TOXICOLOGY LABS Flashcards
therapeutic drug monitoring
- optimum dosing
- improve therapeutic effect + avoid side effects or toxic effects
- therpeutic dosing for condition (renal func, preg, newborn, geriatric)
- blood serum or plasma, urine
- trough conc (check before next dose)
- peak conc (30-60 min post dose)
pharmacokinetic principles
LADME
- liberation (when capsule breaks)
- absorption (taking w food? any resections affect it?)
- distribution (reaching target/proper exposure)
- metabolism (liver/renal func, cyp450, grapefruit juice)
- elimination
alcohols
- acute v chronic lead to?
- peak
- equivalent liquor, wine, beer
- test
- acute intox
- chronic abuse–> pancreatic ds or liver cirrhosis
- peak 30-75 min post ingestion
- 1 oz liq, 4oz wine, 12 oz beer
- breath and blood test
types of alcohols
methanol, ethylene glycol, isopropanol
methanol
- found in?
- Sx
- moonshine, washer fluid
- impaired vision up to blindness, vom, seizures, coma
isopropanol
- found in?
- Sx
- rubbing alcohol
- vom, abd pain, hematemesis, melena, coma
ethylene glycol
- found in?
- Sx
- antifreeze
- anuria, vom, seizures, coma
environmental toxins
occupational exposures
- heavy metal, gases, caustic compounds
contamination
- soil, ground water
others
- carbon moxonide
- mercury
- cyanide
- insecticidfes
- lead
carbon monoxide
- patho
- adult v. children sx
patho
- carbon monoxide binds to O2 binding sites on HgB
adults sx
- heart, CNS and lungs, vision, hearing, periph nerve conduction issues
- MI, HAQ, permanent neuro impairment
children sx
- mimics gastroenteritis
carboxyhemoglobin relative to total HgB testing ranges
- 0.1-0.9
- 1.5-10
- 10-30
- 40-60
- 60-70
- 80
0.1-0.9 = nl for non smoking adult
1.5-10 = smoking adult
10-30= inc HA, severe dyspnea on exertion
40-60= severe HA, dyspnea w tachy, can be fatal
60-70= coma, seizures, often fatal
80 = rapidly fatal
at what carboxyhemoglobin levels do Sx start?
10-30%
enviro toxins
lead
- who does it primarily affect
- sx
- when to screen
- primarily effects children
Sx (impaired cognitive and behav impairment)
- seizures
- mental retardation
- chronic behav dysfunc
- anemia
- renal tox
- recurrent vom + abd pain
peds screening
- based on exposure or risk
who should be screened for lead poisoning
all children at risk
- lived in house built before 1978
- low income households
- immigrant, refugee
- hobbies that expose to lead
lead poisoning unique finding
lead line in gums
- region between teeth and gingiva show dark area of insoluble lead
drugs of abuse
- goal of testing
- types of testing
- goal to detect past exposure by detecting metabolites
- present or absent
- urine, serum, meconium, breath, saliva, hair, nails
drugs of abuse
- list names
amphetamines, barbiturates, benzodiazepines, cannabinooids, cocaine, opiates and opioids, phencyclidine, alcohols
detection window w/urine testing
- amphetamines
- barbiturates
- benzos
- methadone
- phencyclidine
- THC/marijuana
- amphetamines: 2-4 days
- barbiturates: 1->5 days
- benzos: 2- >8 days
- methadone: 1-4 days
- phencyclidine: 7-14 days
- THC/marijuana: 20-30 days
detection window w/urine testing
- cocaine + heavy user?
- opiates + heavy user?
cocaine metabolite
- 2- >7 days
- heavy users may remain pos 6-10 days using sensitive immunoassay w 15-0 ng/mL cutoff
opiates
- 2- >5 days
- heavy users may remain pos up to 7-8 days
drugs of abuse workup
create case of drug abuse with assigned drug, disucss SS of agent when abused, discuss lab workup, and then overdose tx
