Insecticide & Opioid Poisoning and Treatment.pptx

1. Insecticide & Opioid
Poisoning and Treatment
By: Dr. Sarita Sharma
Assistant Professor
Department of Pharmacology
Mumbai

2. Introduction:
• Insecticides are variable group of chemical substances used for killing,
control or eradication of unwanted pests, insects and worms etc.
• Poisoning may can be due to accident or suicidal tendency.
• Some of the most commonly used insecticides belong to the following
groups of compounds
1. ORGANO PHOSPHORUS GROUP
2. CARBAMATES
3. CHLORINATED GROUP
4. NAPHTHALENE

3. 1.ORGANO PHOSPHORUS GROUP OF INSECTICIDES:
• widely used group of dangerous poisons used as Insecticides for spraying crops
and for fumigation of ships and go downs.
• Classification of Organo phosphorus compounds
1. ALKYL GROUP
2. ARYL GROUP
1. Hexa Ethyl Tetra Phosphate ( HETP )
2. Tetra Ethyl Pyro Phosphate ( TEPP )
3. Octa Methyl Pyro Phosphate ( OMPP )
4. Malathion
5. Dipterex
1. Parathion
2. Paraoxon
3. Chlorothion
4. Diazinon
5. Eketox
2.CARBAMATE GROUP OF INSECTICIDES:
group of poisonous organic compounds which lack phosphate group and unlike organo
phosphorus insecticides have carbamate groups substituted instead of alkyl or aryl groups in
the hydrocarbon chain.

4. MODE OF ACTION OF BOTH ORGANO PHOSPHORUS AND CARBAMATE GROUP OF
INSECTICIDES:
• They are powerful inhibitors of Cholinesterase enzyme which is present in the
synapses of ganglions and neuromuscular junctions and responsible for
degradation of acetylcholine.
• The resulted accumulation of acetylcholine causes hyper excitation of voluntary
and involuntary muscles with increased secretions all together resulting in toxic
symptoms.
• FATAL DOSE : organo phosphorus compounds varies with the type of compound
• carbamates ranges between 25mg to 350mg orally
• FATAL PERIOD The fatal period for both organo phosphorus and carbamate insecticides
ranges from half an hour to 3 weeks

5. PORTAL OF ENTRY
• 1. Gastrointestinal Tract
• 2. Inhalation
• 3. Open wounds
• 4. Contact with mucous membrane
• 5. Eyes
• 6. Contact with skin

6. SYMPTOMS OF ORGANOPHOSPHORUS & CARBAMATE POISONING
• Symptoms can be classified on the basis of Pharmacological actions of
organophosphates (Ach abundance at synapse)
a. Muscarine like effects: b. nicotinic like effects: c. CNS:
1. Bronchial Tree
a. increases
secretions
b. dyspnoea
c. cough
d. edema
e. cyanosis
2. Gastrointestinal
Tract
a. salivation
b. nausea
c. anorexia
d. cramps
e. epigastric pain
f. involuntary
defecation
3. Heart
a. bradycardia
4. Eyes
a. Red tears
called
Chromogenic
tears
b. meiosis
c. blurred vision
5. Skin a. excessive sweating 6. Urinary bladder a. incontinence
a. weakness b.
twitching c. cramps
d. increased blood
pressure
1. Irritability, confusion,
tremors, convulsions.
2. respiratory depression.
3. Tremors of hands, lips,
face or tongue.
CAUSE OF DEATH: 1. Respiratory Paralysis or
failure 2.Edema of lungs or brain
Others: 1.Garlic like odour 2. Skin exposed to
poison is red and blistered

7. LAB DIAGNOSIS:
• The essential finding in Lab diagnosis is depression of CHOLINESTERASE
ACTIVITY.
• In acute poisoning, signs and symptoms generally occur when > 50% of
cholinesterase is inhibited.
• 1. P- nitrophenol test: P- nitrophenol is a metabolite of some
OPCs(organophosphates compounds) and is excreted in the urine.
• Its excretion in urine can be used as a confirmation test of OPC poisoning. This
test can also be performed on vomitus or gastric Lavage contents.
• 2. Thin Layer Chromatography.
• 3. Spectrophotometry

8. Treatment of Organo phosphorus and carbamate poisoning
• 1. Decontamination -
• 2. Care of Airway - artificial respiratory support
• 3. Administration of antidote- Atropine-initial dose of 1mg I/V - Repeat a dose
of 2 mg every 15 minutes until atropinization is achieved.
• The average patient requires approximately 40mg of atropine per day, but larger doses of 500 to 1000mg per
day may be necessary.
• 4. Administration of cholinesterase reactivators- oxime compounds like 1.PAM
(Pyridine 2 Aldoxime Methiodide) 1 to 2gm diluted in 5% isotonic saline and
repeated 12 hourly. 2. P2S (Pralidoxime chloride) 400mg IV and repeated if
necessary(only in organo phosphorus poisoining)
• 5. diuretics and bronchodilators also given if required.
1. Remove the person from the source of poison. 2. Strip off all contaminated clothes and wash
the skin and mucous membrane thoroughly with water. 3. Gastric lavage with water, KMnO4.
Atropinization is manifested by drying of
secretions, tachycardia, flushing, dry
mouth and dilated pupils.

9. 3. CHLORINATED INSECTICIDES:
These insecticides contain chlorine in their molecular structure. Some of them
include.
1. DDT ( Di Chloro Di Phenyl Tri Chloro Ethane)
2. Gammaxine
3. Hexaphane
MODE OF ACTION - It acts on the motor cortex and the cerebellum.
PORTAL OF ENTRY 1. Oral 2. Local 3. Inhalation
FATAL DOSE-150 to 160 mg per kilogram body weight (10.5 gm for 70 kg adult)
FATAL PERIOD -from half to four hours

10. SYMPTOMS OF CHLORO GROUP INSECTICIDE POISONING
• 1. Nausea and Vomiting
• 2. Coughing
• 3. Excitability
• 4. Vertigo
• 5. Weakness
• 6. Muscular tremors
• 7. Convulsions
• 8. Tingling in arms and legs
• 9. Paralysis of legs
• 10. Pulmonary edema
• 11. Unconsciousness and coma
• 12. Death from respiratory failure

11. TREATMENT:
• 1. Gastric lavage.
• 2. Inject atropine to prevent pulmonary edema.
• 3. Calcium Gluconate I/V
• 4. Oxygen inhalation or artificial respiration.
• 5. diazepam for convulsions.
• 6. Barbiturates for muscular twitching & tremors.

12. 4.NAPHTHALENE (two combined benzene ring structure)
It is used as moth balls as pesticides eg in cloths (phenyl ki golian), as deodorants
in lavatories, in dying industry and electrical equipment as an insulator.
FATAL DOSE -2 gms
FATAL PERIOD- few hours to 3 days
SIGNS AND SYMPTOMS -1. Headache, nausea and vomiting
2. In the kidney it causes acute nephritis, painful micturation, dark brown colored
urine with albumin and hemoglobin in it
4. Jaundice, Haemoglobinuria, hemolytic anemia
5. Dermatitis on contact
6. Convulsions, cyanosis, perspiration, coma and death

13. TREATMENT OF NAPHTHALENE POISONING:
• 1. Keep body warm
• 2. Stomach wash
• 3. Purgatives
• 4. Avoid fats as they dissolve naphthalene
• 5. Sodium bicarbonate to alkaline the urine
• 6. Blood transfusion
• 7. Hydrocortisone for hemolysis
• 8. Low fat and high carbohydrate, protein and vitamin diet
• 9. I/V glucose

14. Opioid poisoning & treatment

15. Opium a dark brown resinous material obtained from poppy i.e Papaver
somniferum capsule.
It contains two types of alkaloids
Benzo-isoquinoline
derivatives
1) Papaverine
2) Noscapine
both are non analgesics.
Phenanthrene derivatives
1) Morphine
2) Codeine
3) Thebaine

16. Morphine: it is principle alkaloid in opium & widely used.
Pharmacological actions:
1) Central nervous system: it is having depressant & stimulant action on CNS.
1) Analgesia
2) Sedation
3) Mood & subjective effects
4) Respiratory center
5) CTZ (increases nausea & vomiting)
6) Vagal centre: stimulation causes bradycardia
7) Cortical area & hippocampus : excitation causes rigidity, immobility. convulsions may occur.
8) Neuro-endocrine: FSH,ACTH, levels are lowered, while prolactin & gonadotropine
hormone levels are raised
9) CVS: vasodilation due to Histamine release.
10) GIT: spasm, decrease all GIT secretions, constipation.

17. Pharmacokinetics:
 GIVEN by IM route
 circulated in all body tissues,
 Metabolised liver by glucuronide conjugation….gives active metabolite
morphine 6 glucuronide.
 Plasma half life is 2-3 hours.
 Parenteral dose effect last for 4-6 hours.
 Elimination is within 24 hours.
Adverse effects:
Sedation, mental confusion, lethargy, vomiting,
Idiosyncrasy, allergy, apnoea, acute morphine poisoning, tolerance &
dependence.

18. Treatment for opioid poisoning:
1) Naloxone: it is N-alylnor-oxymorphone & it is competitive antagonist of all
opioid receptors. Block the µ receptor in very low doses.
it is injected IV (0.4-0.8mg) antagonize all actions of morphine.
• Pharmacokinetics: inactive orally because of high first pass metabolism in the
liver.
IV injected acts for 2-3 minutes.
Metabolism is by glucurunidation.
half life in adult 1 hour & 3 hours in new born.
• Adverse effects: rise in blood pressure, pulmonary edema.

19. Use: in morphine poisoning,
To reverse respiratory depression due to opioids.
In alcohol intoxication

20. 2) Naltrexone: it is chemically related to naloxone & it is another important
opioid antagonist. It is more potent than naloxone.
Pharmacokinetics: it is orally active & having a long duration of action (1-2 days)
which makes it suitable for opioid blockade therapy for post addicts
50mg/day is given orally.
Also used in alcohol withdrawal condition.
Side-effects: nausea, headache & high doses lead to hepatotoxicity.
3) Nalmefene: it is having longer bioavailability & it is long acting.
But hepatotoxic.

21. Thank you