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Drug of Abuse Tests

Neurology

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