ANALGESICS TOXICITY AND TREATMENT

Presented By:

Maham Shafiq

M Phil Pharmaceutics

2013-2015

University College of pharmacy

Univeristy of the Punjab,Lahore Pakistan

CLASSIFICATION OF ANALGESIC DRUGS

Narcotic Analgesics

Non-Narcotic Analgesics

Morphine Paracetamol

Diamorphine (Heroin) Salicylate

Dihydrocodiene, codeineOther anti inflammatory drugs e.g. Ibuprofen

Methadone Mefenamic acid

ACETAMINOPHEN(PARACETAMOL) TOXICITY

Metabolized by glucuronidation ,sulfation P450 mixed function oxidase system to a highly

toxic reactive intermediate. With acute overdose >150-200mg/kg, or 8-10 g in

an average adult, hepatocellular glutathione is depleted and the reactive intermediate attacks other proteins and causes necrosis.

Hepatotoxicity(long term uses)

DIAGNOSIS:

The diagnosis after acute overdose is based on measurement of serum acetaminophen level.

Shortly After ingestion Nausea and vomiting

Sever poisoning Hepatic necrosis jaundice,hepatic encephalopathy,renal failure and death

TREATMENTActivated charcoal

Withing 1 -2 Hour

Antidote

N-acetylcysteine intravenously.

N-acetylcysteine

Loading dose = 140mg/kg orally, Maintance dose=70mg/kg every 4 hrs. Dilute the solution 5% with water juice or soda

If vomiting interfere

OVERDOSE WITH ASPRIN AND THE SALICYTES:

An intentional overdose with aspirin is the most common cause of salicylate intoxication; overdose may be with methylsalicylate.

Poisoning may also occur as a result of transdermal absorption from skin ointments containing salicylate.

Gastric lavage Upto 12 hr

Activated charcoal

Mild

Severe (with plasma salicylate concentration above 1000 mg/liter)

50-100 g for every 4 hours until recovery

haemodialysis haemoperfusion.

TREATMENT

OPIOD ANALGESICS

morphine codeine, oxycodone, fentanyl are popular drugs of abuse and cause of

frequent hospitalization of overdose

DIAGNOSISMild intoxication euphoria, drowsiness and

constricted pupils.

More severe intoxication hypotension, bradycardia, hypothermia, coma and respiratory arrest

TREATMENTIn emergency Assist ventilation

Administer activated charcoal.

opioid antagonist/antidote Naloxone

Administer 0.4-2mg IVand repeat as needed to awaken the patient and maintain airway protective reflexes and spontaneous breathing

CA-ANTAGONISTS TOXICITY AND TREATMENT

Calcium channel blockers are used to decrease Blood pressure in patients with hypertension

verapamil, diltiazem, nifedipine, nicardipine, amlodipine etc.

DIAGNOSISSigns and symptoms Chest pain, Palpitations,

Flushing, Weakness, Confusion, Seizure, dizziness. Headache. Nausea, Vomiting

Physical examination findings Slow heart rate, Hypotension, Depressed level of consciousness

Abnormal findings on blood tests

Hyperglycemia, Hypokalemia Acidosis

On ECG Bradycardia atrioventricular (AV) block.

TREATMENTEmergency treatment:

Stabilize patient airway, breathing, and assist ventilation.

Activated charcoal For ingested drugs

Treat bradycardia with atropine 0.5-2mg I/v, isoproterinol2-20mcg/min by I/v infusion, or a transcutaneous or internal cardiac pacemaker.

Sustained release product

Whole bowelirrigation

ANTIDOTESCalcium Chloride 10% -10ml

Calcium gluconate 10% -20ml

Epinepherine 1-4mcg/min

Insulin 0.5-1 U/kg/IV bolus followed by infusion of 05-1 U/kg/hr

Glucagon 5-10mg/iv

DIGOXIN TOXICITY AND TREATMENT

Cardiac glycosides are derived from a variety of plants and are widely used to treat heart failure and supraventricular arrhythmias

digoxin, digitoxin are derived from digitalis.

DIAGNOSIS:

Acute over dosage nausea, vomiting, bradycardia, hyperkalemia and AV block frequently occur

Chronic toxicity Hypokalemic due to concurrent diuretic treatment and more commonly present with ventricular arrhythmias.

TREATMENTIn emergency administer Activated

charcoal

Increases GI elimination and systemic clearance

Hemodialysis

Magnesium: 2 g IV initially, consider maintenance

treat hyperkalemia, but is not effective for reversal of toxicity because of the extensive tissue distribution of digoxin