What is caffeine?

CAFFEINA-CAFFEINE.

Caffeine (theine) is a feebly basic, proximate principle, obtained from the dried leaves of Thea sinensis or tea plant (Nat. Ord. Ternstræmiaceae), from the dried seeds of Coffea arabica or coffee plant (Nat. Ord. Rubiacea), or from guarana (a paste prepared from the crushed or ground seeds of Paullinia cupana (Nat. Ord. Sapindacea). Guarana is official.)

What are its physiological actions?

In medicinal doses, caffeine is a cerebral stimulant, causing nervous restlessness, increased mental activity and wakefulness; it also increases the cardiac force, raises the arterial pressure, and acts as a decided diuretic. After poisonous amounts, there is also confusion of thought, with delirium, muscular tremblings, cardiac oppression, quickened respiration, cold extremities, symptoms of collapse, rise of temperature, and (in animals) tonic and clonic convulsions, muscular weakness, general paresis, and death from paralysis of respiration.

It increases the power of the heart and raises arterial tension, probably by a direct stimulant effect upon the heart muscle. It is diuretic, not only indirectly by increasing the blood pressure, but also by some direct action on the secreting cells of the kidney itself. The convulsions are probable due to spinal stimulation. In moderate doses, caffeine is said to be entirely destroyed in the system; in toxic doses, it is partly destroyed and partly eliminated by the kidneys. Its effect on the elimination of waste products is at present uncertain.

What are its medicinal uses?

As a cardiac tonic (more rapid in action, but not so enduring as digitalis), it is used to meet the same indications which call for the use of digitalis. In cases of sudden heart failure, it may be used hypodermically combined with equal parts of sodium salicylate, which renders it more soluble in water.

As a combined cardiac stimulant and diuretic it is very useful in the latter stages of chronic Bright's disease with weak heart.

As a diuretic in all renal and cardiac dropsies it is very serviceable. It is also employed as a cerebral stimulant in nervous and neuralgic headaches, and combined with other antagonists in opium poisoning.

How is caffeine administered?

CAFFEINA (Caffeine) may be given in pill, capsule or solution, dose gr. j-v (0.06–0.3) or more. For administration in fluid form caffeine citrate (so-called) is preferred as more soluble.

When given as a cerebral stimulant, one dose of gr. ij-v (0.13–0.3) is usually sufficient, but as a cardiac tonic and diuretic this dose should be repeated twice daily, and gradually increased if necessary up to gr. x-xij (0.6–0.8).

CAFFEINA CITRATA (citrated caffeine), dose gr. ij-v (0.13–0.3). CAFFEINA CITRATA EFFERVESCENS (effervescent citrated caffeine), dose 3j-iij (4.0-12.0).

GUARANA (Guarana) contains tannic acid as well as caffeine in considerable quantities, and is principally used in neuralgic and in sick-headache. In Brazil, whence it comes, it is also used as an astringent in diarrhoeal affections, dose 3j (4.0).

EXTRACTUM GUARANÆ FLUIDUM (fluid extract of guarana), dose mx-xx (0.6-1.2).

What is adonidin?

ADONIDIN.

Adonidin (not official) is a glucoside, obtained from the root of Adonis vernalis (Nat. Ord. Ranunculaceae), a plant of northern and central Europe.

What are its effects, uses and modes of administration?

The effects of adonidin are almost identical with those of digitalis (but are much more quickly produced), as it stimulates the cardiac muscle and contained motor ganglia, thus increasing the force of the cardiac contractions at the same time that, by stimulating the inhibitory fibres of the vagi, it increases the length of the diastole and thus slows the heart. The arterial tension is also elevated, probably by stimulation of the vaso-motor centres. In large doses it paralyzes both the heart and vessels, the arterial tension falls and the heart is finally arrested in diastole. It sometimes (not as frequently as does digitalis) causes nausea, vomiting and diarrhoea. It sometimes proves diuretic. It is used as a cardiac tonic in the same class of diseases in which digitalis is employed, and may be substituted for it where the latter disagrees or is too slow in its action.

It may be alternated with digitalis for a few weeks during a course of the latter. Dose gr. — (0.008–0.03) every 3 or 4 hours, in pill or capsule.

What is strophanthus ?

STROPHANTHUS.

Strophanthus is the seed of S. hispidus (Nat. Ord. Apocynaceæ), an African plant which has been used by the natives as an arrowpoison, and called by them Kombé or Ineé. It contains a crystalline glucoside, called strophanthin.

What are its effects, uses and modes of administration?

The effects of strophanthus are more rapid in action, but much more evanescent, than those of digitalis. It appears to act upon the muscles directly, and to have little or no effect upon the nervous system.

In moderate doses it greatly increases the strength of the cardiac systole, prolongs the diastole and increases the arterial tension probably by acting on the muscular walls of the vessels. In large doses it increases the contractibility of all the striated muscles and finally arrests the heart in systole.

It proves diuretic by increasing the arterial tension, and has no cumulative effects. It is used as a substitute for digitalis in cardiac diseases when a temporary effect or a temporary change of medicines is desirable. From its diuretic action it has been successfully employed in various forms of oedema depending on a weak circulation and general cardiac and renal dropsies. The tincture of strophanthus (tinctura strophanthi-5 per cent. by weight) is used; dose mj-x (0.06-0.6) t. i. d.; or strophanthin may be cautiously administered hypodermically; dose gr. 1ooo (0.0006-0.001).

SPARTEINÆ SULPHAS-SPARTEINE SULPHATE.

What is sparteine?

Sparteine is a liquid alkaloid obtained from Cytisus Scoparius, or broom (Nat. Ord. Leguminosa).

What are its effects and uses, and how is it administered? Sparteine is a cardiac tonic, in moderate doses increasing the force and persistence of the cardiac contractions by direct action upon the

heart or its contained motor ganglia, and at first increasing its frequency by paralyzing the vagi, afterward decreasing the pulse-rate by its direct action on the heart. When the cardiac rhythm is disturbed it renders its contractions regular. In large doses it depresses the heart and causes death from paralysis of the respiratory centre. It depresses the cerebral and spinal centres. It has no diuretic properties. It has been used as a substitute for digitalis in cardiac diseases, and in cases of feebleness and irregularity of cardiac action. It is inferior to digitalis as a cardiac tonic, but may be used as a succedaneum to it. It is administered in the form of sulphate (official), of which the dose is gr. 2-4 (0.003-0.01), hypodermically; or if given internally, gr. 4-j or ij (0.01–0.06–0.13) in capsule or pill.

STRYCHNINA-STRYCHNINE.

Is strychnine prescribed for its cardiac effects?

The use of strychnine as a cardiac tonic has been noticed under the head of nux vomica (q. v.); dose gr. 36-26 (0.002–0.003) internally, or gr. (0.001) if used hypodermically.

What is cimicifuga ?

CIMICIFUGA.

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Cimicifuga is the rhizome and roots of C. racemosa, black snakeroot or cohosh (Nat. Ord. Ranunculaceae), a common indigenous plant. It contains a volatile oil, to which its virtues are probably due. A crystalline principle has also recently been obtained from it. Its effects on the circulation are supposed to resemble those of digitalis, while it acts on involuntary muscular fibres similarly to ergot. Recently it has been said, however, that it is a direct depressant to the cardiac muscle or its ganglia. It depresses the reflexes and occasionally causes nausea and vomiting. Its action is mild and not well understood. It is also diuretic and expectorant. It has been used as a cardiac tonic in fatty heart, as a diaphoretic in rheumatism, as a diuretic in dropsies, as an expectorant in chronic bronchitis, and as an antispasmodic in chorea, in which disease it is sometimes of value, combined with tonics and laxatives. It is not often prescribed.

EXTRACTUM CIMICIFUGE FLUIDUM (fluid extract of cimicifuga), dose f3ss-j (2.0-4.0).

TINCTURA CIMICIFUGE (tincture of cimicifuga), dose f3ss-ij (2.0

8.0).

EXTRACTUM CIMICIFUGE (extract of cimicifuga), dose gr. iij-v (0.2-0.3).

What is convallaria?

CONVALLARIA.

Convallaria is the rhizome and roots of C. majalis, or lily of the valley (Nat. Ord. Liliaceae), a European plant naturalized in this country.

It contains two glucosides, convallamarin and convallarin, to the former of which it probably owes its action on the heart, while the latter appears to cause nausea, diarrhoea and gastric pain.

The results of the investigations regarding the physiological action of this plant are very contradictory, but it seems to slow the heart and increases the blood-pressure in small doses. In toxic doses the cardiac action becomes rapid, the arterial pressure gradually falls, and death occurs from heart-failure.

It is used in all cases of cardiac weakness whether accompanied by valvular lesion or not, as in dilatation or fatty heart. It is also used in palpitation.

EXTRACTUM CONVALLARIE FLUIDUM (fluid extract of convallaria), dose mv-xv (0.3–0.9).

ORDER II.-CARDIAC SEDATIVES.

What are cardiac sedatives?

Cardiac sedatives are medicines which are used to diminish the force and frequency of the cardiac contractions when they are morbidly increased, and thus to depress the circulation.

Name the principal cardiac sedatives.

Antimonials, aconite and its alkaloid, veratrum viride and its alkaloids, veratrine, gelsemium, pulsatilla, arnica, the vegetable acids.

ANTIMONIUM-ANTIMONY.

What are the sources of antimony?

Antimony is a metallic element found native in the form of black antimonious sulphide.