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Path Week 2 > C - Toxicology > Flashcards

C - Toxicology Flashcards

1
Q

list sources of tox samples

A

antemortem serum / blood
post mortem blood - femoral vein
vitreous humour
stomach contents
liver
urine
hair

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2
Q

list 9 of the most common drugs of abuse in tox

A

ethanol
heroin
cocaine
amphetamines
methadone
benzos
cannabis
pregbalin
new psychoactive compounds

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3
Q

in what cases is ethanol tox found

A

OD
RTAs
liver cirrhosis

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4
Q

how can ethanol cause death if other drugs are taken too

A

additive effects with other depressants

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5
Q

who dies of rapid death from heroin

A

naive users
high tolerane ppl who have quit

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6
Q

what do heroin users die from

A

resp depression
aspiration pneumonitis

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7
Q

what does prognosis with heroin depend on

A

TOLERANCE

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8
Q

describe half-life of heroin products with timings

A

diacetylmorphine (3 mins) –> 6-MAM (30 mins)—> morphine (6 hours)

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9
Q

what is actually measured in heroin blood screen

A

morphine

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10
Q

what is a speedball

A

depressant + stimulant (usually cocaine)

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11
Q

acute dangers of cocaine

A

cardiac dysrhythmias
acute heart failure
myocardial infarction

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12
Q

chronic dangers of cocaine

A

myocardium damage
ventricular arrhythmias
suddendeath

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13
Q

which group is most at risk from cocaine death

A

body packers - bag splits in their stomach so OD

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14
Q

how can the effects of cocaine be prolonged

A

mix with ethanol to get cocaethylene

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15
Q

why is cocaine difficult to measure PM

A

degrades in blood

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16
Q

how is cocaine result PM interpreted

A

with witness behaviour, cardiopathology and pattern of drug use

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17
Q

what causes death in amphetamine OD

A

direct toxic effect on heart

18
Q

complications of amphetamine use

A

hyperthermia
rhabdomyolysis –> muscle necrosis –> renal failure

19
Q

how long does it take to die from methadone OD once ingested

A

4-6 hours

20
Q

what doses can kill a child / adult with methadone

A

5mL child, 60mL adult

21
Q

what is maintenance dose of methadone

A

5 to 200mL

22
Q

what does the dose of maintenane methadone depend on

A

heroin tolerance

23
Q

how common in benzo death

A

very rare alone

24
Q

is cannabis fatal

A

no

25
Q

how can you determine if cannabis was the cause of a RTA

A

investigation of impairment that dose would cause

26
Q

what is the ‘lethal combination’ with cannabis

A

cannabis + alcohol + driving

27
Q

what % of coroners cases have pregablabin present

A

9%

28
Q

when is pregablin used

A

heroin users to cause euphoria
prescribed for epilepsy / neuropathic pain

29
Q

give examples of new psychoactive compounds

A

stimulants
synthetic cannabinoids - spice
synthetic opioids - carfentanil, isotonitazene
hallucinogenic compounds

30
Q

what is carfentanil normally used for

A

elephant tranquilliser

31
Q

how does carfentanil potency compare to morphine

A

10,000x more potent

32
Q

how does isotonitazene potency compare to morphine

A

500x more potent

33
Q

what is the problem with new psychoactive compounds

A

+++ potency vs original drugs
severe ADRs even in low doses

34
Q

what are the problems with interpretation of tox results

A

need lots of Hx info to interpret results!!
- tolerance
site dependence
PM redistribution of drugs
individual variation in response
stability of drugs

35
Q

how can PM redistribution of blood affect drug conc

A

drugs released from tissues into blood after death
relates to volume distribution

36
Q

how can the ratio of parent drug:metabolite be used to determine if chronic use or OD

A

the closer 1:1, then the more likely to be chronic use

37
Q

why is hair used for analysis

A

only sample that can detect chronic use

38
Q

for how long can drugs be detected in blood

A

12 hours

39
Q

for how long can drugs be detected in urine

A

2-3 days

40
Q

how can hair analysis show chronic use

A

drugs incorporated into hair from blood during growth
hair grows 1cm/month therefore every 1cm that contains a drug = 1 month of use

41
Q

limitation of hair use in analysis

A

limited by hair length - if 5cm hair only, can only see 5 months of drug use
contamination by smoke/powder
cosmetic Tx can remove drugs from hair
darker hair incorporates more drug
can not be used to determine cause of death as it takes 5-10 days for hair to come above scalp

42
Q

to what scenarios can hair analysis be applied

A

child custody cases
Ix spiked drinks defencefs
drug naive deaths
monitoring drug use in employment / driving

Path Week 2 (18 decks)

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