3000 Toxicology

Question 1

Describe the steps involved in toxicology assessment.

Answer 1

The steps in toxicology assessment include identifying the danger, considering the risk factors, and mitigating the risks.

Question 2

Explain the importance of clinical assessment in toxicology.

Answer 2

Clinical assessment is crucial as it helps determine the amount of the drug, identify the toxin, assess the dose and route of administration, evaluate the time since exposure, and understand the intent behind drug use.

Question 3

Define toxidrome and its significance in toxicology.

Answer 3

Toxidrome refers to the classic signs and symptoms that result from the effects of a drug on the body, helping to identify the type of poisoning.

Question 4

How does acute ethanol intoxication affect the body?

Answer 4

Acute ethanol intoxication causes physiological disturbances such as euphoria progressing to sedation, disinhibition, hypotension, tachycardia, temperature irregularities, and impaired cognition.

Question 5

Do alcohol levels peak after ingestion, and if so, when?

Answer 5

Yes, alcohol levels peak 30-90 minutes after ingestion, especially when the stomach is empty.

Question 6

Explain the clinical features of binge drinking in males and females.

Answer 6

Binge drinking is defined as consuming 5 or more standard drinks for males and 4 or more for females, leading to symptoms like euphoria, sedation, impaired coordination, and potential respiratory depression.

Question 7

Describe the effects of ethanol on blood clotting.

Answer 7

Ethanol intoxication can interfere with blood clotting by reducing the number of platelets and making them less sticky, increasing the risk of bleeding within a trauma.

Question 8

Identify the potential complications of acute ethanol intoxication.

Answer 8

Complications include physical injury, respiratory depression, dehydration from vomiting, and altered mental status.

Question 9

How does chronic alcoholism lead to hepatic encephalopathy?

Answer 9

Chronic alcoholism can lead to hepatic encephalopathy due to liver disease, where toxins build up in the blood and impair brain function.

Question 10

Explain the role of the pituitary gland in ethanol intoxication.

Answer 10

Ethanol inhibits the production of antidiuretic hormone from the pituitary gland, leading to increased urination.

Question 11

Define the term ‘sedative-hypnotic’ in the context of toxicology.

Answer 11

Sedative-hypnotic refers to substances that depress the central nervous system, leading to sedation and relaxation.

Question 12

Describe the clinical features of Gamma Hydroxybutyrate (GHB) intoxication.

Answer 12

GHB is a sedative-hypnotic that can cause sedation, respiratory depression, and altered consciousness.

Question 13

How can drug use lead to violent behavior and psychosis?

Answer 13

Drug use can alter brain chemistry and function, potentially leading to violent behavior and psychosis as side effects.

Question 14

Explain the significance of monitoring vital signs in toxicology assessments.

Answer 14

Monitoring vital signs such as BGL, temperature, ECG, and SP02 is essential to assess the patient’s condition and the impact of drugs on their physiological state.

Question 15

Describe the impact of drugs on ECG readings.

Answer 15

Drugs can cause arrhythmias, tachycardias, QRS widening, and prolonged QT intervals, which are critical to monitor during a toxicology assessment.

Question 16

Identify the routes of drug administration and their relevance in toxicology.

Answer 16

Routes of drug administration include oral, snorting, and intravenous (IV), which are relevant for assessing the speed and extent of drug absorption.

Question 17

Explain the importance of time since exposure in clinical assessment.

Answer 17

Time since exposure helps determine where the patient is in the clinical course of intoxication and guides treatment decisions.

Question 18

Define the term ‘intent’ in the context of drug use.

Answer 18

Intent refers to the purpose behind drug use, such as self-harm, intentional overdose, or recreational use, which can influence treatment approaches.

Question 19

Describe the clinical features of alcohol intoxication.

Answer 19

Clinical features include euphoria, sedation, disinhibition, impaired coordination, slurred speech, and potential respiratory depression.

Question 20

How does vasodilation occur due to ethanol consumption?

Answer 20

Ethanol causes vasodilation by decreasing the sensation of the medulla, leading to lower blood pressure.

Question 21

Explain the relationship between drug use and changes in symptoms over time.

Answer 21

Symptoms of drug use can change over time, indicating the progression of intoxication or withdrawal, which is critical for clinical assessment.

Question 22

Describe the primary use of GHB in medical settings.

Answer 22

Originally used for anesthetic purposes but was short-lived due to unwanted side effects.

Question 23

Explain the typical physical characteristics of GHB.

Answer 23

GHB is a clear liquid, typically bitter or salty in taste, and can be ingested orally or intravenously.

Question 24

How does GHB affect dopamine levels in the brain at lower doses?

Answer 24

At lower doses, GHB stimulates dopamine release in the brain, contributing to feelings of euphoria.

Question 25

What are the effects of high doses of GHB on the central nervous system?

Answer 25

High doses of GHB can lead to inhibition of dopamine, CNS depression, respiratory depression, and potentially a large increase in dopamine.

Question 26

Define the sedative-hypnotic class of drugs and its relation to GHB.

Answer 26

GHB is predominantly known as a CNS depressant with secondary respiratory depression, placing it in the sedative-hypnotic class.

Question 27

Explain the onset of action for GHB when ingested.

Answer 27

GHB has a rapid onset of action, typically within 15 minutes after ingestion.

Question 28

What is the role of naloxone in the context of GHB use?

Answer 28

Naloxone can be considered to rule out any other opioid influence when assessing a patient.

Question 29

List some common street names for GHB.

Answer 29

Common names include G, fantasy, liquid ecstasy, liquid X, Georgia home boy, blue nitro, soap, juice, and water.

Question 30

Describe the clinical features associated with GHB use.

Answer 30

Clinical features include euphoria, respiratory depression, delirium, paranoia, depression, anxiety, hallucinations, tachycardia, nausea, vomiting, muscle tremors, and sedation.

Question 31

What are the potential high-dose effects of GHB?

Answer 31

High doses can lead to seizure activity, CNS depression, apnoea, bradycardia, and hypotension.

Question 32

Define opioids and their origin.

Answer 32

Opioids are the world's oldest known drugs, derived from the opium poppy plant, used both medicinally and recreationally.

Question 33

Differentiate between legal and illegal opioids.

Answer 33

Opioids can be categorized into two groups: legal/prescription opioids and illegal/street drugs.

Question 34

What are the risks associated with mixing clinical medications with recreational drugs and alcohol?

Answer 34

Mixing clinical medications with recreational drugs and alcohol can lead to dangerous and potentially fatal interactions.

Question 35

Identify risk factors for opioid dependence.

Answer 35

Risk factors include opioid dependence, high dose opioids, mental health disorders, and certain behaviors.

Question 36

Explain how opioids interact with the blood-brain barrier.

Answer 36

Opioids easily pass through the blood-brain barrier and bind with opioid receptors located primarily in the brain, spinal cord, and digestive tract.

Question 37

What is the effect of opioids on synaptic neurotransmission?

Answer 37

Opioids inhibit synaptic neurotransmission, affecting pain perception and mood.

Question 38

Describe the route of administration for opioids and its impact on onset speed.

Answer 38

The route of administration for opioids can vary, and it significantly affects the speed of onset of their effects.

Question 39

Explain the potential consequences of tolerance and dependence on opioids.

Answer 39

Tolerance and dependence on opioids can lead to withdrawal symptoms or the need for sudden cessation, known as going cold turkey.

Question 40

Define opium and its source.

Answer 40

Opium is a specific extract from the opioid poppy.

Question 41

Differentiate between opiates and opioids.

Answer 41

Opiates are derivatives of opium, while opioids refer to any substance that can bind to an opioid receptor and elicit a response.

Question 42

What is the common reference for narcotics, and what does it imply?

Answer 42

Narcotics commonly refer to sleep-inducing substances, particularly heroin.

Question 43

Identify illegal forms of opioids and their common methods of use.

Answer 43

Heroin, also known as gear or smack, is illegal and is typically mixed with water, heated, then injected or can be smoked.

Question 44

List some prescription opioids and their forms of administration.

Answer 44

Prescription opioids include fentanyl, morphine, codeine, buprenorphine, methadone, and tramadol, available in tablets, liquid, and slow-release patches.

Question 45

How quickly do intravenous opioids reach peak effect?

Answer 45

Intravenous opioids typically reach peak effect after about 10 minutes.

Question 46

Describe clinical features associated with opioid use.

Answer 46

Clinical features of opioid use include pinpoint pupils, itchiness, nausea and vomiting, euphoria, sedation, respiratory depression, apnoea, hypotension, and bradycardia.

Question 47

Explain the mechanism of action of opioids and its potential fatal consequence.

Answer 47

Opioids act on the part of the brain that controls breathing, and respiratory depression can lead to death.

Question 48

What is methamphetamine and its classification?

Answer 48

Methamphetamine is a sympathomimetic drug that poses significant public health issues due to its high addiction potential.

Question 49

Discuss the trends in methamphetamine-related deaths in Australia from 2009 to 2015.

Answer 49

The death rate from methamphetamine use in Australia more than doubled between 2009 and 2015.

Question 50

Describe the effects of methamphetamine on the body.

Answer 50

Methamphetamine can be derived from plants or synthesized from over-the-counter medications, causing adrenergic stimulation that increases heart rate and blood pressure.

Question 51

How does methamphetamine affect mood?

Answer 51

Methamphetamine induces alterations in mood by activating serotonin and dopamine receptors.

Question 52

What are the common routes of administration for methamphetamine?

Answer 52

Methamphetamine can be taken in powder or crystalline form via nasal, oral, or intravenous routes.

Question 53

Contrast the effects of methamphetamine with those of GHB.

Answer 53

Taking methamphetamine is the opposite of taking GHB, as methamphetamine stimulates the sympathetic nervous system, while GHB has depressant effects.

Question 54

List clinical features associated with methamphetamine use.

Answer 54

Clinical features include euphoria, hallucinations, delirium, agitation, tachycardia, hypertension, diaphoresis, dilated pupils, hyperthermia, myoclonic movements, and seizures.

Question 55

Identify rare complications associated with methamphetamine use.

Answer 55

Rare complications include rhabdomyolysis, cerebral oedema, cardiac ischaemia, acute pulmonary oedema, aortic and carotid artery dissections, and intracranial haemorrhage.

Question 56

What is the treatment approach for methamphetamine-related issues?

Answer 56

Treatment involves symptomatic management, temperature control, sedation for combative patients, and early ECG monitoring.

Question 57

Define quetiapine and its primary uses.

Answer 57

Quetiapine is an atypical antipsychotic medication primarily used for managing schizophrenia, bipolar disorder, and major depression.

Question 58

Explain the role of quetiapine in relation to stimulant use.

Answer 58

Quetiapine is commonly used as a 'downer' to counteract the comedown effects from methamphetamine.

Question 59

Describe the use of quetiapine after a weekend of drug and alcohol use.

Answer 59

Quetiapine is used as a downer to help individuals achieve good sleep when their bodies cannot rest due to anxiety and muscle spasms after heavy drug and alcohol consumption.

Question 60

Explain the formulations available for quetiapine.

Answer 60

Quetiapine is available in immediate release formulations, which act rapidly, and altered release formulations.

Question 61

Define the neurotransmitter receptors affected by quetiapine.

Answer 61

Quetiapine affects multiple neurotransmitter receptors including serotonin, dopamine, adrenergic, and histamine receptors.

Question 62

List the clinical features of quetiapine overdose.

Answer 62

Clinical features of quetiapine overdose include dilated pupils, confusion, delirium, CNS depression leading to coma, tachycardia, hypotension, seizures (rare), and anticholinergic toxicity.

Question 63

How should hypotension be managed in a quetiapine overdose?

Answer 63

Hypotension in a quetiapine overdose should be managed with fluids and noradrenaline, avoiding adrenaline due to its beta 2 effects which can worsen hypotension.

Question 64

Explain the role of activated charcoal in quetiapine overdose management.

Answer 64

Activated charcoal can be administered orally or via a nasogastric tube to help absorb the drug and reduce its effects in cases of quetiapine overdose.

Question 65

Describe paracetamol and its common uses.

Answer 65

Paracetamol is an analgesic and anti-pyretic medication widely used for pain relief and fever reduction.

Question 66

What is the significance of paracetamol in cases of overdose?

Answer 66

Paracetamol is involved in 50% of all intentional overdoses and is the most common cause of acute liver failure, often leading to liver transplants.

Question 67

Explain the potential consequences of paracetamol overdose.

Answer 67

Paracetamol overdose can lead to hepatic necrosis and drug-induced liver injury, which can be fatal, especially as symptoms may appear late.

Question 68

Define the toxicity threshold for paracetamol overdose.

Answer 68

Toxicity from paracetamol occurs with single ingestions of 200 mg/kg or 10 g.

Question 69

What action did the TGA take in 2023 regarding paracetamol?

Answer 69

In 2023, the TGA published a decision to reduce the size of paracetamol packs in stores to decrease the risk of overdose.

Question 70

Describe the clinical features of paracetamol overdose in Stage 1 (1-24 hours).

Answer 70

Stage 1 symptoms include nausea, vomiting, diaphoresis, pallor, and lethargy.

Question 71

What are the clinical features of paracetamol overdose in Stage 2 (24-72 hours)?

Answer 71

In Stage 2, evidence of hepatotoxicity becomes evident, often accompanied by right upper quadrant pain.

Question 72

Explain the symptoms present in Stage 3 (72-96 hours) of paracetamol overdose.

Answer 72

Stage 3 symptoms include all Stage 1 symptoms plus jaundice and altered mentation due to hepatic encephalopathy.

Question 73

Define patient capacity in decision-making.

Answer 73

A patient has capacity to make a decision if they can understand the relevant information, including benefits and risks, and have been given all necessary information in an understandable way.

Question 74

Describe the importance of retaining information in decision-making.

Answer 74

Retaining information is crucial as it allows individuals to make informed choices, even if the retention is only for a limited time.

Question 75

Explain the significance of understanding treatment options.

Answer 75

Understanding treatment options involves knowing what each option entails and the reasons behind them, which is essential for making informed health decisions.

Question 76

How should one weigh the consequences of their choices?

Answer 76

Weighing the consequences involves evaluating the potential outcomes of each choice, including the benefits and drawbacks, to make a well-informed decision.

Question 77

Define the impact of not having treatment or transport.

Answer 77

Not having treatment or transport can lead to negative health outcomes or hinder access to necessary services, affecting overall well-being.

Question 78

Do individuals need to communicate their decisions?

Answer 78

Yes, individuals must communicate their decisions clearly to ensure that their choices are understood and respected by others involved.

Question 79

Explain how consequences can affect decision-making.

Answer 79

Consequences can significantly influence decision-making by highlighting the potential risks and benefits associated with each choice, guiding individuals toward the best option.