Toxicology (part 2) Flashcards
(150 cards)
1
Q
therapeutic drugs that undergo toxicology
A
Salicylates
Acetaminophen
2
Q
aka Salicylates
A
Acetylsalicylic acid or Aspirin
3
Q
Common analgesic (relieves pain), antipyretic (anti-fever), anti-inflammatory and anticoagulant
A
Salicylates
4
Q
Mechanism of salicylates as anticoagulant
A
blocks cyclooxygenase reducing thromboxane and prostaglandins
5
Q
Adverse effects of Salicylates
A
Platelet aggregation inhibition
GI function interference
Rye Syndrome (in children)
Viral infection
6
Q
Treatment for Salicylates toxicity
A
Neutralization and elimination
Maintain electrolyte imbalance
7
Q
Salicylates intoxication value
A
Serum lvl: >90 mg/dL 6 hrs after ingestion
8
Q
Effects of acute ingestion of Salicylates (high doses)
A
Metabolic acidosis (salicylates are acid)
Respiratory alkalosis (direct stimulation of the respiratory center, causing hyperventilation)
Inhibits Kreb’s cycle (increases lactate
and pyruvate formation → muscle cramps)
Ketone formation
Death
9
Q
Methods for Salicylate measurement
A
Gas Chromatography
Liquid Chromatography
Chromogenic Assay (Trinder Reaction)
10
Q
Has the highest analytical sensitivity for salicylates
A
Liquid Chromatography
11
Q
A method for salicylate measurement that uses ferric nitrate to form a colored complex measured using spectro
A
Chromogenic Assay (Trinder Reaction)
12
Q
aka Acetaminophen
A
Paracetamol
13
Q
a common analgesic
A
Acetaminophen
14
Q
Common brand (US) of Acetaminophen
A
TYLENOL
15
Q
predicts acetaminophen-induced hepatic damage based on serum conc. of acetaminophen at a known time after ingestion (graphical representation)
A
Rumack-Matthew Nomogram
16
Q
Rumack-Matthew Nomogram must not be used in these individuals
A
px. with ethanol abuse
(metabolizes acetaminophen at rapid rate)
17
Q
Rumack-Matthew Nomogram is used for predicting?
A
acetaminophen-induced hepatic damage
18
Q
Effect of Acetaminophen overdose
A
severe hepatotoxicity
19
Q
Acetaminophen overdose value
A
300 ug/mL 2 hours after ingestion
20
Q
Acetaminophen measurement methods
A
Immunoassay – commonly used
HPLC – reference method
21
Q
DRUGS OF ABUSE assessed in toxicology
A
Amphetamines
Ecstasy
Anabolic Steroid
Cannabinoids
Cocaine (crack)
Opiates
Phencyclidine
Sedatives-Hypnotics
OTHERS:
Lysergic Acid Diethylamide (LSD)
Piperazines
Methaqualone (Quaalude)
Tryptamines
22
Q
can cross the placenta
A
arsenic
cocaine
23
Q
Most common Amphetamines
A
SHABU
24
Q
drug of abuse with ↓ therapeutic dose; very close to toxic dose
A
Amphetamines
25
drugs that develops tolerance (HIGH POTENTIAL ABUSE)
Amphetamines
Cannabinoids
Opiates
26
Amphetamines is a tx for
narcolepsy (uncontrolled sleeping)
attention deficit disorder
27
Drug for reducing weight (induces anorexia nervosa)
Amphetamines
28
Blocks dopamine receptors in the brain causing initial effects
Amphetamines
29
Examples of Amphetamines
Amphetamines
Methamphetamines (Shabu/Ice, Poor Man’s Ecstasy)
Methylphenidate (Tx: hyperactive children)
Benzphenidate
Diethylpropion
30
Amphetamine-like compounds
Ephedrine
Pseudoephedrine
Phenylpropanolamine
31
content of Chinese drug said to be effective against COVID-19 (Lianhua Qingwen); may induce hypertension
Ephedrine
32
INITIAL EFFECTS of Amphetamines
Increased mental and physical capacity
33
ADVERSE/TOXIC EFFECTS of Amphetamines
Restlessness
Irritability
Psychosis
34
An amphetamine derivative
Ecstasy
35
Ecstasy is a derivative of
3,4-methylenedioxymethamphetamine
36
A designer drug (modified form of the available drug of abuse)
Ecstasy
37
INITIAL EFFECTS of Ecstasy
Hallucinations
Euphoria
Emphatic and emotional response
Increased visual and tactile sensitivity
38
ADVERSE EFFECTS of Ecstasy
* Headaches
* Nausea
* Vomiting
* Anxiety
* Agitation
* Impaired memory
* Violent behavior
* Tachycardia
* Hypertension
* Respiratory depression
* Seizure
* Hyperthermia
* Multiple organ toxicity
39
Testosterone derivatives
Anabolic Steroid
40
Anabolic Steroid is initially a tx for
male hypogonadism
41
↑ muscle mass (used by athletes)
Anabolic Steroid
42
Chronic use of Anabolic Steroid causes
* Toxic hepatitis
* Accelerated atherosclerosis
* Abnormal plt aggregation
* Cardiomegaly
* Testicular atrophy
* Sterility
* Impotence
43
Group of psychoactive compounds found in marijuana
Cannabinoids
44
Cannabinoids is naturally derived from
Cannabis sativa leaves
45
drugs of abuse that are CNS stimulants
Cannabinoids
Cocaine (crack)
46
most potent and abundant compound of marijuana
Tetrahydrocannabinoid (THC)
47
A hallucinogen; a lipophilic substance; Rapidly distributed to hydrophobic compartments (brain, fats); Reaches brain w/n 30 sec upon exposure
Tetrahydrocannabinoid (THC)
48
MAJOR URINARY METABOLITE of Cannabinoids
11-nor-deltatetrahydrocannabinol-9-carboxylic acid (THC-COOH)
49
11-nor-deltatetrahydrocannabinol-9-carboxylic acid (THC-COOH) is detected in urine with SINGLE THC use for
3-5 days
50
11-nor-deltatetrahydrocannabinol-9-carboxylic acid (THC-COOH) is detected in urine with CHRONIC use for
4 weeks (or 45 days)
51
T/F
Cannabinoids accumulates in adipose tissue; not readily excreted in urine (slow elimination) – only eliminated when fats are metabolized
T
52
INITIAL EFFECTS of Cannabinoids
Sense of well-being
Euphoria
53
THC Adverse effects
memory and intellectual impairment
54
Toxic Effects of Cannabinoids
* Paranoia
* Disorientation
* Altered physical senses
* Bronchopulmonary dse
55
Methods for Cannabinoids
IA (screening)
GC-MS (confirmatory)
56
An alkaloid salt (in the form of ecgonine)
Cocaine (crack)
57
Cocaine (crack) is naturally derived from
Coca-plant (Erythroxylon coca)
58
Effective local anesthetic for nasopharyngeal surgery
Cocaine
59
NOT a TRUE ADDICTIVE DRUG (fails to develop dependence)
Cocaine
60
Potent CNS stimulator
Cocaine
61
METABOLITE of Cocaine
Benzoylecgonine
62
single use of cocaine can be detected for
3 days
63
chronic use of cocaine can be detected for
20 days
64
INITIAL EFFECTS of cocaine
Excitement
Euphoria
65
Cocaine overdose causes
violent behavior
66
Adverse/toxic effects of cocaine
* Hypertension, arrythmias, seizure, MI
* Uterine malformation
* Mental retardation, slow mental development and drug dependence (newborns)
* Sudden death (due to direct toxicity to myocardium
67
drug of abuse that can cause sudden death (due to direct toxicity to myocardium)
cocaine
68
Capable of analgesia, sedation and anesthesia
Opiates
69
Opiates is derived from
opium poppy plant
70
Types of opiates
Naturally occurring
Chemically modified
Synthetic
71
Naturally occurring opiates
Opium
Morphine
Codeine
72
powerful analgesic; relieves excruciating pain (burn, cancer); a heroin metabolite
Morphine
73
Mild analgesic and antitussive (relieves cough)
Codeine
74
Chemically modified opiates
Heroin
Hydromorphone (Dialudin)
Oxycodone (Percodan)
75
Synthetic opiates
Meperidine (Demerol)
Methadone (Dolophine)
Proxyphene (Darvon)
Pentazocine (Talwin)
Fentanyl (Sublimaze)
76
major drug of abuse (1960’s -70’s)
HEROIN
77
Forms of Heroin
No. 4 (China white)
No. 3 (Brown sugar) –
No. 2 and 1
78
purest form of heroin
No. 4 (China white)
79
heroin form used for smoking
No. 3 (Brown sugar)
80
unprocessed heroin
No. 2 and 1
81
MAJOR METABOLITES of HEROIN
N-acetylmorphine
Morphine
82
ADVERSE/TOXIC EFFECTS of Opiates
Respiratory acidosis
Myoglobinuria
Cardiopulmonary failure
Pupillary constriction (pinpoint pupils)
83
Antidote for opiate toxicity
Naloxone (Narcan) – opiate inhibitor
84
methods for opiate
IA (screening)
GC-MS (confirmatory)
85
used to detect morphine and codeine; can cross react with other opiates (nonspecific)
IA (screening)
86
aka Phencyclidine
angel dust
angel hair
peace dust
87
Illicit drug with stimulant, depressant, anesthetic, and hallucinogenic properties
Phencyclidine
88
Lipophilic drugs
Phencyclidine
Tetrahydrocannabinoid (THC)
89
10-15% of this administered drug is eliminated and unchanged
Phencyclidine
90
Initial effect of Phencyclidine
Hallucinations
91
Adverse effects of Phencyclidine
* Agitation
* Hostility
* Paranoia
92
OVERDOSE effects of Phencyclidine
Stupor
Coma
93
T/F
Methods for PCD det. detects the metabolite
F
detects parent drug – PCD itself
94
PCD Chronic user can detect the drug for
30 days after abstinence
95
methods for PCD
IA (screening)
GC-MS (confirmatory)
96
Tranquilizers
Sedatives-Hypnotics
97
drugs that are CNS depressant
Sedatives-Hypnotics
98
COMMON TYPES of Sedatives-Hypnotics
Barbiturates
Benzodiazepines
99
condensation products of urea and malonic acid
Barbiturates
100
has higher abuse potential than benzodiazepines
Barbiturates
101
Examples of Barbiturates
Phenobarbital (long acting)
Amobarbital (intermediate acting)
Secobarbital, Pentobarbital (short acting)
102
treatment for cocaine addiction
Benzodiazepines
103
most commonly found in abused and overdose situations due to wide availability
Benzodiazepines
104
Examples of Benzodiazepines
Diazepam (Valium)
Chlordiazepoxide (Librium)
Lorazepam (Ativan)
105
a minor tranquilizers; rapid control of acute seizure
Diazepam (Valium)
106
Overdose effects of Sedatives-Hypnotics
Lethargy
Slurred speech
Coma
Respiratory depression (most serious toxicity; may
result to death)
107
most serious toxicity of sedatives
Respiratory depression
108
methods for sedatives det.
IA (screening)
GC-MS (confirmatory)
109
a hallucinogen; one of the most potent pharmacologic material
Lysergic Acid Diethylamide (LSD), Lysergide
110
Shows the same pleasant feeling as amphetamines
Piperazines
111
Major derivatives of Piperazines
N-benzylpiperazines (BZP)
Phenylpiperazines
112
Minor derivatives of Piperazines
1-(3,4-methylene-dioxybenzyl) piperazine (MDMP)
1-(3- trifluoromethylphenyl) piperazine (TFMPP/Molly)
113
Most popular Piperazines
BZP
TFMPP/Molly
114
2,3-disubstituted quinazoline with anesthetic, antihistamine, antitussive, and hallucinogenic properties
Methaqualone (Quaalude)
115
a drug that is a serotonin derivative
Tryptamines
116
Examples of Tryptamines
N,N-dimethyltryptamine (DMT)/Businessman’s lunch
Psilocin
Ayahuasca
117
N,N-dimethyltryptamine (DMT) (a tryptamine) is aka
Businessman’s lunch
118
a short-term hallucinogen
N,N-dimethyltryptamine (DMT)/Businessman’s lunch
119
hallucinogen; component of magic mushrooms (Psilocybe)
Psilocin
120
tea with tryptamines
Ayahuasca
121
R.A. 9165 is aka
COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002
122
COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002 is aka
R.A. 9165
123
Head of the Laboratory
Pathologist
Doctor who undergone training under DOH for lab management
124
Analyst of the laboratory
Medical technologist
Pharmacist
Chemist
Nurses
125
Requirement when conducting drug testing in Remote Collection Site
permit from Bureau of Health Facilities and Services – Center for Health Development (BHFS-CHD/DOH) 10 days prior
126
Accepted Specimens for drug testing
Urine (most commonly used)
Saliva
Blood
Hair
Sweat
Tissue
Nail Clippings
127
type of collection that requires validity test
Unobserved Collection
128
urine creatinine value indicating adulterated spx
<20 mg/dL
129
SG indicating that the specimen is no longer urine
<1.003
130
Agents used for Specimen Tampering
Water (most common)
Salt (2nd most common)
Others: Liquid soap, Bleach, Vinegar, Ammonia, Baking soda, Glutaraldehyde,
Potassium Nitrate, Lemon Juice, Cologne
131
Documents required for drug testing
Consent form
Custody and Control Form
Memorandum for Record
132
Screening methods for drug testing
Thin-layer Chromatography
Gas-liquid Chromatography
Colorimetric “spot” test
133
May be used as confirmatory test for drugs detected by TLC
Gas-liquid Chromatography
134
Confirmatory tests for drug testing
Enzyme Multiplied Immunoassay technique [EMIT]
Gas-Chromatography/Mass Spectrometry
135
Utilizes antibodies to detect drugs
Enzyme Multiplied Immunoassay technique [EMIT]
136
first line confirmatory and reference method; can detect low drug levels
Gas-Chromatography/Mass Spectrometry
137
detect presence of specific compound (separation technique)
GC
138
quantitate the compound detected by GC
MS
139
T/F
any method is valid in the absence of GC/MS provided that it is completely different from the 1st method
T
140
Amphetamine cut-off level (ng/mL) in URINE using EMIT
500
141
Amphetamine cut-off level (ng/mL) in URINE using GC-MS
250
142
Marijuana cut-off level (ng/mL) in URINE using EMIT
50
143
Marijuana cut-off level (ng/mL) in URINE using GC-MS
25
144
Cocaine cut-off level (ng/mL) in URINE using EMIT
150
145
Cocaine cut-off level (ng/mL) in URINE using GC-MS
100
146
Opiates cut-off level (ng/mL) in URINE using EMIT
2000
147
Opiates cut-off level (ng/mL) in URINE using GC-MS
2000
148
PCD cut-off level (ng/mL) in URINE using EMIT
25
149
PCD cut-off level (ng/mL) in URINE using GC-MS
25
150
Drugs with the same cut-off levels (ng/mL) in urine using EMIT and GC-MS
Opiates
PCD
