Question&Answer Sample: Drug Toxicity
Publication Date:
- “G” is the street name of the commonly abused street drug GHB. Like many drugs, the risk of toxicity is increased when mixed with other drugs. Identify another commonly used drug that can be toxic when mixed with GHB. Discuss the progression of effects leading to toxicity and death from the combination of the two drugs.
GHB is toxic on its own. It is entirely possible to suffer or die if too much of the drug is taken. Beyond that, it has been true in the past that there have been no antidotes that can be taken to counteract the toxicity. Indeed, opiates can be countered with Narcan. However, no such remedy has existed when it comes to GHB, although that is starting to change. Beyond that, GHB tends to be made more toxic and dangerous when certain other drugs are taken at the same time. The toxicity of GHB is enhanced when there are any other drugs involved that also depress the central nervous system (CNS). The main CNS depressants that should never be combined with GHB would include benzodiazepines, non-benzodiazepine sedative hypnotics and barbiturates. Examples of benzodiazepines would include diazepam (Valium), clonazepam (Klonopin), alprazolam (Xanax), triazolam (Halcion) and estazolam (Prosom). Sedative hypnotics would include zolpidem (Ambien), eszopiclone (Lunesta) and zaleplon (Sonata). Finally, barbiturates would include mephobarbital (Mebaral), phenobarbital (Luminal) and pentobarbital (Nembutal). Just like with GHB, the use of CNS depressants, in and of itself, can lead to problems. This would include when patients are prescribed but do not follow the directions from the doctor, a person is taking another patient’s medicine and a person takes more than what they should be. For example, if a person takes double the prescribed dose to “get high”, this would be risky. As noted above, taking any of those drugs at the same time as GHB will tend to lead to negative health reactions, if not death. Effects that can be seen with GHB and other CNS depressants leading to toxicity would include slurred speech, lack of concentration, confusion, headache, dizziness, slower breathing, lower blood pressure, memory or movement problems, dry mouth and dizziness. In extreme cases, there can be loss of consciousness, cardiac arrest and death (NIH, 2018).
- Identify the six toxicological principles that are applied in evaluating a poisoned individual. Give an example of two of these principles.
Six things that should be assessed when it comes to toxicology would include absorption, excretion, metabolism, distribution to tissues, dose and exposure. Absorption would speak to how much is absorbed into the skin. Metabolism, in terms of toxicity, is the way and manner in which the body processes and absorbs the drug or drugs in question. Distribution to tissues is how the drug is sent to other parts of the body as the drug is imported and metabolized. Excretion is when the body removes the substance from the body. This is typically done in the form of movement through the kidneys. Eventual removal comes from defecation and/or urination of the patient. The two important aspects of toxicology that will be covered will be the other two that have been mentioned. Dosage is the amount of the drug in question. This is typically measured in milligrams (mg) or milliliters (mL). In many cases, the actual amount of the drug will be defined in terms of how much should be given for each kilogram of body weight. For example, a given drug may be administered at 20 mg for each kilogram of body weight. If the patient is an infant that weighs five kilograms, the proper dosage would be 100 mg. This is because five kilograms times 20 mg per kilogram would be 100 mg (5 * 20). Exposure is like dosage, although it speaks to something slightly different. Exposure relates to how much of a drug a person is exposed to, regardless of how it comes about. In some cases, the exposure can be willful and intentional. Other times, it can be unwitting or unknown. Examples of exposure and how it can lead to dosage would include liquid, pill and inhaled. Points of exposure can include lungs, blood stream (e.g. intravenous) and through drinking something (Merck, 2019; NIH, 2019).
- How can toxicant absorption be reduced after exposure to the skin? How can absorption be reduced for orally consumed chemicals?
When it comes to skin-based exposure, there are a few things that should be considered. This would include the integrity of the skin, the location of the exposure, the physical and chemical properties of the hazardous substance, the concentration of the chemical on the skin surface, how long the exposure lasted and the surface area of the skin that was exposed to the substance. Those details matter because the answers to those questions will influence the intercellular lipid pathway, the transcellular permeation and the appendage travel related to the exposure. A tactic that should always be used for skin exposure is to flush the affected area with water. How long that flush should last will depend on the substance. For minor issues, five minutes is usually enough. For corrosive or alkaline substances, the time horizon can be up to an hour. In many cases, chemical exposure can lead to burns. If that occurs, the medical professionals should treat them as if they were thermal burns. Treatment beyond the above will depend on what was exposed to the patient and in what amount. In many cases, the damage is already done. One must often wait to see if the patient will recover. In those cases, removal of the toxin is about the only recourse (NIH, 2019).
When it comes to orally consumed substances, the pathway always starts the same. There is the mouth, the esophagus, the stomach, the small intestine and the large intestine. After that, there is a split. Some of the toxic substance can move to the rectum and the anus. However, the other direction is towards the liver and the heart. If the heart is accessed, this also leads to exposure to the arteries. One of the common treatments for oral exposure is to induce vomiting. If a small amount of time has passed since ingestion, this is often enough to stabilize and save the patient. This can be done using ipecac syrup. If that syrup is not available, then extending a finger into the throat of the patient is also an option. It should be noted that there are some instances where induced vomiting will not be the best action. Commonly, this is because there is no benefit to it. What is much more pervasive when it comes to ingested substances would be activated charcoal. That substance is used to absorb drugs and poisons that enter the body. The reason behind the substance is to limit the amount of the substance that is absorbed into the bloodstream (NIH, 2019).
- Identify the four categories of street drugs, and provide an example of each. Discuss symptoms of the use of each drug.
The four types are stimulants, depressants, opiates and hallucinogens. Examples of stimulants would include cocaine, methamphetamine and amphetamines. Symptoms seen from the use of these drugs would include enhanced energy, hyper-alertness, being very talkative, being very active and being very excited. Examples of depressants would include GHB (i.e. the date rape drug), opiates and barbiturates. Illicit and illegal use of prescription-based depressants (e.g. Klonopin, Xanax, OxyContin, etc.) can also be referred to as illicit. Symptoms of depressant use would include being relaxed, “chilled out”, mellow and some rather nasty paradoxical effects. Examples of this would include enhanced anxiety, nightmares and aggression (Mind, 2019).
As can be seen above, opiates have some overlap with depressants. Even so, they are commonly mentioned separately. Examples of opiates would usually include heroin. There is also illicit and illegal use of prescription opiates. Examples of opiate side effects would include a rush of pleasure, being in a dreamy state and being drowsy. These drugs tend to cause severe drowsiness. They can be very addictive. They are also fatal at high doses. Finally, there are hallucinogens. The main examples of this drug are LSD and PCP. These drugs cause hallucinations and other mental destabilization and paranoia. These drugs cause several severe reactions and side effects. They include being detached from one’s surroundings, having major mood swings, having an altered sense of space and time, seeing things that are not there and feelings of insight. It is common for people on PCP or LSD to have mystical or religious experiences. In other cases, these drugs can cause violent and irrational outbursts. For example, some people on PCP will become belligerent. Those people can be very hard to suppress and control when they enter that state. Even though some people have positive experiences when it comes to hallucinogens, many others do not (Mind, 2019).
References
Merck. (2019). Absorption, Distribution, Metabolism, and Excretion – Toxicology – Veterinary
Manual. Retrieved from https://www.merckvetmanual.com/toxicology/toxicology-
introduction/absorption,-distribution,-metabolism,-and-excretion
Mind. (2019). Types of recreational drug | Mind, the mental health charity – help for mental
health problems. Retrieved from https://www.mind.org.uk/information-support/types-of-
mental-health-problems/drugs-recreational-drugs-alcohol/types-of-recreational-
drug/#.XOQRA1JKhhE
NIH. (2018). Prescription CNS Depressants. Retrieved from
https://www.drugabuse.gov/publications/drugfacts/prescription-cns-depressants
NIH. (2019). ToxTutor – Dose Estimates of Toxic Effects. Retrieved from
https://toxtutor.nlm.nih.gov/02-004.html