Quinine (C20H24N2O2 + 3H2O = 378.26) is an alkaloid derived from the bark of several species of Cinchona, trees of South America.

Pharmacodynamics.

Central Nervous System. - Slight stimulation, then depression.

Muscular System. - Temporary stimulation, followed by depression. The uterine muscle is stimulated to rhythmical contractions.

Respiration is thought to be slightly accelerated; centric (?)

Heart. - Apparently not affected.

Blood-pressure. - Very little effect; possibly slight raise.

Eye. - Degenerative changes in retinal cells and optic nerve.

Ear. - Degenerative changes in spiral ganglion in cochlea.

Alimentary Tract. - Mildly irritant.

Secretory Glands. - Kidney and liver mildly irritated.

Metabolism. - Quinine diminishes the destruction of the nitrogenous constituents of the tissues.

Temperature is lowered through diminished metabolism.

Absorption takes place readily from mucosa and subcutaneous tissues.

Excretion. - Three-fourths of the drug is usually destroyed in the tissues; the balance is very slowly excreted in the urine.

Quinine is a poison to all protoplasm. Hence, even in medicinal doses, the number of leucocytes will be diminished, some erythrocytes will be destroyed, and most of the cells of the body, as well as the ferments, will be hindered in their activity.

Symptoms.

Therapeutic Doses.

Some roaring in the ears. Contraction of field of vision. Possible exanthems. Occasional giddiness.

Large Doses.

Marked roaring in the ears. Marked visual disturbances. Mental confusion and depression. Muscular weakness. Nausea and possible vomiting. Slow, gasping respiration. Unconsciousness in some cases.

Therapeutics.

Quinine is a specific in most cases of malaria.

Dosage.

Quininae Sulphas, 0.3 to 1 Gm. Quininae Bisulphas, 0.3 to 1 Gm. Quininae Hydrochloridum, 0.3 to 1 Gm.

Some people have a marked idiosyncrasy for quinine, closes of 1 grain producing distressing and alarming symptoms. Care should be taken, therefore, to ascertain the way a given patient may react.

Quinine 78

Crimson = stimulation. Green = irritation. Violet = depression.