‫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 Fatal dose

1. Atropine 5mg (Atropin

&hyoscamine)
8mg==hyoscine

15-30mg
2. Nicotine 40-60mg(1 drop )
contained in 2-4 gm of
tobacco in GIT
3. Strychnine 15-30 mg (In 2 hrs)

4. Aconitine 1 gm of the plant

(fatal period 1-4 5 ml of the tincture
hrs) 1-2 mg of aconitine
5mg digitoxine
5. Digitalis 3mg digoxine

6. Cocaine 30mg pure IV

‫يعني محتاج خمس‬ 1gm by snuffing(20mg in
‫خطوط علشان يدخل‬ one line)
‫في التسمم‬

7. Opium 2-5 gm of opium

Acute 100-500gm of morphine
poisoning period 6-12 hours

8. lSD 35μg is hallucinogenic but

street dose need to be
200μg
‫خللي بالك ميكرو جرام‬
5mg/kg ==sensory
9.mescaline hallucination
50mg/kg ==sever
hypotension&Resp.depres
sion

10.nutmeg 10-15mg i.e (2-3 nutmegs)

 ‫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 *All ms relaxed
Abd.&Resp.ms are* *Resp resumed
involved==stoppage
of resp. movement

No heart beat* *Heart beats again

No arrhythmia*
Hypertension*

Eye==bulges* eye== ball retract*

pupil==dilated* pupil== contract*
again
face, lips are
*cyanosed cyanosis disappear*
patient is suffering
from peripheral
*asphyxia

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 Occur in cardiac patient
the drug Slow onset
He is non cardiac Visual yellow
patient hallucinations
Nausea ,vomiting Confusions
,Abd pain Hallucinations
Arrhythemia All types of 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

‫يا رب يا منجي من المهالك‬

Cocaine Morphine
Acute 30mm Iv mg -20 mg 15
1mg snuffing therapeutic
Action Euphoria )once Euphoria with 1 st
)+forever dose due to
increase in+ analgesia
activity &sleepy== then
dysphoria
Pupil Mydriasis Pinpoint

Cvs Tachycardia
,hypertension Bradycardia
+increased +orthoststic
pulse==increase hypotension
myocardial Coma &death due
activity without to inhibition of RC
sufficient oxygen
supply ==increase
load on
heart==circulator
y failure
Ttt
Gastric lavage I can make GL at
with activated delayed time due to
charcoal inhibition of gastric
ABCDs motility
‫والباقي معروف‬ 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