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Forensics > 14. alcohol and drug abuse > Flashcards

14. alcohol and drug abuse Flashcards

1
Q

Alcohol goes through 3 phases in the body:

A
  1. absorptive phase: taken up by all tissues according to their water content, blood level rises until it reaches a peak after about 60 minutes
  2. equilubration phase : after about 60 minutes the blood:urine ration = 1:1.3
  3. metabolic phase: alcohol ets broken down in the liver at the rate of about 15 mg per hour
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2
Q

describe alcohol metabolism

A

alcohol gets metabolized in the liver into acetaldehyde and then to acetate which gives of H2O and CO2

if the system is overwhelmed, then there is a build up of acetaldehyde that leads to increase of lactate and lipids, and decrease of glucose

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3
Q

there are 3 outcomes of drinking leading to death and harm from alcohol abuse

A
  1. acute intoxication
  2. trauma while intoxicated
  3. chronic illness
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4
Q

what re physiological effects of alcohol (3)

A
  1. CNS depressant
  2. acts on GABA A inhibitory receptors
  3. at very high alcohol levels, the respiratory centre in the brain is paralysed and breathing stops
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5
Q

Clinical and behavioral effects of increasing levels of blood alcohol: 0.08 g/dl

A

euphoria, impaired co-ordination

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6
Q

Clinical and behavioral effects of increasing levels of blood alcohol: 0.08-0.2 g/dl

A

unsteadiness, slurring of speech, drowsiness, poor judgement and reaction

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7
Q

Clinical and behavioral effects of increasing levels of blood alcohol: 0.2-0.3 g/dl

A

increasing unsteadiness, falling, slurring, drowsiness, nausea

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8
Q

Clinical and behavioral effects of increasing levels of blood alcohol: 0.2-0.4 g/dl

A

semi-consciousness, labored breathing

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9
Q

Clinical and behavioral effects of increasing levels of blood alcohol: 0.4 g/dl

A

coma, respiratory depression, death

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10
Q

legal level of alcohol for driving: England, Scotland (europe), B&H

A

England: 0.08 g/dl
Scotland 0.05 g/dl (europe)
B&H (0.03 g/dl)

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11
Q

Death from acute intoxication occurs at what level?

A

usually 0.35 g/dl but could be higher

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12
Q

death is due to respiratory depression but may be contributed to by: (4)

A
  1. other substances (additive effects of medication or drugs of abuse)
  2. inhalation of vomit (Alcohol stimulates vomiting and it can block airways)
  3. postural asphyxia (lying awkwardly while intoxicated, thus compromising breathing)
  4. natural disease (people with chronic heart or respiratory disease can die at lower levels of intoxication)
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13
Q

what are examples of trauma while intoxicated (6)

A
  1. frowning
  2. falls
  3. fights
  4. fire
  5. hypthermia
  6. RTCs
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14
Q

what are some things that affect vulnerability to intoxication?

A
  1. drinking habits
  2. young people (become comatose earlier, hypoglycemia more likely)
  3. older persons (achieve higher blood alcohol levels with lesser consumption)
  4. women (allegedly)
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15
Q

what are alcohol related diseases (chronic illness) 6

A

primarly:
1. liver disease
2. pneumonia
3. general neglect

less often:
1. cardiomyopathy
2. seizures
3. various cancers

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16
Q

what changes in the liver do we observe in chronic abuse?

A
  1. fatty change = globules of fat accumulate in the hepatocytes
  2. alcoholic hepatitis = individual hepatocytes die off and trigger and inflammatory response
  3. cirrhosis = the inflammation heals by scarring, creating irregular nodules of hepatocytes surrounded by fibrous tissue
17
Q

what is a fatty liver disease

A

specific cause of sudden death i.e. within hours
mechanism is probably alcoholic ketoacidoss (AKA, reflected by high levels of beta hydroxybutarate in the blood

18
Q

Cirrhosis kills by __ and __

A

hepatic failure (jaundice, ascites, encephalopathy)
ruptured oesophageal varices (GIT hemorrhage)

19
Q

Drugs that give effect of: relaxation and a sense of wellbeing (2)

A

cannabis
benzodiazepines

20
Q

Drugs that give effect of: stimulation, energy, a feeling of strength

A

cocaine, amphetamine

21
Q

Drugs that give effect of: heightened sensory appreciation, hallucinations (6)

A

MDMA, ketamine, LSD, khat, NPS, solvents

22
Q

Drugs that give effect of: indifference to pain, hunger, tiredness (3)

A

heroin, methadone, buprenorphine

23
Q

Drugs that give effect of: muscle building

A

anabolic steroids

24
Q

Drugs that give effect of: sexual stimulation and muscle relaxation (2)

A

amyl nitrates, GHB

25
Q

The effect of drug is influenced by: (4)

A
  1. the amount taken
  2. the extent of previous use (tolerance)
  3. the person’s expectations
  4. surroundings in which the drug is taken
26
Q

Drugs that primarly reduce pain can have legitimate medical use. They occurs in 3 forms:

A
  1. natural (morphine, codeine)
  2. semi-synthetic (heroin)
  3. totally synthetic (methadone, pethidine)
27
Q

risks of opioids

A

sedation, vomiting
unconsciousness, respiratory depression, death

28
Q

what are two main opiate drugs which are abused?

A
  1. heroin
  2. methadone
29
Q

describe heroin intake

A
  • usually injected, sometimes inhaled after heated up
  • drug acts rapidly, person can die within minutes of injection
30
Q

typical post mortem findings in a case of heroin overdose (4)

A
  1. fresh needle puncture
  2. acute pulmonary oedema, sometimes seen as froth at the mouth and nose
  3. potential fatal level of heroin in the blood (detected as morphine becuase heroin gets quickly broken down)
  4. possible additional signs of chronic abuse (older needle punctures, chronic groin sinus, chronic leg ulcers, scars from old self-harming)
31
Q

what is methadone

A

it is an opiate drug which is prescribed for heroin to wean addicts of it, but often abused itself.

taken orally

32
Q

methadone final cause of death

A

bronchopneumonia (because of lying deeply unconscious for several hours)

33
Q

what drugs are primarily depressants? (4)

A
  1. alcohol
  2. benzodiazepines
  3. volatile substances
  4. GHB (gamma hydroxybutyrate)
34
Q

what are date-rape drugs

A

benzodiazepines

35
Q

what drugs are primarily stimulants? (2)

A

2 priniciple drug groups are:
1. cocaine, crack cocaine
2. amphetamine, amphetamine based drugs

36
Q

what are alkyl nitrates?

A

primarily vasodilator drug mainly used to enhance sexual performance in gay community to loosen up the a-hole

SE of severe headache and dizziness

37
Q

what drugs to alter perceptual function and produce hallucinations (5)

A

cannabis, nover psychoactive substances, ketamine, lsd, magic mushrooms

Forensics (15 decks)

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