Drugs Flashcards
(179 cards)
1
Q
List common drug classes
A
Opiates - most important Depressants Benzodiazepines (sedative) Stimulants Hallucinogens Cannabis Nicotine VSA
2
Q
List common opiates
A
Morphine Heroin Methadone Dipipanone, Pethidine Pentazocine, Buprenorphine Detropropoxyphene, Codeine, DHC
Includes synthetic and semi-synthetic compounds
3
Q
List common depressants
A
Alcohol
Barbiturates - less common now
Benzodiazepines
4
Q
List common benzodiazepines
A
Diazepam (valium) - most common
Temazepam
Lorazepam
Many others - typically end in -pam
5
Q
List common stimulants
A
Amphetamines
Cocaine
6
Q
List common hallucinogens
A
LSD
Magic mushrooms
7
Q
Define drug abuse
A
An excessive or improper use of drugs, especially through self-administration for nonmedical purposes
8
Q
Define drug dependence
A
A physical or psychologic state in which a person displays withdrawal symptoms if drug use is halted suddenly; can lead to addiction.
9
Q
What is a dependence syndrome
A
A cluster of behavioural, cognitive, and physiological phenomena that may develop after repeated substance use.
10
Q
List some of the phenomena (features) of dependence syndromes
A
A strong desire to take the drug
Impaired control over its use
Persistent use despite harmful consequences
A higher priority given to drug use than to other activities and obligations
Increased tolerance
A physical withdrawal reaction when drug use is discontinued
11
Q
Does a dependence syndrome always relate to a single substance
A
No
It can be specific to one
Can apply to a specific class of drug - e.g. all opiates not just one
Or can be dependent on a wider range of drugs despite pharmacological differences
12
Q
Define drug addiction
A
A chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences
Involves functional changes to the brain which may last a long time after a person has stopped taking drugs
You know you have an issue but continue the behaviour
13
Q
A drug addiction is considered a brain disorder - true or false
A
True
It involves functional changes to the brain circuits involving reward, stress, and self-control
May persist after stopping
14
Q
Define drug misuse
A
The taking of a drug which harms or threatens
to harm the physical/mental health or
social well-being of an individual, other
individuals, or society at large or which
is illegal
Includes licit & illicit drugs, prescribed
medications
15
Q
What is the ICD-10 definition of drug dependence syndrome
A
A cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviors that once had greater value (drug seeking takes over)
16
Q
According to the ICD 10 what is the central descriptive characteristic of dependence syndrome
A
The desire (often strong, sometimes overpowering) to take the psychoactive drugs (which may or not have been medically prescribed), alcohol, or tobacco
17
Q
According to the ICD 10 what can happen with a return to substance misuse after abstinence
A
There can be a more rapid reappearance of other features of the syndrome
Past-addicts will fall back into the syndrome quicker
(when compared with nondependent individuals)
18
Q
What is included in the Misuse of Drugs Act
A
Provides the legal framework for control of drugs according to potential for misuse
Details requirements for prescription, safe custody & record-keeping
Classifies drugs and penalties for supply & possession offences, allowing premises to be used for drug production
19
Q
List the Class A drugs
A
Major opiates Cocaine, crack LSD Injectable amphetamines Magic mushrooms
Major risk for misuse
20
Q
What is the sentence for dealing Class As
A
Up to life in prison
21
Q
What is the sentence for possessing Class As
A
Up to 7 years
22
Q
What is the sentence for dealing Class Bs
A
Up to 14 years
23
Q
What is the sentence for possessing Class Bs
A
Up to 5 years
24
Q
List the Class B drugs
A
Cannabis Oral amphetamines Ritalin - ADHD drug Pholcodeine Mephedrone (Bubbles) - less common Synth Cannabinoids
25
List the Class C drugs
Tranquilisers (Benzodiazepines)
Some Painkillers (Buprenorphine, Dextropropoxyphene) - strong opiate types
GHB
Ketamine
26
What is the sentence for dealing Class Cs
Up to 14 years
27
What is the sentence for possessing Class Cs
Up to 2 years
28
What does the misuse of drugs regulations 2001 define
Defines who may produce, possess, supply,
| prescribe & administer certain drugs
29
Describe schedule 1 drugs (as per the misuse of drugs regulations 2001)
These are prohibited without a home office license
Don't really have a medicinal use
Includes LSD, cannabis, opium, ecstasy
30
Describe schedule 2 drugs (as per the misuse of drugs regulations 2001)
These drugs require controlled prescribing, custody and registers
Includes heroin, methadone, cocaine and amphetamines'
31
Describe schedule 3 drugs (as per the misuse of drugs regulations 2001)
Includes barbiturates and pentazocine
32
Describe schedule 4 drugs
Includes benzodiazepines
33
Describe schedule 5 drugs (as per the misuse of drugs regulations 2001)
These are medications which contain a small amount of controlled substance such as co-codamol
May be available over the counter or on prescription
34
What is covered by the Medicine Act 1968
Controls the production & supply of drugs
| Includes the general sales list (over the counter), pharmacy medicine and prescription only
35
Which effects do all drugs of dependence have in common
An initial pleasurable effect
A rebound unpleasant effect on stopping
They potentiate each other and lead to a vicious cycle
36
Drug dependence usually starts off as psychological - true or false
True
| In early stages the desire to take it is greater than the physical need
37
How does dug dependence cause neuro-adaption
The nerve cells become used to the presence of the drug and alter their excitability in response
38
What effect do stimulant drugs have on nerve cells and neuro-adaptability
The nerve fibres adapt to become less excitable (due to persistent stimulation)
When the drug is removed the person crashes
39
What effect do depressant drugs have on nerve cells and neuro-adaptability
In the presence of the drug a stronger signal is needed to trigger the nerve
If the drug is taken away the nerves become grossly overexcited (new higher level without the damping effect of drug)
40
Describe tolerance
With persistent use the body becomes more used to the drug
More and more is required to get the same clinical effect
This is why addicts can take very high doses
41
What is meant by physical drug dependence
This is when the person will experience withdrawal symptoms on stopping the drug
The body is so used to the presence of the drug that it cant cope without it
42
Where is withdrawal a big issue
In custody
Addicts who are kept in will have an interruption to their usual drug use which can send them into withdrawal
The police etc. should be on the lookout for this
43
Which type of drug has mainly replaced barbiturates in drug abuse
Benzodiazepines
44
In addiction the drug overtakes the other key survival needs - true or false
True
The drug stimulates the reward centers and provide all the 'pleasure' the person needs
No longer seek normal rewards like friendship, achievement, sex, food etc
45
Which country has the highest rate of drug use (per head)
Scotland
| 3x higher than rest of UK
46
What is the most common drug used in Scotland
Cocaine
| 4% of Scots use it
47
Drug abusers are more likely to die than the general population - true or false
True
| found to be 12x more likely (in 2010)
48
Drug deaths increasing in Scotland - true or false
True
| Significant rise since 2015
49
Which city has the worst drug death rate in Scotland
Dundee
| Worst place in Scotland (and therefore UK and Europe)
50
Which group accounts for the greatest proportion of drug death
Seems to be due to older uses (50s-60s)
| Used to be young people (novices)
51
Which single drug is responsible for the greatest number of drug deaths in
Heroin
| But poly drug use is also very common
52
Describe the typical demographic of drug death victims
Mostly white males from deprived areas
75% unemployed, 75% single
50% living alone
33% had children
53
Which other health/addiction/social problems are commonly seen in those who die from drug use
40% also had alcohol problems
40% psychiatric problems
33% in contact with drug treatment service
Recent negative life events, previous suicide attempts or self harm
History of sexual abuse - more common in women
10% are Hep C positive
5% with liver disease
54
Where do most drug deaths occur
75% deaths occurred at home
66% someone in vicinity
Many also have ambulances attending and resus attempts
55
Why do people take drugs
Enjoyment - either social or as an escape
Due to their environment - more common in deprived areas, associated with gangs
Natural curiosity
As a defence mechanism - stress etc
Natural rebellion - young people trying it out
Cost - VFM per hour of effect: drugs cheaper than alcohol
56
List some preparations of cannabis
Leaves and flowers can be turned into a herbal preparation (grind them)
Rolled into cigarettes' - joints
Smoked through a bong
Put into food
Resin - hash
Oils - solvent extraction from resin (more concentrated)
57
Where does cannabis come from
Herbal cannabis comes from dried leaves, flowers of the cannabis plant
58
What is the active compound in cannabis
TetraHydroCannabinol (THC)
59
Describe the appearance of cannabis resin
Hard, breakable substance
Can be bitten into - used to break up
Dark in colour
60
Cannabis resin is a good bite substrate - true or false
True
| Very good at holding the shape of the teeth - get good casts
61
List the positive acute psychological effects of cannabis
Talkative, hilarity, well-being, confidence
Appreciation of sound & colour
Time slows
62
List the negative acute psychological effects of cannabis
```
Nausea
Hunger (the munchies)
Poor concentration
Impaired driving
Anxiety, agitation, paranoia
Cannabis psychosis
```
63
Most drugs can be linked to severe psychological problems - true or false
TRUE
| Uncertain whether this is due to personal susceptibility or whether the drug alone triggers this
64
List the acute physical effects of cannabis
```
Dry mouth
Dilated pupils
Red eyes
Tachycardia
Hypertension
Postural hypotension
```
Often not specific enough for police to prove
65
List some of the chronic effects of cannabis use
Psychosis - schizophrenia
Amotivational syndrome - only care about smoking
Reduced sperm count in men
Reduced fertility in women
Bronchitis & emphysema
? Lung cancer
This is due to the lack of filters in joint - more hydrocarbons
66
List signs of cannabis withdrawal
```
Irritability - opposite to usual drug effect
Mood change
Restlessness
Loss of appetite
weight loss
Insomnia
```
67
How do withdrawal symptoms relate to the type of drug
If the drug is a stimulant then withdrawal will have a depressant effect
Opposite is true for depressant drugs (withdrawal is excitation)
68
Which drug has the street name Valium
Diazepam
| Most common Benzo
69
How was temazepam prepared
Jellies - fluid filled capsules
Banned because you could easily draw the fluid for injection
Now get in in tablets
70
Describe benzodiazepines
They are sedatives and anxiolytics (tranquillizers)
Very commonly abused
Can have both psychological and physical dependence
71
List the acute psychological effects of benzodiazepines
Relief of anxiety, relaxation - positive
Impaired memory
Paradoxical aggression
Uncharacteristic criminal behaviour
Uncontrollable emotions
‘Hangover’ - feel groggy the day after taking them
72
The effects of benzodiazepines are potentiated by alcohol - true or false
True
| Effects become stronger if taken with alcohol
73
List the acute physical effects of benzodiazepines
```
Dizziness
Sedation
Incoordination
Sexual dysfunction
Weight gain
Hypotension & coma with high dose (brain stem depression)
```
74
OD from benzos alone is rare - true or false
It can cause death through brain stem depression but usually another substance is involved in death
75
List the chronic effects of benzodiazepines
Chronic intoxication
Tolerance
Psychological & physical dependence
76
How long does it take for benzo withdrawal to set in
2-3 days
77
List features of benzo withdrawal
```
Anxiety, insomnia
Sweating, headache
Tremor, nausea
Disordered perceptions - hallucination
Hypersensitivity to stimuli
Psychosis
Convulsions - can be dangerous, due to over excitability of brain
```
78
List some of the street names for amphetamines
uppers, ‘A’, speed, whizz, sulph, cranks, wake-up, hearts
79
List some of the street names for dextroamphetamines
dex, dexy, dexies
80
Which drug is also known as ICE or crystal meth
Methamphetamine
81
What is the full name of MDMA
3,4, Methylenedioxymethamphetamine
82
List street names of Methylenedioxyamphetamine
MDA
| EVE - partner drug to ADAM (MDMA)
83
List other names for MDMA
ADAM
ecstasy
E's
doves
84
What are the medical uses of amphetamines
Narcolepsy
Some areas of psychiatry
No longer used really
85
What type of drug are amphetamines
Synthetic stimulants
86
How are amphetamines taken
Orally
Usually as tablets or powder
Can be taken, snorted, smoked or injected
Associated with rave culture
87
List the acute psychological effects of amphetamines
```
Increase in adrenaline
Euphoria, calm, peace and friendliness
Heightened awareness & concentration
Increased energy (dancing)
Irritability, restlessness
Irrational behaviour, confusion
Hallucinations, delusions, paranoia
Psychosis
```
88
List the acute physical effects of amphetamines'
```
Due to effect of adrenaline again
Tachycardia, hypertension, tachypnoea
Loss of appetite
Dilated pupils, brisk reflexes
Dry mouth, blurred vision, dizziness
Sweating, flushing or pallor
Teeth-grinding, repetitive actions
Pyrexia, Dehydration - dangerous
```
89
Why is a lot of water usually handed out at raves
Amphetamine use is common in rave culture
| These have dehydration and pyrexia as side effects so water is used to counteract it
90
List acute adverse effects of amphetamine use
Arrhythmias - adrenaline effect goes to far
Stroke (ICH, SAH) - due to increased BP
Hyperpyrexia
DIC - clotting deficiency caused by pyrexia/dehydration
Acute paranoid psychosis
91
List chronic adverse effects of amphetamine use
```
Aggression, fatigue & insomnia
Anorexia, malnutrition & weight loss
Diarrhoea & vomiting
Heart muscle damage (cardiomyopathy) - pumping hard/fast for too long
Chronic paranoid psychosis
Depression, schizophreni
```
92
List other names for mephedrone
Bubbles”
Plant Food - sold as this
Miaow miaow
93
What is mephedrone derived from
Cathinone found in Khat plant which is found in E. Africa and Arabia
Traditionally the leaves were chewed to relieve fatigue (mild euphoria and stimulant)
94
What is the chemical name of mephedrone
4-Methyl Meth Cathinone (MMCAT)
95
How is mephedrone manufactured and sold in the UK
Mephedrone is typically synthetic in the UK
| Sold on the internet as plant food
96
How is mephedrone taken
Crystalline powder which is taken orally or snorted (painful)
Taken as tablets
It is a stimulant
97
When was mephedrone made illegal in the UK
```
April 2010
Lots of derivatives produced which were shut down
Made a class B
```
98
Describe what happens when you take mephedrone
Initial euphoria and energy rush as it is a stimulant (similar to E and coke)
Has a very unpleasant comedown (crash) with sleep disturbance
Associated with severe paranoia and depression as well as many suicides
99
List some of the physical effects of mephedrone
```
Tachycardia, Hypertension
Insomnia, Anorexia
Chewing/grinding teeth (bruxism)
Nystagmus
Blue & cold extremities (vasoconstriction)
Pains in the chest, throat and nose
Nosebleeds when snorted
Tolerance & Dependence
```
100
What is cocaine derived from
Coca leaves which are found in South America
101
How is crack cocaine made
Heating and chemical alteration of the cocaine powder (e.g. mixed with baking powder)
It crystallizes into crack crystals
102
Cocaine abuse is associated with crime - true or false
True
Associated with gun use
the drug itself makes people aggressive
103
The initial high from cocaine is very intense and pleasurable - true or false
True
The first time is supposedly very good
However, people then chase this initial high which is hard to recreate - leads to addiction
104
Cocaine is naturally occurring - true or false
True
| It comes from the coca plant
105
How is cocaine taken
Snorted
Smoked (crack)
Rubbed on
Injected
106
How are coca leaves converted to cocaine
The leaves are turned into a paste and then a powder
| This manufacturing process is illegal
107
Describe crack cocaine
More pure form of cocaine and gives a cleaner hit
108
List the acute psychological effects of cocaine
Euphoria, well-being - intense
Formication - feeling insects under skin
Irritability & confusion
Hallucinations, paranoia, depression
109
List the acute physical effects of cocaine
Tachycardia, hypertension, tachypnoea
Dilated pupils,
Increased mental excitement
Hyperpyrexia
110
List chronic effects of cocaine
```
Chest pains, muscle spasm
Weight loss
Perforated nasal septum - snorting
“Crack keratitis” of the eyes.
Erosion of tooth enamel
‘Crack callus’ of the fingers - from lighting up
Male impotence
Female orgasm problems
```
111
How does cocaine use lead to a perforated nasal septum
Occurs when the drug is snorted
It anaesthetizes the septum at first but then starts to erode it
Eventually the blood vessels are affected and you get tissue degeneration
Septum may disappear
112
List signs of cocaine withdrawal
```
Intense psychological craving
Irritability, depression
Muscle pains & tremor
Hunger
Exhaustion & prolonged sleep - even up to 2 days!
```
Reflex excitability due to removal of stimulant
113
How can cocaine be tested for
```
Cocaine and its metabolites are detectable in:
Blood
Urine
Nasal swabs
Hair
Saliva
```
Easily detected
114
How can cocaine affect the heart
Premature Atherosclerosis
Coronary artery thrombosis
MI
Heart muscle damage - stimulant effect stresses the muscle fibres
- Acute contraction band necrosis due to catecholamine stress
Chronic scarring - cardiomyopathy
Fatal arrhythmia - common cause of death before the chronic damage
115
How can cocaine affect the brain
Can cause brain haemorrhage - intracerebral or SA
Can cause brain infarction via arterial spasm
Kills through stroke
116
What is LSD
A synthetic hallucinogenic drug
117
What is LSD
It is semi -synthetic hallucinogenic drug
118
In which decade was LSD popular
In the 60s
Less common now
Those who took it back then may suffer flashbacks years later
119
What is the chemical name for LSD
LySergic acid Diethylamide
120
What is LSD derived from
Derived from lysergic acid, found in ergot fungus which grows on rye grains
121
What is LSD derived from
Derived from lysergic acid, found in ergot fungus which grows on rye grains
Further processing gives final product - semi-synthetic
122
What was LSD originally used for
Initially synthesised in 1938 and had some psychiatric use
123
How long does LSD take to take effect
Effects within 1 h, peak 4 h, lasts 12 h.
124
Is LSD a drug of dependence
Not really compared to others
| Can build tolerance but few dependent on it
125
List the acute psychological effects of LSD
```
Effects vary widely - good & bad trips
Bad trips can be terrifying
Depend on to mood & environment
Hallucinations - visual & auditory
Distorted perception of time, distance & speed - common to think you can fly
Mood swings, paranoia & violence
```
126
List the acute physical effects of LSD
```
Hypertension, tachycardia
Dilated pupils
Tremor & incoordination
Flushing & nausea
Pyrexia
```
127
List some of the chronic effects of LSD use
```
Tolerance develops but not dependence
Abortion in pregnant women
Anxiety & psychosis
Later flashbacks - may be triggered by another stimulus
Can occur years later
```
128
Why was methadone introduce
It is a synthetic opiate that aims to replace heroin and reduce addiction
However, people become addicted to this
129
What are opiates derived from
The opium poppy
| This grows in SE and SW Asia
130
What is opium a mixture of
Alkaloids
Morphine makes up 10%
other compounds include noscapine, papaverine, codeine and thebaine (seen as contaminants in heroin)
131
How is the opium poppy processed to make opium
Unripe seed capsule is scored
Milky extract emerges
Dries to brown gummy residue - this is opium
132
Opium has been used in medicine for centuries - true or false
True
Used for many ailments - particularly pain relief
Even coughs and toothache!
133
When was morphine first converted to heroin
In 1874
| Produced via acetylation (adds acetyl groups, if 2 are added its heroin)
134
What is diamorphine
Heroin
| Morphine with 2 acetyl groups added
135
What is heroin broken down to in the body
First to 6-monoacetylmprohine (in a few minutes) and then morphine (takes 5-25 mins) - caused by loss of acetyl groups
Addition of other structures converts morphine to morphine-3-glucuronide (inactive) and morphine-6-glucoronide (active)
136
List the medical uses of opiates
Pain relief (analgesia)
Cough suppressants
Anti-diarrhoeal drugs
137
List different preparations of heroin
White powder
| Brown powder
138
How is heroin taken
Injected - most common
Smoked -chasing the dragon (smoking on foil)
Sniffed
139
Which paraphernalia is associated with IV heroin use
Burnt spoon - may see blood or residue on it
| Lemon juice - dissolves the heroin better tan water
140
Which safety measures are now provided to IV heroin users
Needle exchanges - clean needles
Sachets of citric acid
Naloxone
141
List the acute psychological effects of opiate abuse
Rush of euphoria
Contentment - head rolls back, instant relief
Relief of anxiety
Inability to concentrate
142
List the acute physical effects of opiate abuse
Constricted pupils
Nausea & vomiting
Suppression of cough reflex - can lead to aspiration
Decreased heart and breathing rate - act on breathing centers
Unconsciousness, respiratory arrest and death
Fatal reaction to impurities
143
How can heroin overdose be reversed
Naloxone (Narcan) administration
| It reverses the effects of heroin very quickly
144
Foam at the mouth seen in opiate abusers is a sign of what
Terminal heart failure
| seen in death from respiratory failure and cardiac arrest
145
List the chronic effects of opiate abuse
```
Tolerance - need to take more and more
Physical & psychological dependence
Constipation
Loss of libido
Complications of IV injection
```
146
How long does it take withdrawal to set in if opiates are stopped cold turkey
Commences after 8-15 h
Peaks at 36-48 h
Subsides over 5-10 days
147
What withdrawal symptoms are seen if opiates are stopped cold turkey
```
Clinical effects opposite of intoxication
Craving
Anxiety, restlessness, irritability
Alternate sweating and shivering
Generalised aches & weakness
Cramps in back, legs and abdomen
Insomnia
```
148
What physical signs of withdrawal are seen if opiates are stopped cold turkey
```
Dilated pupils
Watering eyes (lacrimation), yawning
Tachycardia, hypertension
Cold clammy skin with goose flesh
Loudly audible bowel sounds
Nausea, vomiting & diarrhoea
```
Shows they are really withdrawing - cant be faked like symptoms
149
Addicts may fake the symptoms of withdrawal - true or false
True
They often know the symptoms well but may fake them to get more opiates from medical providers
Physical signs will be absent if faking
150
How can withdrawal be confirmed
There is a clinical withdrawal scale
Looks at factors such as HR, RR, pupils, pain, tremor, mental state, sweating etc.
Determines how much medication they will get - methadone
151
What determines the dose of methadone given to someone withdrawal
The severity of symptoms as determined by the clinical withdrawal scale
e.g. mild = 10mg
Severe = 20mg
152
What is the maximum dose of methadone that can be given in the first 24 hours
40mg
153
Where would you look for needle punctures in a suspected IV user
Crook of elbow
Along the line of a vein
Groin
154
Which skin signs may be seen in IV drug users
Needle puncture marks
Associated bruising (seen on skin and also overlying the vein when incised)
Marks from the ligature
Sinuses with chronic use - funneling of skin, puckered and scarred
155
Describe the pattern of effect and use in heroin
Take a hit and get the euphoric high
Levels start to fall and they become straight (most time in this phase)
Then start to withdraw and usually take another shot
156
Describe the pattern of effect and use in methadone
Single dose lasts 24h
Keeps them straight but does not give the euphoria or high
Avoids both high and withdrawal
157
What is the half life of heroin
Very short - only about 3-6 minutes
158
when testing for heroin use which compounds are you actually looking for in the blood
Usually 6MAM as heroin breaks down too quickly to be picked up
159
If heroin is detected in the blood what does it suggest
That they died almost instantly - hasn't had time to be broken down
160
Tolerance to heroin is lost quickly - true or false
True
Both gained and lost quickly
Therefore if use is interrupted (e.g. prison) and they go back to their old dose it can result in fatal overdose
161
Morphine levels are lower in death than in life - true or false
False
| Levels of morphine are no different to those in living addicts
162
Describe the cocktail effect
When multiple drugs are taken at the same time
One can potentiate the other
Or if all drugs have the same effect it can be very intense - e.g. multiple depressants increase risk of respiratory depression
163
Why might someone inject an oral pharmaceutical
They may actually enjoy the act of injecting - social event, part of their process
May not have a great effect but some still enjoy it
164
How can oral pharmaceuticals be used for injection
Tablet crushed, dissolved & injected
Gelatinous capsule content extracted by a needle
Can just inject methadone liquid
165
What effect can tablet fillers have if oral pharmaceuticals are injected
Can get into the bloodstream alongside drugs
| Filtered out by lung and liver where they can cause damage and inflammation - granulomas
166
List common tablet fillers
Starch
Cellulose
Talc
Cotton - drug strained through as some fibres get in
167
Which infections are common in IV drug users
```
Septicaemia
Acute endocarditis
Anthrax - cases seen in contaminated heroin batch
Skin Abscesses
Necrotising fasciitis
Hepatitis B, C
HIV
Opportunistic infections
```
168
List some systemic complications of IV drug use
Heart: enlargement, endocarditis
Lung: scarring, FB granulomas
Liver: granulomas
Brain: blood vessels, neurones all damaged
169
How do lung granulomas appear on microscopy
Foreign material present
| Birefringent in polarized light
170
The toxic effects of a drug are usually dose dependent - true or false
True
171
The collateral side effects of a drug are usually dose dependent - true or false
False
172
List general adverse effects of drugs
Dose dependent Toxic effects
Dose independent collateral side effects
Idiosynchratic reaction
Allergic reaction to impurities
Hazards related to route of administration
Chronic effects (heart, lungs, liver, brain)
173
How can you tell is a PM drug level has been fatal
You can't!
Massive intra-individual variation - depends on tolerance
Also have to consider the cocktail effect and the PM redistribution of the drug
174
How can PM redistribution affect drug level analysis
May produce an artefactual elevation of measured drug conc
175
How do drugs redistribute after death
Passive diffusion of drug from a site of high conc. (“reservoir”) into neighboring blood vessels
Central blood vessels are most vulnerable
176
Which vessels are most affected by PM drug redistribution
Central vessels such as heart, aorta, pulmonary vessels and the IVC
177
Drugs present in the stomach at death will be redistributed where
Will contaminate the heart blood
178
Drugs present in the liver at death will be redistributed where
Abdominal vessels
179
Where should samples for drug testing be taken from to reduce the chance of contamination from redistribution
Peripheral vessels such as the femoral vein
