Recreational Toxicology

Question 1

Ricin structure

Answer 1

A chain + B chain

Question 2

Ricin MOA

Answer 2

Breaks down proteins

Question 3

Ricin poisoning management

Answer 3

Nothing to do in acute phase
Supportive treatment

Question 4

LD50

Answer 4

Lethal dose that kills 50% of the population

Question 5

What state are most nerve agents in at room temp

Answer 5

Liquid, then evaporate into gas

Question 6

What type of agent is Sarin

Answer 6

Organophosphate

Question 7

2 pneumonics for symptoms of organophosphate poisoning/ cholinergic crisis

Answer 7

DUMBELLS -
diarrhoea
Urination
Myosis
Bronchorrhea
Bradycardia
Emesis
Lacrimation
Lethargy
Salivation/Sweating / Seizures

SLUDGE
Sweating/ Salivation / Seizures
Lacrimation
Urination
Diarrhoea
GI cramps + pain
Emesis

Question 8

Organophosphate poisoning red flags

Answer 8

Secretions + Seizures

Question 9

Main nerve agent antidote

Answer 9

Atropine - dries up secretions

Question 10

Most ‘problematic’ cholinergic sx

Answer 10

Bronchorrhea

Question 11

Which services carry atropine

Answer 11

Ambulances carry 4 self help packs
Large volumes carried by specialist providers

Question 12

Cholinergics

Answer 12

Compounds that mimic the action of acetylcholine +/or butyrylcholine

Question 13

Muscarinic

Answer 13

Type of ACH receptor involved in parasympathetic nervous system
Decreases HR, GI muscle contraction, incr GI secretions, incr gland secretion, urine release, contracts eye muscles, erections

Question 14

Nicotinic

Answer 14

Type of ACH receptor
Involved in neuro transmission, neuro modulation, cognitive function, and voluntary motor control, adrenaline+noradrenaline release + sympathetic nervous system activation

Question 15

Anticholinergic

Answer 15

Class of drugs that block ACH
Reduce secretions, have many side effects
Used for allergic and inflam disease, Parkinson’s, overactive bladder, and motion sickness

Question 16

Acetylcholine

Answer 16

Excitatory Neurotransmitter that acts on muscarinic and Nicotinic receptors

Question 17

Cholinesterase

Answer 17

Enzyme present in the CNS that catalyses hydrolysis of ACH into acetic acid and choline

Question 18

Anticholinesterase

Answer 18

Class of drugs that inhibit breakdown of ACh
Used for Alzheimer’s and myasthenia Gravis
Novichok, organophosphate

Question 19

Ageing

Answer 19

biochemical process by which the agent-enzyme complex becomes completely resistant to oxime reactivation
Makes binding irreversible

Question 20

Cyanide toxicity treatment

Answer 20

1) nitrates 2) methylene blue

Cyanide + nitrate -> methylHb
MethylHb + methylene blue -> Hb

Question 21

Crack lung

Answer 21

Form of COPD caused by crack use
Forms soaces in the lungs

Question 22

Major vascular risk from crack use

Answer 22

Aortic dissection

Question 23

Why is it difficult to make antidotes for drugs

Answer 23

Often have multiple MOAs

Question 24

Why do people use crack

Answer 24

Powerful stimulant
Highly addictive
Numbs feelings

Question 25

Crack

Answer 25

Crystal form of cocaine that can be smoked to get a 5-10 min high

Question 26

How does crack cause harm

Answer 26

Overdose Incr risk of heart attack, stroke, aortic dissection Paranoia, disruption of personal relationships Addiction Effects amount of glutamate in brain affecting cognition and memory Increases sensitivity to stress

Question 27

Crack/cocaine OD

Answer 27

Tachycardia Hypertension Diaphoresis Mydriasis Seizures Hallucination Delirium Violent behaviour Hyperthermia Arrhythmia Chest pain DIB Haemoptysis

Question 28

Crack/cocaine OD PH tx

Answer 28

Rapid cooling for hyperthermia Benzodiazepines Supportive tx

Question 29

Why do people take MDMA

Answer 29

Happy ‘Loved up’ Energised

Question 30

Effects of MDMA

Answer 30

Nausea Muscle cramps Gurning / jaw tightening Blurred vision Chills Hyperthermia Sweating Tachycardia Hypertension Hyperactivity Bruxism Restlessness Insomnia Concentration difficulty

Question 31

MDMA

Answer 31

Synthetic psychoactive drug Powder, crystal, or in pills Class A Stimulant

Question 32

How does MDMA cause harm

Answer 32

Increased risk of unsafe sex Serotonin syndrome Dehydration, hyperthermia, HF, kidney failure Depression, aggression, impulsiveness, anxiety Sleep problems Liver failure Repeated use depletes serotonin - depression and anxiety

Question 33

MDMA MOA

Answer 33

Increases concentration of noradrenaline, dopamine, and serotonin in the synaptic cleft - inhibits serotonin and dopamine reuptake - stimulates serotonin and dopamine release - Inhibits monoamine oxidase activity Effects Thermoregulation and autonomic nervous system Increases ADH levels

Question 34

MDMA OD

Answer 34

Tachycardia Hypertension Dysrhythmia Anxiety + agitation Hallucination Seizures Mydriasis Diaphoresis Hyperthermia Serotonin syndrome Rhabdomyolysis DIC

Question 35

Serotonin syndrome

Answer 35

Hyperpyrexia, muscle rigidity, breathing difficulty Tx - cyproheptadind, ventilation, supportive

Question 36

PH tx of mdma OD

Answer 36

Rapid cooling Benzodiazepines- psychomotor agitation and shivering Cyproheptadine - serotonin syndromeABCDE cardiac monitoring

Question 37

Effects of MDMA on water balance

Answer 37

Decreases ADH Incr thirst (hyperthermia) Sweating Hot clubs,Dancing

Question 38

GHB

Question 39

Why do people use GHB

Question 40

GHB MOA

Question 41

GHB signs and sx

Question 42

GHB OD

Question 43

GHB PH tx

Question 44

What causes Hyperpyrexia

Answer 44

Muscle contractions and rigidity

Question 45

Spice

Question 46

Spice MOA

Question 47

Why people use spice

Question 48

Spice signs and sx

Question 49

Spice OD

Question 50

Spice PH tx

Question 51

How spice causes harm

Question 52

Cocaine/crack MOA