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AT CHEMPATH > ChemPath: Drug, Forensics and Toxicology > Flashcards

ChemPath: Drug, Forensics and Toxicology Flashcards

1
Q

What sorts of deaths are reported to the coroner and what act is this under?

A

Section 3 of the Coroner’s Act 1887

  1. Violent
  2. Unnatural or sudden
  3. Cause of death is unknown

A number of these require analysis for drugs and alcohol in order to establish the cause of death

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2
Q

What sorts of case types are reported to the coroner?

A
  • Addicts / drug use
  • Sudden unexplained / natural
  • Hanging
  • Overdoses
  • Road Traffic Collisions
  • Train deaths
  • Self-inflicted injury
  • Fire
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3
Q

What samples do coroners take?

A
  • Ante-mortem serum / blood
  • Post-mortem blood
  • Heart blood, cavity blood (screening)
  • Femoral vein blood (screening and quantitation)
  • Urine
  • Stomach contents
  • Vitreous humor
  • Hair
  • Liver
  • Others – bile, muscle, powders, syringes
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4
Q

What is the most common drug problem?

A

Alcohol

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5
Q

What are the main problems associated with alcohol?

A
  • OD
  • Accidents including RTCs
  • Additive effects other respiratory depressant drugs
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6
Q

What are the main problems associated with heroine?

A
  • IV injection, volatilised
  • Fatal OD with both routes of ingestion
  • Additive effects other respiratory depressant drugs
  • Few rapid deaths
  • Most respiratory depression or aspiration pneumonitis
  • Tolerance
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7
Q

What is toxicology?

A

Concerned with anaylsing samples of drugs/poisins and interpreting the significance of the results.

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8
Q

What does ‘forensic’ mean?

A

Results/reports used in court

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9
Q

Why might drug levels appear erroneoously elevated post-mortem?

A

Tissue breakdown can lead to the release of drugs from various tissues

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10
Q

Where can a sample be taken from for drug concentration measurement?

A

Femoral vein blood

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11
Q

When is vitreous humour used as a sample?

A

Used to measure glucose (may be elevated in DKA)

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12
Q

How can heroin overdose kill?

A

Respiratory depression or aspiration pneumonitis

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13
Q

What are the acute dangers of cocaine?

A
  • Cardiac dysrhythmias
  • Acute heart failure
  • MI
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14
Q

What is the effectof mixing ethanol with cocaine?

A

Forms cocaethylene which prolongs the effects of cocaine

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15
Q

What happes to cocaine in post-mortem blood?

A

Breaks down rapidly so the concentration in post-mortem blood may be considerable lower than at the time of death.

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16
Q

Describe the consequences of amphetamine overdose.

A

Causes hyperthermia → rhabdomyolysis → renal failure

Also has a direct toxic effect on the heart

17
Q

List some examples of legal highs.

A
  • Stimulats (e.g. bath salts)
  • Synthetic cannabinoids / k2 spice
  • Synthetic opioids (e.g. acetylfentanyl)
  • Hallucinogenic compounds
18
Q

How long can drugs be detected for in the:

  1. Blood and serum
  2. Urine
A
  1. Blood and serum = 12 hours
  2. Urine = 2-3 days
19
Q

How are hair samples used in forensic toxicology?

A
  • Demonstrating a history of drug use or lack of it
  • Demonstrating tolerance or lack of tolerance to drugs (helps interpret post-mortem drug concentrations)
  • Compliance with medications (e.g. antipsychotics)

NOTE: hair samples are rarely used in coroner’s toxicology but it is used in forensic investigations

20
Q

What are the issues with hair analysis?

A
  • Environmental contamination
  • Cosmetic treatment - perm/bleaching/dyeing may remove some drug
  • Hair colour - darker hair retains more drug
21
Q

What are the main drugs used in chemsex?

A

GHB

Methylamphetamine (crystal meth)

Mephedrone (MCAT)

22
Q

Where is the most important PM blood sample taken from

A

Femoral vein

23
Q

How to differentiate between chronic use and acute OD of a drug in PM blood?

A

Acute: high metabolite : parent drug ratio

Chronic: high parent drug : metabolite ratio

24
Q

How fast does hair grow?

A

1cm / month

25
Q

What is the gold standard test for identification of toxicological analysis?

A

GC-MS (gas chromatography/mass spectrometry)

26
Q

How does GC-MS and LC-MS differ?

A

GC-MS = gas chromatography/mass spectrometry
LC-MS = liquid chromatography

GCMS is the gold standard
However LCMS is more sensitive and can analyse a wider range of analytes

27
Q

What test is used to analyse ethanol/solvenets in PM blood?

A

Headspace GC

28
Q

When is quantitation of toxins/analytes done?

A

Done (on blood sample) if the concentration found in the screen is above the therapeutic range

29
Q

What is heroin measured as in a PM?

A

Measured as morphine
Because Heroin -> 1-acetylmorphine -> morphine

30
Q

What factors affect the interpretaation of PM drug concentrations?

A

Tolerance
Stability of drug e.g. cocaine breaks down rapidly
Volume of distribution (Vd) - tissues breakdown which redistributes drug after death, hence PM blood conc can’t be used to calculate dose
Individual variations in response

AT CHEMPATH (24 decks)

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