Clinical toxicology testing and performing enhancing drugs

Question 1

what is impacted the most from society due to alcohol abuse

Answer 1

lost productivity

Question 2

why is urine a preferred specimen

Answer 2

higher [] of drugs compared to others

screening assay compatible

Question 3

limitations of urine as a specimen

Answer 3

dont know how much or when drugs were ingested

ritalin/methlyphenidate or oral hypoglycemics will NOT be detected

Question 4

how long can weed stay in the urine

Answer 4

30 days

Question 5

how long can herioin and alcohol stay in the urine

Answer 5

less than a day

Question 6

what is the workflow for testing of drugs

Answer 6

1 immunoassay testing (screen)
2. GCMS = targeted scan
3. LC/MS/MS = opiod ID

Question 7

What is KIMS immunoassay based on

Answer 7

competitive homogenous immunoassay by using R1 and R2

Question 8

What does KIMS detect

Answer 8

THC
Benzodiazepines
Opiates (poppy seeds pos)

Question 9

what is a false pos for KIMS

Answer 9

Oxaprozin aka daypro

Question 10

How does a KIMS immunoassay work

Answer 10

when drug is not present - clumping of ab = high absorbance

when drug is present - binds to ab without clumping = low absorbance

Question 11

How does EMIT and DRI immunoassays work

Answer 11

when drug is not present - G6PD binds to reagent 1 ab = no reaction

when drug is present - G6PD is free and converts G6P into NADH = absorbance change

Question 12

what drugs can EMIT and DRI test

Answer 12

antidepressants

oxycodone (ONLY DRI)

Question 13

what absorbance is EMIT and DRI use

Answer 13

340nm

Question 14

how does CEDIA immunoassay work

Answer 14

when drug is not present - ED is bound to reagent 1 ab = no reaction

when drug is present - ED is bound to EA and converts CPR = absorbance change

Question 15

what absorbance does CEDIA use

Answer 15

570nm

Question 16

what drugs does CEDIA detect

Answer 16

Fentanyl

Question 17

what drugs are immunoassays good at for avoiding cross reactivity

Answer 17

lorazepam and temazepam glucuronide

Question 18

what factors is mass spec based on

Answer 18

based on retention time and fragmentation patterns

Question 19

what drug is seen as impurities

Answer 19

oxycodone

Question 20

3 ways of adulterating a sample

Answer 20

1. internal and external dilution (drinking or adding water)
2. tampering (adding agent)
3. substitution (not your sample)

Question 21

how do we test if a sample has been tempered or adulterated

Answer 21

test pH

Question 22

how do we test if a sample has been substituted

Answer 22

test creatinine and specific gravity

Question 23

why are stat drugs not tested

Answer 23

does not rule out poisoning

no good information from acute care

many drugs cause similar symptoms

false pos possible

Question 24

what is the role of WADA in drug regulation

Answer 24

world anti doping association acredited by 1 lab

establishes banned substances

normal physiological proccess of athleetes

Question 25

what happens when you abuse steroids

Answer 25

1. High BP/LDL 2. liver and heart damage 3. cancer 4. premature epiphyseal fusion

Question 26

What synthetic PED causes liver damage when abused

Answer 26

anavar

Question 27

what endogenous PED causes organomegaly

Answer 27

insulin

Question 28

what stimulants cause cardiac arrest

Answer 28

amphetamines

Question 29

what stimulant causes bronchoconstriction

Answer 29

clenbuterol

Question 30

what biological PED causes acceleration of existing cancers

Answer 30

hCG

Question 31

what ratio of testosterone: epitestosterone indicates doping

Answer 31

>6;1

Question 32

why is epitestosterone better to ID PED usage

Answer 32

more stable in blood

Question 33

what tests are used to confirm EPO

Answer 33

laminar flow immunoassay (chromatography - screening) and isoelectric focussing (electrophoresis - confirmatory) for exogenous doping rHuEPO and darbepoetin alpha

Question 34

how does WADA perform EPO testing

Answer 34

Biological passports

Question 35

what are issues with hGH detection

Answer 35

1. cross reactivity (similar hormones related) 2. hormone standardization (many forms of hGH)

Question 36

how do we test for hGH (avoiding issues with detection)

Answer 36

test for IGF-1

Question 37

what are the cons of immunoassay for PED screenign

Answer 37

easy to tamper false pos = binding random compounds false neg = poor binding affinity

Question 38

what are SARMS for and an example of

Answer 38

Ligandrol = for muscle growth

Question 39

why are exogenous use of endogenous hormones difficult to detect

Answer 39

endogenous hormones fluctuates and diurnal variation