Neurology
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| EtOH: Always assume: | other drugs may be involved
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| Blood EtOH usu measured on: | whole blood (serum levels 12% higher than whole blood)
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| EtOH PK | clearance by zero-order kinetics (constant rate); half life: 18 mg/dL/hr
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| EtOh detection window | blood: 1.5-12 hr (urine an extra 1-2 hrs); urine assays less reliable
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| EtOH correlation: Partition Ratio: | Breath is 1; Urine is 1.3; Blood is 2100 (avg. range 1300:1 to 3100:1)
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| EtOH test methods | Alcohol dehydrogenase: all alcohols (quant); GLC: quant & qualitative
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| Chronic alcohol use: labs | macrocytosis; anemia (later); high AST, ALT, GGT, CDT
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| Substance abuse testing: | no universal requirement for informed consent; pt safety & tx comes first
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| DHHS guidelines for testing drugs: | Amphetamines, cannabinoids, cocaine, opiates & PCP; workplace cut-off levels may not be appropriate for clinical setting
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| Urine drug test methods | Immunoassay; GC-MS (HPLC)
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| Drug test: Immunoassay | fast; large-scale screening; false pos & req confirm by HPLC
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| Drug test: HPLC | accurate; time consuming; expensive
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| Opiates | Natl: heroin & hydrocodone; synthetic: meperidine & methadone (less detectable)
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| Horse tranquilizer: | PCP
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| Serum drug screen | for OD/EtOH; 1 mL min, green top tube; tests: Acetaminophen; Salicylate; Tricyclics; Ethanol
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| Drug with longest detection time: | Benzo or THC
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| Drugs with lowest/highest detection thresholds: | Lowest: THC; highest: amphetamine
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| Blood EtOH usually measured on: | whole blood (serum levels 12% higher than whole blood)
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| Chronic alcohol use: labs | macrocytosis; anemia (later); high AST, ALT, GGT, CDT
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| Urine drug test methods | Immunoassay; GC-MS (HPLC)
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| Drug test: Immunoassay | fast; large-scale screening; false pos & req confirm by HPLC
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| Drug test: HPLC | accurate; time consuming; expensive
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| Opiates | Natl: heroin & hydrocodone; synthetic: meperidine & methadone (less detectable)
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| Drug with longest detection time: | Benzo or THC
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| Drugs with lowest/highest detection thresholds: | Lowest: THC; highest: amphetamine
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