Exam 2
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| 3 routes of exposure/absorption | Ingestion, Inhalation, and Transdermal absorption
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| What does TD50 mean? | Dose that will have toxic response in ½ the population
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| What does ED50 mean? | Dose that will have beneficial effect in ½ the population
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| Naloxone (Narcan) | opiate antagonist, compete with opiate
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| N-acetylcysteine | acetaminophen poisoning
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| Activated Charcoal | absorbs certain drugs in GI system
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| Gastric lavage | pump the stomach
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| Chelating agents | heavy metal poisoning
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| Blood alcohol level of 0.40% | Unconsciousness, depression, breathing difficulty and slowed heartbeat; sometimes death
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| How fast is alcohol cleared from the body | Alcohol is cleared at an hourly rate of 18 mg/dl in female and 15 mg/dl in males
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| Methanol | Methanol (ADH)--> formaldehyde (ALDH)--> formic acid
Formic acid causes severe acidosis/optic neuropathy
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| Isopropanol | Metabolized to acetone—long half-life
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| Treatment for Alcohol poisoning | Administer fomepizole or ethanol to compete for ADH binding sites and inhibit metabolism of ethylene glycol, sodium bicarbonate given to offset the acidosis, hemodialysis/forced diuresis to enhance removal
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| Analysis of Alcohol | Whole blood, serum, urine, saliva, or breath (higher in serum than whole blood)
Most labs use enzymatic method (alcohol dehydrogenase)
Ethanol + NAD (ADH) --> Acetaldehyde + NADH
Production of NADH can be measured or can be coupled with indicator react
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| Breath alcohol test | Principle: Concentration ratio of blood to breath is 2100:1
Screening test: if initial value between 0.02 and 0.04, confirmatory test done (15 minute waiting period)
Methods: infrared absorption, photometric, GC, electrochemical oxidation (fuel cell)
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| Saliva alcohol test | Principle- ADH reaction using swab and diaphorase color indicator
Potential for use in screening
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| Urine alcohol test | Urine roughly 1.3 X blood concentration (postabsorptive phase). Not approved by DOT
Postmortem alcohol can also be analyzed
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| Reference method used to test Alcohol levels | GC (gas chromatography)
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| Gas Chromatography (alcohol testing) | Reference method
1. Dilutes serum/blood with NaCl solution in closed container
2. Volatiles separate into the air space (head space)
3. Head space is sampled to quantitate analytes
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| Osmometry (alcohol testing) | Freezing point depression osmometer may also be used to determine the osmotic strength of a solution
Freezing point depression
Presence of alcohol will increase the measured osmolarity, increase the osmol gap.
Not specific for alcohol
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| Carbon monoxide background info | Colorless, odorless, blood is cherry red
Affinity for hemoglobin 200x greater than O2 (shift to the left)
Causes hypoxia (decrease of oxygen delivered to tissues)
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| Treatment for Carbon Monoxide | remove CO source, give O2, may use hyperbaric oxygen in extreme cases, can force it off
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| Types of Alcohols covered (4) | Ethanol, Methanol, Ethylene glycol, Isopropanol
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| 5 Heavy metals covered | Arsenic, Mercury, Lead, Cadmium, Pesticides
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| 3 Anti-cholingergics covered | Trycyclic antidepressants, Pehnothiazines, Antihistamines
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| Methanol analysis | GC and Osometry
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| Methanol Background Info | Solvent, Body breaks down, Formic acid causes acidosis/optic neuropathy
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| Ethylene glycol Treatment | 1) administer fomepizole or ethanol to bind to ADH binding sites and inhibit metabolism of ethylene glycol. 2) Sodium bicarbonate is given to offset acidosis. 3) hemodialysis forces diuresis to enhance removal
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| Ethanol Testing methods (5) | breath alcohol (ratio of blood to breath 2100:1), Saliva alchol (ADH reaction), Urine alcohol (1.3 times blood concentration), GC (reference method), Osmotery (not specific for alcohol)
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| Carbon Monoxide Lab monitoring, and Specimen types | Carboxyhemoglobin and oxyhemoglobin levels
Whole blood, EDTA sample, Heparinized whole blood
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| CO Testing (3 types) | 1) Spot (Qualitative)
2) Spectrohotometric (most common, different wavelengths measure different fractions of hemoglobin)
3) GC (reference method, accurate/precise, CO + potassium ferricyanide, presence of CO measured by change in thermal conductivity
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| Cyanide Info | Almond ordor,Headache, di zziness, respiratory depression. Binds heme iron, depletes cell ATP, O2 not utilized, increased pO2 levels and hypoxia
Exposure: inhalation, transdermal absorption, used in industrial processes, insecticides, rodent poison
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| Cyanide Tests (2) | ISE (ion specific electrode), and Photometric
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| Cyanide 1) lab monitor 2) Specimen 3) Treatment | 1) urine
2) Cyanide converted to thiocyanate (enzymatically) and excreted renally
3) Administer sodium nitrite, causes formation of methemoglobin which binds to and clears cyanide
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| Arsenic Info | Garlic breath, vomiting, GI distress. Chronic: Anemia, Renal failure. Usually accidental exposure. Rat Poisoning
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| Arsenic 1) Specimen 2) Test 3) Treatment | 1) urine (recent exposure), hair and nails (long term)
2) Atomic absorption
3) Gastric lavage
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| Mercury 1) Info 2) Toxic effects | 1) inhalation or ingestion, usually from contaminated foods. Neurological symptoms: Tremors, behavioral changes, mumbling, loss of balance.
2) Inhibition of enzymes, GI, tremors, renal dysfunction
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| Mercury 1) Specimen 2) Tests 3) Treatment | 1) Blood or urine
2) Measure whole blood or 24 hour urine
3) Chelaters, EDTA and BAL
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| Lead 1) Info 2) Toxic symptoms | 1) Paint, old plumbing, children more susceptible.
Inhibits enzymes, synthesis of heme, accumulates over time. Heaviest in bones.
2) GI irritation, decreased IQ, kidney damage, CNS damage
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| Lead 1) specimen 2) tests 3) treatment 4) lab monitor | 1) whole blood
2) Atomic absorption and spectrophotometry
3) chelators, EDTA and BAL
4) BUN and creatinine, also basophilic stippling on blood smear
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| Cadmium Info | Industrial, Inhalation, Renal tubular dysfunction (proteinuria, etc.)
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| Cadmium Toxic Symptoms | Protein binding inhibits enzymes.
Accumulates and affects kidneys
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| Cadmium 1) Specimen 2) Test | 1) Whole blood or urine
2) Atomic absorption and Spectrophometry
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| Pesticide Info | Death from respiratory failure.
Tightness in chest, Increase bronchial secretions, Increase sweating and salivation, GI disruptions, Involuntary urination and defication
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| Pesticides 1) Tests 2) Lab monitoring | 1) Immunoassay
2) Measure pseudocholinesterase activity
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| Tricyclic antidepressant Info | Treats depression, Headaches, ADD. Narrow therapeutic range, fatal toxicity
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| Tricyclic antidepressant toxic symptoms | Tachycardia, dialed pupils, dry skin/mouth, decrease GI motility, Resp Depression
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| Tricyclic Treatment | Gastic lavage, Activated charcoal, IV fluids, NaHCO3 for dysrhythmias
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| Phenothiazines Info | Treatment for psychiatric illness
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| Pehnothiazines Toxic symptoms | CNS, cardiovasuclar, sedation, coma, resp depression, seizures, hypotension
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| Phenothiazines Testing | TLC
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| Phenothiazines Treatment | IV fluids, gastric lavage, activated charcoal
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| Antihistamines info | Treats allergy and colds
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| Antihistamines Toxic symptoms | CNS depression, sedation, ataxia, coma, excitement, dilated pupils,urinary retention
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| Antihistamines Determination | not commonly done, some urine drug screenings will detect
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| Antihistamines Treatment | Gastric lavage, activated charcoal
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| Amphetamine info | Stimulant, Meth high potential for abuse
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| Amphetamine Toxic symptoms | OD rare, hypertension, convulsions, cardiac
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| Amphetamine Determination | Immunoassay
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| Amphetamine Therapeutic uses | Narcolepsy, ADD, OTC cold medicines
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| MDMA (ecstasy) Info | Adverse effects: (headache, nausea, anxiety, violent behavior, hypertension, resp depression, renal failure)
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| MDMA (ecstasy) Detection | GCMS (not immunoassay)
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| Weed Info | lipophilic sequesters in fat. 1/2 life 1 day (single use) or 3-5 days. Impairment of short-term memory. dependence
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| Weed Specimen | Urine
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| Weed Lab monitor | TCH-COOH
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| Weed Determination | Immunoassay (screening) GCMS (confirmation)
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| Cocaine info | Short 1/3 life. Local anesthetic, CNS stimulant, euphoric feeling. Toxic effect: hypertension, seizure, MI
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| Cocaine Specimen, Lab monitor, and Tests | Urine, Benzyoylegonine in urine 3 days (single) 20 days (chronic), Immunoassy, GCMS
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| Phencylidine (PCP) info | Stimulant, depressant, anesthetic, hallucinogen. Long 1/2 life (lipophilic), Agitation, hostility, paranoia
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| Phencylidine (PCP) Lab monitor | Detect parent drug (PCP)
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| Phencylidine (PCP) Testing | Immunoassay and GCMS
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| Narcotics/Opiates/Opioids Natural form | Opium, Morphine, Codeine
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| Narcotics/Opiates/Opioids Chemically modified | Heroin, Oxycodone
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| Narcotics/Opiates/Opioids Synthetic form | Demerol, Methadone
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| Narcotics/Opiates/Opioids Info | High potential for abuse, Depress CNS relieve pain
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| Narcotics/Opiates/Opioids Toxic symptoms | Overdose: classic triad (coma, resp depression, miosis (pinpoint pupils)), resp acidosis
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| Narcotics/Opiates/Opioids Determination and Treatment | Immunoassay and CGMS
Naloxone (Narcan) antidote that quickly reverses CNS depression
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| Barbiturates (Names) | Secobarbital, Pentobarbital, Phenobarbital
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| Benzos (Names) | Valium, Ativan
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| Sedatives Info | CNS depressant. Overdose: lethargy, slurred speech, coma, death
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| Sedatives Toxic | CNS and Resp depression, cardiac insufficiency, hypotension
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| Sedatives Determination and Treatment | Immunassay, GC or LC.
Supportive, ABC's (airway, breathing, ciruclation), Flumazenil can be given
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| Steroids Info | Treat male hypogonadism, abuse: muscle mass
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| Steroid Toxic Effects | quality and purity questionable. hepatitis, enlarged heart, stroke, MI, Aggression, Testicular atrophy, sterility
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| Steroid Determination | Screen with testosterone/epitesterone ratio (high can mean exogenous source)
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| GHB Toxic effects | Nausea, vomiting, hypotension, resp depression. "date rape drug" muscle relaxant. Outside US treats Alcohol, opioid withdrawl
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| GHB Determination | GCMS (GHB rapidly eliminated)
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| LSD (Lysergic acid diethylamide) info | Binds serotonin receptors in CNS, perceptual distortions, rapidly changing emotions, OD rare. most clinical effects are benign, no medical intervention needed
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| LSD (Lysergic acid diethylamide) Determination | Rapid excretion, Immunoassay within 12-24 hours. GCMS (confirmatory)
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| Salicylates Info | Aspirin, Analgesic < 60mg. Inhibits cyclooxygenase which decreases thromboxane and prostaglandin.
Adverse effects: inhibit platelet aggregation, GI function, Reye's syndrome (fatal disease when children OD)
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| Salicylates Excessive ingestion | Respiratory alkalosis, Inhibits Krebs cycle, Increase lactate, Metabolic acidosis, Excess ketones produced.
Initial alkalosis --> GI irritation, metabolic acidosis. Acid-base imbalance, usually net acidosis
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| Salicylates Determination and Testing | Trinder reaction (most common), GC or LC (most sensitive/specific).
Neutralize the acid, regulate electrolytes (IV), diuresis, NaHCO3
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| Acetaminophen (Tylenol) Overdose | Nausea, vomiting, malaise, pallor, anorexia, buildup of MFO due to glutathione depletion.
MFO causes cell damage/necrosis of liver
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| Acetaminophen (Tylenol) Determination and Treatment | Immunoassay and Competitive enzyme/FPIA
Treatment: N-acetylcysteine conjugate the toxin and excretion
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