Poisoning apomorphine

Apomorphine hydrochloride (44 Apokyn Bertek, 2004), is a semisynthetic derivative of opium alkaloid morphine (43) isolated from poppy (Papaver somniferum), and it has long been known for its erectile activity at the effective dose of 2-6 mg physicians discovered the effect over 100 years ago, but found the drug, at a much higher dose (ca. 200 mg), to be more suitable for poison victims as an emetic because it also causes serious nausea and vomiting. Apomorphine exerts its erectile effect at the central nervous system the drug has been found to be a non-selective dopamine agonist which activates both Di-like and D2-like... 

Gastric lavage (with hypertonic saline solution, apomorphine injection for ingested poison). 

Emesis can be induced with ipecacsyrup (never extract of ipecac), and this method is sometimes used to treat childhood ingestions at home under telephone supervision of a physician or poison control center personnel. Ipecac should not be used if the suspected intoxicant is a corrosive agent, a petroleum distillate, or a rapidly acting convulsant. Previously popular methods of inducing emesis such as fingertip stimulation of the pharynx, salt water, and apomorphine are ineffective or dangerous and should not be used. 

Apomorphine is a dopamine agonist with a variegated pattern of usage. Given parenter-ally as an emetic agent to aid elimination of orally ingested poisons, it is not without hazards (hypotension, respiratory depression). In akinetic motor disturbances, it is a back-up drug. Taken orally, it supposedly is beneficial in erectile dysfunction. 

Apart from specific antidotes (if they exist), the treatment of poisonings also calls for symptomatic measures (control of blood pressure and blood electrolytes monitoring of cardiac and respiratory function prevention of toxin absorption by activated charcoal). An important step is early emptying of the stomach by gastric lavage and, if necessary, administration of an osmotic laxative. Use of emetics (saturated NaCl solution, ipecac syrup, apomorphine s.c.) is inadvisable. 

Numerous emetics have been advocated in the past for the treatment of the poisoned patient. Past emetics have included apomorphine, egg whites, saltwater, copper sulfate, and household dish-washing liquid. However, the use of these agents is fraught with ineffectiveness and potential harm to the patient. The only acceptable emetic that may be considered is syrup of ipecac. 

Apomorphine stimulates the CIV. and causes emesis. The drug is unstable in solution and must be prepared just prior to use. Apomorphine is not effective orally and must be given parenterally, usually subcutaneously, 6 mg for adults and 0.06 mg/kg for children. Vomiting ensues in 3-5 minutes. Subcutaneous administration can be an advantage with an uncooperative patient. Because apomorphine is a respiratory depressant, it should not be used if the patient has been poisoned by a CNS depressant or if the patient s respiration is slow and labored. At present, apomorphine is used rarely as an emetic. 

There is no known chemical antidote to phosphorus. The treatment is, therefore, limited to the removal of the unabsorbed portions of the poison by the action of an emetic, zinc or copper sulfate, or apomorphin, as expeditiously as possible, and the administration of French oil of turpentine—the older the oil the... 

II. Indications. Apomorphine was previously used for Induction of emesis In the acute management of oral poisoning, but it has been abandoned because of its potential for respiratory depression and its inconvenient formulation (soluble... 

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