Quininae Salicylas (Gen., Quininae Salicylatis)

Eng., Quinine Salicylate.

Form, Odor, Taste, Incompatibility And Dose

Same'as Quininae Sulphas.

Solubility

In about 77 parts of water or 14 parts of alcohol.

Quininae Tannas (Gen., Quininae Tannatis)

Eng., Quinine Tannate.

Form

A pale-yellow or yellowish-white powder.

Odor And Taste

Odorless and tasteless or not having more than a slightly bitter or astringent taste.

Solubility

Only slightly soluble in water; somewhat more soluble in alcohol.

Average Dose

3 grains (02 Gm.).

Cinchoninae Sulphas

Eng., Cinchonine Sulphate.

Form, Odor, Taste, Incompatibility

Same as Quininae Sulphas.

Solubility

In 60 parts of water or 12 1/2 parts of alcohol

Average Dose

2 1/2 grains (0.15 Gm.).

Cinchonidinae Sulphas

Eng., Cinchonidine Sulphate. Form, Odor, Taste, Incompatibility.-Same as Quininae Sulphas. Solubility.-In 65 parts of water or 90 parts of alcohol. Average Dose.-2 l/2 grains (0.15 Gm.).

Therapeutic Action

Cinchona and its preparations and official alkaloids are antimalarial, antipyretic, tonic, antiseptic.

Uses

The preparations of cinchona are used as bitter tonics. The alkaloids other than quinine are seldom employed by the profession.

Quinine-by the mouth-is used for malaria, coryza, influenza, bronchitis, pertussis, erysipelas, septicemia, etc.

By Enema

Injections or irrigations are used for amebic dysentery, pinworms, ulcerated colon, gonorrhea, cystitis, abscesses, etc.

Externally

For sores, ulcers, scalp diseases.

By Needle

For malaria and as a local anesthetic.

Cinchonism

Severe results from taking quinine are very rare, but considerable discomfort is quite common. Many people have such an idiosyncrasy for the drug that even a few grains will occasion alarming symptoms. The usual toxic symptoms are a sense of fullness in the head, dizziness, ringing in the ears, nausea, partial or even total deafness. There may be itching of the skin with or without eruption. The skin may show lesions anywhere from a mild erythema to purpura hemorrhagica. These symptoms may be accompanied with an elevation of temperature. Quinine given during pregnancy may produce an abortion.

Treatment

The unpleasant symptoms of cinchonism may be in part prevented by associating the bromides with the drug. If very disagreeable symptoms develop, the drug should be discontinued unless there is more demand for its continuance. Sodium or potassium bromide in rather large doses may be given and elimination favored. The cutaneous symptoms may be treated by starch or bran baths and antipruritic inunctions or applications, if necessary. Hypodermic injections of adrenalin may be of value.

Administration

By Mouth.-The Bark, Fluidextract and Tincture are seldom used. The Compound Tincture is frequently employed, but as it contains only about 0.3 grain total alkaloids to the teaspoonful it has little effect except that due to its bitter taste.

It should be remembered that the tinctures and fluidextract of cinchona contain tannic acid. The use of the Compound Tincture is illustrated in the following prescription, in which case it is said to prevent the unpleasant gastric disturbances that might result from the use of the other agents. The cinchona alkaloids are not precipitated for reasons elsewhere explained.

M.

Sig

Teaspoonful in water an hour before meals.

Tasteless Administration By Mouth

The quinine salts in capsules are by far the most desirable form for administration in the vast majority of cases, where the patient is old enough to swallow a capsule. Pills and tablets possess no advantages over capsules and are particularly subject to the disadvantages mentioned under Pills, p. 377, and Tablets, p. 377.

The prescriber should see that the pharmacist dispenses the capsules free from adhering particles.

The salts of choice seem to be Quinine Sulphate, Hydrobromide, and Hydrochloride for general use as an antiperiodic and tonic, and Quinine Hydrobromide and Salicylate for colds, influenza, tonsillitis, etc.

Not more than 5 grains should usually be ordered to the capsule.

Some frequently used prescriptions are as follows:

In the treatment of malaria:

Ft. cap. no. xviij.

Sig

Take six (6) each day as directed.

Written instructions should be given, based on the time of the expected chill, so that the greatest possible concentration of the drug may be present in the blood at the time of liberation of the malaria organisms. With this in view, it is certainly necessary to base the size of the dose on the probable amount of blood in the particular patient (size of patient).

The prescription direction may read as

Sig

One each morning at 6, 7, 8, 9, 10, 11. .

For children, see below, and p. 135.

In the treatment of malaria following the first three days of quinine in large doses:

M. ft. cap. no. l.

Sig

One after each meal.

While it is customary to continue the treatment longer than sixteen days, it is usually desirable to order in the above amount, so that the other ingredients may be changed or discontinued, as conditions may indicate.

This may be prescribed for children in the proper doses, put into powders, and directions given that they may be administered in syrup of chocolate. For adults the Massa Ferri Carbonatis is frequently used instead of the Ferrum Reductum.

In the treatment of subinvolution of the uterus:

M. ft. cap. no. xxx.

Sig

One before each meal.