellular
  potassium following extensive muscle damage..
• Respiratory failure may occur.

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Venom And Fatal Dose

• Amount of venom injected at a bite
• 200-350mg
• 150-200mg
• 22mg
• 4.5mg

• venom Fatal Dose
• Cobra 15mg
• Viper -- 40mg
• Krait -- 6mg
• Echin carinata 8mg
• (sea snake)

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Fatal period

• Cobra few mints to hours..
• Viper few hours to days
• Sea snake bite is merely not fatal.
• However sudden death may be due to fright

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Treatment of snake bite

• Principle
• To avoid the anxiety and fear.
• Prevention of the spread of venom (First Aid).
• Use of specific anti venoms.
• General measures

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SCORPIONS

• Poisonous Principle
• Toxalbumen which is haemolytic or neurotoxic.
• ITS TOXICITY IS WORSE THAN THAT OF THE SNAKES,
  BUT ONLY A SMALL QUANTITY IS INJECTED.

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BEES AND WASPS

• The poisonous principles contain complex mixture
  of biochemical compounds ranging from simple
  amines to complicated proteins and enzymes.
• Histamines.
• Attacks lasts for 24 hours.
• Anaphylactic reaction occurs immediately or
  within 20 minutes.
• Death may occur in 2-15 minutes.

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OPIUM

• Opium is valued for the alkaloids it contains,
  the total alkaloid content varying from 5-25. A
  large number of alkaloids have been isolated from
  opium-
• Morphine
• Codeine
• Thebane
• Narcotine
• Narcine
• Papaverine

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• The Morphine content of opium is maximum at the
  first lancing and then rapidly decreases in
  successive lancings.
• SEEDS ARE FREE FROM ALKALOIDS.
• Narcotine is said to be the first alkaloid to
  appear three days after sprouting.

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• Opium alkaloids
• The characteristic action of principal opium
  alkaloids is their simultaneous depressing and
  exciting effect on the CNS. The order of action
  increases-morphine, papavarine, codeine,
  narcotine and thebane.
• Morphine is a powerful analgesic and narcotic and
  also has stimulant action. It especially
  depresses the thalamus, sensory cortex,
  respiratory and cough centres. It stimulates the
  spinal cord, the vagus and vomiting centres and
  the third nerve centre.
• It increases the tone of involuntary muscles,
  specially in the sphincters of the alimentary
  tract.

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• Codeine
• Resembles morphine in its general effects but is
  less narcotic. It stimulates not only the spinal
  cord, but also the lower parts of the brain.
• Papavarine
• Acts chiefly as a relaxant of involuntary muscles
  and has no marked narcotic or analgesic action.
  It relaxes the muscles of the intestinal and
  biliary tracts, bronchial tree, ureter and blood
  vessels including coronary supply.

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• Narcotine
• It is the most abundant of alkaloids after
  morphine and has a very mild narcotic effect.
• It has a colchicine like effect.

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LEAD

• Toxic dose
• 10 gm/70kg for most lead salts.
• 100mg/kg for tetraethyl lead.
• Chronic lead poisoning is called PLUMBISM or
  SATURNISM

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Toxicological symptoms

• Mild toxicity
• (BL 40-60mg/100ml)
• Myalgia.
• Paraesthesia
• Fatigue
• Irritability
• Abd discomfort

• Moderate
• (BL 60-100mg/100ml)
• Arthralgia
• Musular exhaustability
• Tremor
• Headache
• Diffuse abd pain
• Anorexia
• Vomiting
• Constipation
• Weight loss

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• Severe toxicity
• (BL More than 100mg/100ml)
• Lead palsyWrist or foot drop.
• Burtons lineA bluish black lead lines on gums.
• Lead colicSevere abd cramps, tenderness around
  umbilicus.
• Lead encephalopathy Sudden onset of vomiting,
  irritability, headache, ataxia, vertigo,
  convulsions, psychotic manifestations, coma
  death.
• Facial pallor, esp circum oral characteristic
  feature of c/c lead poisoning.

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Lead poisoning - Gum Changes
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Chronic lead poisoning- wrist drop
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Pharmacological action

• Loss of appetite, emaciation, pallor,
  constipation.
• Slowing of heart action.
• Bilateral paralysis of extensor muscles of
  forearm.
• Blue or slate coloured lines appear at the edge
  of gums.
• Coliky, sharp abd. pain.
• Calibre of small blood vessels contracted,
  resulting in delirium,convulsions.
• Albuminuria,Cirrhosis contraction of kidneys.
• Amblyopia amaurosis.

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ANTIDOTE

• An antidote is a substance which can counteract a
  form of poisoning .
• Sometimes, the antidote for a particular toxin is
  manufactured by injecting the toxin into an
  animal in small doses and the resulting
  antibodies are extracted from the animals' blood.
• The venom produced by some snakes, spiders, and
  other venomous animals is often treatable by the
  use of these antivenins, although a number do
  lack one, and a bite or sting from such an animal
  often results in death.
• Some animal venoms, especially those produced by
  arthropods (e.g. certain spiders, scorpions,
  bees, etc.) are only potentially lethal when they
  provoke allergic reactions and induce
  anaphylactic shock as such, there is no
  "antidote" for these venoms because it is not a
  form of poisoning, though anaphylactic shock can
  be treated (e.g., by the use of epinephrine).

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ANTIDOTE

• Some other toxins have no known antidote. For
  example, the poison ricin, which is produced from
  the waste byproduct of castor oil manufacture,
  has no antidote, and as a result is often fatal
  if it enters the human body in sufficient
  quantities.
• Ingested poisons are frequently treated by the
  oral administration of activated charcoal, which
  absorbs the poison, and then it is flushed from
  the digestive tract, removing a large part of the
  toxin.
• Poisons which are injected into the body (such as
  those from bites or stings from venomous animals)
  are usually treated by the use of a constriction
  band which limits the flow of lymph and/or blood
  to the area, thus slowing circulation of the
  poison around the body.

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POISONS THEIR ANTIDOTES

• Anticholinergic poisoning is given physostigmine
  sulfate as the antidote.
• Atropine sulfatepoisoning is given
  Anticholinesteraseand pralidoxime chloride 2-PAM
  as the antidote.
• Benzodiazepine poisoning is given flumazenil as
  the antidote.
• Beta blocker poisoning is given glucagon as the
  antidote.
• Carbon monoxide poisoning is given oxygen as the
  antidote.
• Cyanide poisoning is given amyl nitrite, sodium
  nitrite, and thiosulfate as the antidote. A new
  patented process uses mesoxalic acid as the
  antidote.

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POISONS THEIR ANTIDOTES

• Digoxin poisoning is given Fragment antigen
  binding(Fab) fragments that bind to digoxin
  (trade names Digibind and Digifab) as the
  antidote.
• Ethylene glycol poisoning is given ethanol or
  fomepizole as the antidote.
• Extrapyramidal reactions associated with
  antipsychotic poisoning is given diphenhydramine
  hydrochloride and benztropine mesylate as the
  antidote.
• Heavy metal poisoning is given chelators, calcium
  disodium edetate (EDTA), dimercaprol (BAL),
  penicillamine, and 2,3-dimercaptosuccinic acid
  (DMSA, succimer) as the antidote.
• Heparin poisoning is given protamine sulfate as
  the antidote.
• Iron poisoning is given deferoxamine mesylate as
  the antidote.

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POISONS THEIR ANTIDOTES

• Isoniazid poisoning is given pyridoxine as the
  antidote.
• Methanol poisoning is given ethanol or fomepizole
  as the antidote.
• Methemoglobinemia poisoning is given methylene
  blue as the antidote.
• Opioid poisoning is given naloxone hydrochloride
  as the antidote.
• Paracetamol (acetaminophen) poisoning is given
  N-acetylcysteine as the antidote.
• Thallium poisoning is given Prussian blue as the
  antidote.
• Warfarin poisoning is given vitamin K
  phytonadione and fresh frozen plasma as the
  antidote.

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Administration of Antidotes

• 1) Mechanical or Physical antidotes They
  neutralise poisons by mechanical action or
  prevent their absorption.
• Activated charcoal acts mechanically by
  adsorbing and retaining within its poresorganic ,
  and also to less degree mineral poisons , and
  thus delays the absorption from the stomach.
• Demulcents are substances which form a protective
  coating on gastric mucous membrane and thus do
  not permit the poisons to cause any damage ,eg
  milk,starch, egg-white, mineral oil, milk of
  magnesia , aluminium hydroxide gel.Fats and oils
  should not be used for oil soluble poisons ,
  such as kerosene, phosphorus , organophosphorus
  compounds , DDT ,phenol, turpentine , aniline ,
  acetone , carbontetrachloride etc.
• Bulky food acts as a mechanical antidote to glass
  powder by imprisoning its particles within its
  meshes , and thus prevent damage being effected
  by the sharp glass particles.

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• Chemical antidotes
• They counteract the action of poison by forming
  harmless or insoluble compounds or by oxididsing
  poison when brought into contact with them .
• Common salt decomposes silver nitrate by direct
  chemical action , forming the insoluble silver
  chloride .
• Albumen precipitates mercuric chloride .
• Dialysed iron is used to neutralise arsenic.
• Copper sulphate is used to precipate phosphorus.
• Alkalis neutralise acids by direct chemical
  action.It is safer to give little weak solution
  of an alkaline hydroxide , magnesia or ammonia.
• Acids neutralise alkalis by direct chemical
  action . Only those substances which are harmless
  should be given e.g Vinegar , lemon juice ,
  canned fruit juice.

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• Potassium permanganate has oxidising properties
  15000 solution is used in poisoning for opium
  and its derivatives, strychnine, phosphorus,
  hydrocyanic acid, cyanides, barbituric acid and
  its derivatives, atropine and other alkalis.
• When it reacts with poison in stomach, it looses
  its pink colour.
• A solution of tincture iodine or lugols iodine 15
  drops to half a glass of warm water precipitates
  most alkaloids, lead, mercury, silver, quinine
  and strychnine.
• Tannic acid 4 o r tannin in the form of a strong
  tea or one teaspoonful of tannic acid in water
  tends to precipitate apomorphine,cinchona,
  strychnine , nicotine, cocaine, aconite,
  pilocarpine, lead, silvetr, aluminium, cvobalt,
  copper, mercury, nickle and zinc.
• Universal antidote When the exact poison is not
  known , or when a combination of 2 or more
  poisons had been taken , universal antidote is
  given ,which consists of powdered animal
  charcoal.2 parts magnesium oxide one part,
  tannic acid one part.

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• Physilogical or Pharmacological antidotes
• They acts on the tissues of the body and produce
  symptoms exactly opposite to those caused by the
  poison .
• They are used after some of the poison is
  absorbed in to the circulation. Their use is some
  out limited and not with out danger.These agent
  acts on principles of antagonism by interfering
  with another action upon the enzymes,tissue cells
  or opposing nerve systems.Atropine and
  physostigma are 2 real physiological antidotes as
  both of them affects nerve endings and produc
  opposite effects on heart rate,state of the
  pupils , and glandular secretory activity.

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• Chelating agents Are used in the treatment of
  poisoning of heavy metals .They have a greater
  affinity for the metals as compared to endogenous
  enzymes .
• B.A.L(British anti lewisite ) It is used as
  physiological antidote in arsenic ,lead, bismuth,
  copper, mercury,gold and other heavy metals.
• E.D.T.A(Ethylenediaminetetra acetic acid)It is a
  chelating agent and is effective in lead,
  mercury,copper, cobalt, cadmium, iron and nickle
  poisoning.
• PenicillamineIts a hydrolysis product f
  pencillin.It is a chelating agent of maximum
  efficiency for the heavy metals.
• Meso-2 3-dimercaptosuccinic acid It is used in
  lead mercury and arsenic poisoning.
• 2,3- dimercaptopropane 1-sulfonate Is effective
  in treatment of mercury lead and arsenic
• Desferrioxamine It contains trivalent iron as a
  chelate and is very useful in acute iron
  poisoning .

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Elimination of Poison by Excreation

• Indications
• In severe poisoning
• Progressive deterioration inspite of full
  supportive care.
• When there is high risk of serious morbidity and
  mortality.
• When normal route of excreation of the toxic
  compound is impaired.
• When the poison produces delayed but serious
  toxic effect.
• When the patient is having cardiovascular,
  respiratory or other diseases that increases the
  hazard.

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Excretion

• Renal excretion
• Purging
• Diaphoretics
• Peritonial dialysis
• Haemodialysis
• Charcoal haemoperfusion
• Symtomatic treatment

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APPLICATION
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Thank you