organophosphorous poisoning

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shaikful,DCRM Pharmacy college favourited this 2 Years ago.

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SEMINAR ON ORGANOPHOSPHOROUS POISONING SK.JABBAR IV/IVth B-Pharmacy (08Z41R0048)

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UNDER THE GUIDENCE OF VENKATESWARLU.G M. Pharm.,

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D.C.R.M PHARMACY COLLEGE INKOLLU-523167 (Affiliated to J.N.T.University , Approved by AICTE)

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Toxicology General principles of toxicology Introduction to organophosphorous Classification Mechanism of action Pharmacokinetics symptoms and signs of OP Diagnosis Management of OP poisoning prevention Contents

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TOXICOLOGY: Study of poisons. The term toxicology is derived from Greek words Toxicos – poisonous Logos – Study of

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Know the following general mechanisms by which drugs or chemicals can cause toxicity: Alterations in receptor- ligand interactions-Nicotine Alterations in membrane function- Local anesthetics Interference with cellular energy mechanisms-Cyanide Covalent binding to biomolecules- Organophosphates GENERAL PRINCIPLES OF TOXICOLOGY

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Interference with calcium homeostasis- Cyanide By causing non-lethal alterations in somatic cells-Carcinogens Alterations in ligand-activated transcription factors-Dioxins By inducing programmed cell death -Acetaminophen

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Understand the primary determinants of toxicity Dose and dose rate Duration of exposure: long duration: bad. routes of exposure: inhalation and oral

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Understand how the following factors modify toxicity Biotransformation Parathion Paraxon Methanol Formaldehyde Formic Acid Immune function Phototoxicity: UV toxic compounds Examples: tetracycline

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Understand how to manage a poisoned patient Understand the importance of the history and physical examination in treating a poisoned patient Understand the importance of the laboratory analysis and procedures

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Understand how toxins can be removed or elimination Gastric lavage > 30 minutes have passed since the ingestion of a corrosive material ingestion of hydrocarbons,coma, unconsciousness Understand the importance of the specific drugs in managing the poisoned patient

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ORGANOPHOSPHOROUS POISONING These are chemical agents in widespread use throughout the world, mainly in agriculture. As therapeutic agents, such as ecothiopate used in the treatment of glaucoma. Organophosphates are of significant importance due to their practical usefulness and chemical instability.

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Highly toxic organophosphates: parathion Intermediately toxic organophosphates: coumaphos Low toxicity:diazinon Classification

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MECHANISM OF ACTION Organophosphorous compounds are acid-transferring inhibitors of cholinesterase. Cleavage of the carbon enzyme bond from ACh is complete in a few microseconds. The rate of reactivation will depend on the tissue and the chemical group attached to the enzyme. Reactivation may be enhanced by hydrolysis of the acid-radical-enzyme through the use of oximes

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This process being caused by “ageing” of the inhibited enzyme. Ageing is probably the result of the loss of one alkyl or alkoxy group, leaving a much more stable acetyl cholinesterase. The aged phosphorylated enzyme cannot be reactivated by oximes.

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PHARMACOKINETICS

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symptoms and signs of op Nicotinic receptors Cardiovascular Tachycardia Hypertension Musculoskeletal Weakness Fasciculation's Cramps Paralysis Muscarinic receptors Cardiovascular Bradycardia Respiratory Bronchorrhoea Gastrointestinal Abdominal cramps Genitourinary Urinary continence Glands Excessive salivation

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Diagnosis requires a high index of suspicion. It should be remembered that some patients may present with the nicotinic effects of tachycardia, hypertension and mydiasis. Both true and pseudo cholinesterase levels can be estimated to assess poisoning. DIAGNOSIS

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If u want this video E mail me jabbarshiak@gmail.com

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Skin decontamination Gastric lavage Airway protection Anticholinesterase: Atropine Cholinesterase reactivator: Pralidoxime Feeding-enteral/parental Neck muscle weakness Ocular muscle involvement eg. diplopia Arterial blood gas analysis Management of Organophosphorus compounds poisoning

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Airway and respiration This is important as atropine can precipitate ventricular fibrillation in hypoxic patients. Paradoxically, the early use of adequate atropine will dry respiratory secretions, improve muscle weakness and thereby improve oxygenation.

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Anticholinesterase: Atropine The recommended starting dose of atropine is a 2mg IV bolus. Subsequent doses of 2-5mg every 5-15 minutes should be administered until atropinization is achieved. The signs of adequate atropinization include an increased heart rate, moderately dilated pupils, a dry mouth and a decrease in bronchial secretions. Continuous atropine infusions are used in some centres in doses of 0.02-0.08mg/kg/hr.

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Cholinesterase reactivator: Pralidoxine A direct reaction converting the organophosphate to a harmless compound. A transient reaction protecting the enzyme from further inhibition. Reactivation of the inhibited alkyl phosphorylated enzyme to free the active unit (if given early enough)

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Improved regulation of the availability of pesticides, strict regulation of vendors, and modifications in packaging of pesticides may all help reduce the use of organophosphates as poisons. Adequate provision of information to the public, regular training of health care providers, better availability of drugs /antidotes and the establishment of poison information centres will facilitate in reducing the morbidity and mortality related to organophosphorus poisoning prevention

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Insecticides should be kept out of reach of children, to prevent accidental poisoning. During agricultural spraying, proper precautions should be taken to prevent inhalation and accidental ingestion of the substance. prevention

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Any Questions or Suggestions?

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THANK YOU !

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