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Clinical Lab > toxicology juju > Flashcards

toxicology juju Flashcards

1
Q

What is therapeutic drug monitoring?

A
  • Measuring conc. of a drug/metabolites in order to optimize the dosing to patient/ assess compliance w dosing schedule
  • optimum dosing: improves drug therapeutic effect while avoiding side effects/toxic effects
  • check: blood serum/plasma, urine
  • Used to find appropriate dosing for conditions such as renal dysfunction, pregnancy, newborns, geriatric pts

Use TDM with drugs with:
- A narrow TI
- significant side effects
- low margin of safety

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2
Q

What are the indications for drug monitoring? clinical, legal, forensic

A

Clinical:
- Overdose
- Therapeutic Monitoring

Legal: workers comp

Forensic:
- COD
- DUI
- athletic testing
- employment testing

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3
Q

What are the forensic indications for drug monitoring?

A
  • COD
  • DUI
  • athletic testing
  • employment testing
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4
Q

What are trough concentrations used for

A

To see when due for next dose

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5
Q

Therapeutic Drug monitoring can be done through

A

Blood serum plasma urine

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6
Q

When are peak concentration of most drugs

A

30-60 min post dose

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7
Q

Pharmacokinetic Principles

A

*LADME
*L- Liberation : how the metabolite becomes available in the body
*A- Absorption: movement into circulation
*D- Distribution: body tissues
*M- Metabolism: conversion of drug to active
*E- Elimination

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8
Q

Alcohols description

A

Can be acute intoxication or chronic abuse (Pancreatic disease, Liver cirrhosis)
- peak is 30-75 min post ingestion
- 1 oz liquor, 4 oz wine, 12 oz beer→25-30 mg/dL
- clearance rate: 15- 25 mg/dL/hour (clear up in an hr in normal body non alcoholic)
- screened for via BREATH TEST AND BLOOD TESTS***
- screen for alcohol in pregnancy: AVOID
- metabolism: differs person to person

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9
Q

What tests for alcohol?

A

Breath Test & Blood Test

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10
Q

Alcohol peak?

A

30-75 post ingestion

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11
Q

Alcohols: methanol, ethylene glycol, isopropanol

A

Methanol
- (MUDPILES)
- moonshine
- washer fluid
- sx: imparired vision - blindness*, seizures, vomit, coma

Ethylene glycol:
- antifreeze
- sx: anuria*, vomit, seizures, coma

isopropanol:
- rubbing alcohol
- sx: hematemesis, melena, abdominal pain, vomit, coma

all of them: vomit, coma

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12
Q

Ethylene Glycol poisoning symptoms

A

Anuria, vomiting, seizures, coma

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13
Q

Isopropanol poisoning symptoms

A

Vomiting, abdominal pain, hematemesis, melena, coma

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14
Q

Methanol associated with

A

Moonshine, washer fluid

sx: impaired vision-blindness, vomitting, seizures, coma

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15
Q

Methanol poisoning

A

Impaired vision, blindness, vomit, seizure ,coma

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16
Q

Occupational Environmental Toxins + sources of contamination

A

-Heavy metals
-Gases
-Caustic compounds

contamination sources:
- soil
- ground water

17
Q

Examples of environmental toxins

A

-Carbon monoxide
-Mercury
-Cyanide
-Insecticides
-Lead

18
Q

Carbon monoxide deaths per year?, leading cause of what?

A
  • 4,000 deaths per year, leading cause of accidental & deliberate poisoning (inside the car)
19
Q

With carbon monoxide poisoning there is binding to?

A

Binding of Carbon monoxide to oxygen binding sites on hemoglobin
- can have 50% drop

20
Q

Carbon monoxide poisoning: adults vs kids

A

Adults:
- headache= MC sx**
- heart: MI
- lungs
- CNS: permanent neurological impairment
- vision
- hearing
- peripheral nerve conduction

Kids: mimics Gastroenteritis**
- diarrhea, N/V
- Fetal hb has different binding capacity so infants may not be as affected as adults

21
Q

What can children presentation of carbon monoxide poisoning mimic?

A

gastroenteritis

22
Q

Carboxyhemoglobin Relative to Total Hemoglobin (%) - ranges: nonsmoker, smoker, sx associated

A

nonsmoker normal range: 0.1-0.9 smoking: 1.5-10
10-30: increasingly severe headache, dyspnea on exertion
40-50: + tachycardia, may be fatal
60-70: coma, seizure, often fatal
80: rapidly fatal

23
Q

Lead poisoning primarily effects

A
  • Primarily affects children (greater than 5 µg/dL in blood)
  • Pediatric screening :done at 1 year old & 2 years old
  • labs shows CBC microcytic anemia-LOW hct
  • Impairs cognition and behavior causing: seizures, mental retardation, chronic behavior dysfunction, anemia, renal toxicity, recurrent vomiting and abdominal pain.
24
Q

What is impaired with lead poisoning?

A

-Impaired cognitive and behavioral impairment

causing: seizures, mental retardation, chronic behavior dysfunction, anemia**, renal toxicity, recurrent vomiting and abdominal pain.

25
Q

Lead poisoning monitoring in children

A

5-44 ug/dL:
- f/u blood lead monitoring
- check iron status
- +/- Hb or Hct
- environmental investigation
- lead hazard reduction
- neurodevelopmental monitoring
- abdominal x-ray with bowel decontamination (if indicated)

45-69:
-f/u blood lead monitoring
- check iron status
- Hb or Hct
- free erythrocyte protoporphyrin
- environmental investigation
- lead hazard reduction
- neurodevelopmental monitoring
- abdominal x-ray with bowel decontamination (if indicated)
- oral chelation therapy
- +/- hospitalization

> =70:
- hospitalize
- oral chelation: binds to iron to excrete it

26
Q

what lead levels in adults does not require any action

A

adults: under 25 ug/dL requires no action
children: greater than 5 is poisonous and requires action

27
Q

What are symptoms of lead poisoning?

A

Lead exposure = microcytic anemia* -> hypoxemia
- fatigue, lethargy
- lowered IQ: Mental retardation /developmental delays
- renal toxicity
- difficulty concentrating
- hearing impairment
- muscle/joint pain
- abdominal pain/constipation
- vomiting
- encephalopathy: seizures
- lead line (blue -black line) in gingival gums high exposure

28
Q

What is pediatric and pregnant screening for lead based on

A

Risk or exposure
- do not screen for lead poisoning if asymptomatic
- only screen if you are exposed: paint, certain areas

29
Q

Testing for illicit drugs, addictive and harmful therapeutic agents goal is to

A

*Detect past exposure by detecting metabolites (urine = recent usage)
- hair + nails can show older usage

Can test:
- Urine
- Serum
- Meconium: stool in fetus that forms during 3rd trimester
- breath
- saliva
- hair
- nails

30
Q

peripheral blood smear: lead poisoning

A

basophillic stippling of red cells

31
Q

Detection Window for Commonly Abused Substances Urine Drug of Abuse Testing DAT: Amphetamines, Barbiturates, Benzodiazepines, Cocaine

A

-Amphetamines 2–4 days
-Barbiturates 1 to >5 days- Depends on barbiturate
-Benzodiazepines 2 to >8 days- Depends on benzodiazepine
-Cocaine metabolite 2 to >7 days- Heavy users may remain positive for 6–10 days using sensitive immunoassays with a 150 ng/mL cutoff

-Methadone 1–4 days
-Opiates 2 to >5 days- Heavy users may remain positive for up to 7–8 days
-Phencyclidine 7–14
-THC (marijuana) 20–30

32
Q

Detection Window for Commonly Abused Substances Urine Drug of Abuse Testing DAT: Methadone, opiates, PCP, THC

A

-Methadone 1–4 days
-Opiates 2 to >5 days- Heavy users may remain positive for up to 7–8 days
-Phencyclidine 7–14
-THC (marijuana) 20–30

-Amphetamines 2–4 days
-Barbiturates 1 to >5 days- Depends on barbiturate
-Benzodiazepines 2 to >8 days- Depends on benzodiazepine
-Cocaine metabolite 2 to >7 days- Heavy users may remain positive for 6–10 days using sensitive immunoassays with a 150 ng/mL cutoff

Clinical Lab (17 decks)

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