Transcript Pharmacotherapy of drug poisoning and emergency states

Pharmacotherapy of drug
poisoning and emergency
states
UKRAINE
• In 43 of 190 most controlled large cities of
our country concentration of substances
dangerous for health is overcomes critical
allowed concentrations 520 times
• 34 % of population is under the negative
influence of atmospheric pollution
Causes of acute poisoning
community-acquired
• Drugs
• Chemical substances,
also of plant origin
• Alcohol and it’s surrogates
• Pesticides
8 % of all poisonings - children
(6 months of age)
Side effects (SE) of
drugs
• Takes 5th place among causes of mortality
on the Earth after heart-vascular diseases,
malignant tumors, lungs diseases, traumas
• Among stationary patients frequency of SE
after introduction of drugs makes 2 - 40 %
SE of drugs
• 150 000 – 200 000 people in U.S.A.
die from side effects of drugs
annually
• 76,6 billion $ are spared in U.S.A.
annually to treat complications
attached to drugs usage
Medical mistakes in clinics
• Doctors:
- overdosing
- administration of drugs to patients with
allergy
- mixing up names of the drugs
• Medical nurses:
- introduction of other drug by a mistake
- violation of drug introduction regime
- mistake in medical form
- mixing up names of the drugs
Factors that influence on
toxicity of the poison
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Physical and chemical properties
Dose
Concentration
Speed of introduction
Way of penetration into organism
Age
Condition of the organism
Accumulation of the poison
Tolerance to the poison
Comparing of dose-effect cures of the drugs
with different limits of security
100
Therapeutic
diapason
Drug B
Drugs А and B
Toxic
diapason
50
Drugs A
0
0,1
1
10
100
1000
Comparing of dose-effect curves of hypnosedative drugs A and B
Breath
stop
Drug A
Narcosis
Sedative
effect
Drug B
0,1
1
10
100
1000
Stages of acute poisoning
• TOXICOGENIC – the poison circulates in organism,
there are obvious manifestations of its toxic action or
its metabolites’ action on corresponding structures
(receptors)
• SOMATOGENIC – the poison has been excreted
from the organism but there are manifestations of
damaging of organs and systems (kidney, liver
insufficiency, lung edema, etc.)
Toxic damaging of nervous
system
• Exotoxic coma (barbiturates),
complications – toxic brain edema,
syndrome of lifelong death of brain
• Acute intoxicative psychosis (atropine)
• Syndrome of toxic encephalopathy (salts
of heavy metals, carbon monoxide,
toxicomania)
Toxic damaging of cardiacvascular system
• Exotoxic shock
• Hypertensive syndrome
• Disorders of cardiac rhythm and
conductivity
• Cardiac arrest
• Acute cardiac-vascular insufficiency
(primary toxicogenic collapse, secondary
somatogenic collapse, hematogenic lung
edema)
PRINCIPLES OF ACUTE POISONINGS’
TREATMENT
• Clearing of gastro-intestinal tract, skin,
mucous membranes from the poison
• Absorption, destroying or neutralization of
the poison using specific antagonists
• Elimination of the desorbed poison from the
blood and tissues
• Pathogenetic, symptomatic treatment and
reanimation
Provoking vomiting
• mechanical method
• hypertonic solution (10 %) of sodium chloride
• Apomorphine hydrochloride (0,2-0,5 ml s.c.)
Contraindications:
- coma
- elderly patients
- lung emphysema
- pregnancy
- poisoning with cauterizing substances
- poisoning with volatile liquids
- poisoning with antiemetic drugs
- convulsive episode in anamnesis
STOMACH LAVAGE
Fabre: stomach lavage performed in time even by an
inexperienced person is much more effective than
the most modern methods of treatment, if they are
used late
- after 4-5 hours – in case of poisoning with
spasmolytic drugs, soporific, salicylates
- after 12 hours and more – in case of poisoning
with morphine derivates, noxirone
- after 15 min.-1 hour – in case of poisoning with
cauterizing substances
- after 1-2 days – in case of poisoning with
mushrooms
Gastric lavage
LAXATIVES
If the poison is unknown, only salt
laxatives should be used (!!!) magnesium (sodium) sulfate - 20-30 g
Ricine oil is contraindicated in case of
poisoning with fat-soluble substances
(phosphorus, POS, oil-products, benzole
derivatives etc.)
Vaseline oil decreases resorbtive ability of
intestines
ANTIDOTES
Greek antidoton – anti poison
are used if poison is correctly specifically
identified
- physical – absorb the poison (activated
charcoal, other enterosorbents,)
- chemical – destroy the poison, transform it into
non toxic substance, form complex substances
with it (acids – alkalis, ЕDТА, unithiol,
protamine sulfate)
- physiological – act as antagonists relatively to
the poison on the level of specific receptors
(naloxon, atropine)
Activated charcoal
universal antagonist of physical action
1 g adsorbs 1800 mg of mercury dichloride, 950
mg of strychnine, 800 mg of morphine, 700 mg
of atropine or nicotine, 550 mg of salicylic acid,
it is highly effective in case of poisoning with
alkaloids
Single dose - 20-100 g
not effective – in case of poisonings with acids,
alkalis, phenols, less effective – in case of
poisoning with hydrocyanic acid
CHEMICAL ANTIDOTES
Tannin - 0,5 % solution for poisoning with heavy metals salts
and alkaloids (except morphine, physostygmine, nicotine,
atropine and cocaine)
Potassium permanganate - 0,01-0,02 % - food poisonings,
alkaloids (morphine, strychnine, nicotine, chinine,
physostygmine)
Copper sulfate – poisoning with phosphorus
Sodium chloride – poisoning with silver salts (AgNO3)
Iodine (15 drops per 100 ml of water) precipitates silver, lead,
mercury compounds, strychnine, chinine
Unithiol (dimercaprol, BAL, i.m.) – poisoning with heavy metals
salts, cardiac glycosides
Deferoxamine – poisoning with iron preparations
EDTA (trilon B) – binding lead, copper, magnesium, radioactive
elements - plutonium, uranium, thorium, yttrium compounds
PHYSIOLOGICAL ANTAGONISTS
do not change physical-chemical condition of the poison
Naloxon – poisoning with opiates
Atropine – poisoning with M-cholinomimetics and POS
Physostygmine – poisoning with atropine, curare-like
drugs
Analeptics – poisoning with soporific drugs, narcotics
Flumazenil (anexate) – poisoning with tranquilizers
Potassium chloride – poisoning with cardiac glycosides
Oxygen – poisoning with carbon monoxide
Ethanol – poisoning with methanol, ethylenglycol
MEASURES TO ELIMINATE THE POISON
out of THE ORGANISM
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substitutive blood infusion (10-15 l)
hemosorption (plasma-, lymph-sorption)
hemodialysis (artificial kidney)
peritoneal dialysis
enterosorption
forced diuresis
lung hyperventilation
hyperbaric oxygenation
Hemodialysis, hemosorption
• Effective, if the substance has a small
volume of distribution– theophylline,
carbamazepin, lithium carbonate, salicylates,
valproic acid, barbiturates
• Not effective, if the substance has a big
volume of distribution – rifampicin, lidocain,
sybazon, anaprilin, dyltiazem, digoxin
FORCED DIURESIS
In case of poisoning with substances – weak
acids (salicylates, barbiturates, nalidixic
acid, antibacterial and antidiabetic
sulfonamides, indometacin, indirect
anticoagulants, clofibrate) – alkalizing
organism liquids with NaHCO3
FORCED DIURESIS
• In case of poisoning with substances –
weak alkalis
(chinin, amphetamine, amitryptiline, caffeine,
theophyllin, novocain) –
changing pH of medium to acid side with
vitamin С, ammonium chloride