Datura And Opiates (Atropine, Hyosine, Hyosciamine & Heroin)

Question 1

What are the sources of atropine, hyosine and hyoscyamine?

Answer 1

Datura fastiosa plant (thorn apple)
Atropa bellanoda plant (black berry)
HM plant

Question 2

What are the 5 medical uses of atropine?

Answer 2

-Antidote for organophosphorus compounds and digoxin
- Urinary: urinary incontinence
- Eye: mydriasis
-GIT: antispasmodic
-Chest: bronchodilator

Question 3

2 uses of hyosine….

Answer 3

Truth serum
Treatment of mania cuz it depresses CNS without initial increase (unlike atropine & hyoscyamine

Question 4

MOA of atropine, hyosine & hyoscyamine peripheral and central…

Answer 4

-Atropine & hyoscyamine:
>central: CNS depressant due to anticholinergic (antimuscarinic specifically) which blocks ach release but has initial stimulation cuz when ach. blocked, epinephrine take over which cause stimulation
>peripheral: block muscarinic actions
- Hyosine:
>central: CNS depression
>peripheral: weak

Question 5

Clinical picture of datura poisoning…

Answer 5

-Fixed pupil dilation
-Urinary retention & constipation
-Flushing due to vasodilation ( same as alcohol)
-horse voice and dysphagia
-Atropine sweating
-tachycardia and tachypnea (cuz Ach usually decreases stuff)
-CNS stimulation first causing agetation, euphoria and staggering gate (like in alcohil)
-CNS depression after

Question 6

Cause of death in datura poisoning is…

Answer 6

Respiratory depression

Question 7

3 investigations done for diagnosis of datura…

Answer 7

CBC & electrolytes
ECG: sinus tachycardia
Tropin and tropic acid levels

Question 8

Differential diagnosis of datura poisoning is…. bcz….

Answer 8

Alcohol intoxication
Cuz of staggering gate and bcz it causes CNS stimulation then inhibition like the stages in alcohol intoxification

Question 9

5 treatment methods of datura poisoning…

Answer 9

Supportive: ABCs
GI decontamination
Local antidote: activated charcoal, sodium bicarbonate & hydrogen peroxide
Physiological antidote: Pilocarpine and Physostigmine (3Ps in datura)

Question 10

What is the source of heroin?

Answer 10

Papaversomniferum plant

Question 11

Routes of administration of heroin is…

Answer 11

Smoking
Ingestion

Question 12

Route of administration of morphine is…

Answer 12

Injection

Question 13

3 classifications of opioids are…

Answer 13

Natural: morphine
Semisynthetic: heroin
Synthetic: جلا

Question 14

Other name for heroin is…

Answer 14

Diacetylmorphine

Question 15

2 uses of morphine include…

Answer 15

Painkiller (analgesic)
Treatment of opioid addicts (gradual withdrawal)

Question 16

MOA of opioids is…

Answer 16

Cause analgesic effect by binding to Mu, Delta & kappa receptors in brain. Sigma used to be a 4th receptor but not anymore cuz doesnt respind to naloxone

Question 17

Clinical presentation of opioid toxicity…

Answer 17

• euphoria or dysphoria ( وات زا هل)
• non cardiogenic pulmonary edema
• respiratory depression and cyanosis
• constipation and decreased bowel sound
  -hypothermia
• fixed pin point pupil
  -Needle tracks in IV addicts
• circulatory collapse
• MECONIC ACID BREATH (iconic hero)

Question 18

4 Causes of death in opioid toxicity…

Answer 18

Central asphyxia
Pulmonary edema
Arrhythmia
Irriverisble brain damage due to prolonged hypoxia

Question 19

Investigations done for opioid toxicity is…

Answer 19

-CBC, arterial blood gas, serum electrolyte
- Morphine and meconic acid levels in serum
- ECG
- chest x ray for pulmonary edema

Question 20

How do you treat opioid poisoning?

Answer 20

-Supportive: ABC
-GI decontamination: gastric lavage and activated charcoal local antidote, endotracheal tube also..
-Physiological antidote: atropine (cuz there is miosis and atropine cause mydriasis
-Agonist antagonist (act as agonist when there is no opioid, and antagonost when there is):
- levallorphane & nalorphine (half half of morphine)
-Pure antagonist: Naloxone Nalmefene Naltrxone (Nal=null= no agonist effect)