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Clinical Chemistry > Drugs of Abuse/Alcohol > Flashcards

Drugs of Abuse/Alcohol Flashcards

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1
Q

Cocaine

A
  • Can be used as local anesthetic or CNS stimulant
  • Half-life of 30min-1hr
  • Elimination dependent on Liver metabolization to BE and filtration by kidney
  • Primary metabolite is benzoylecgonine, found in urine for 3 days follwing use; can be up to 20 days with a chronic user
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2
Q

THC

A
  • Half-life 1 day from single use, 3-5 days chronic use
  • Distributes to lipophilic tissue
  • Metabolized by Liver to THC-COOH, which is detectable in urine 3-5 days after
  • Detected by Immunoassays and GC
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3
Q

Benzodiazepines

A
  • Tranquilizer, causes CNS depression
  • Cause respiratory acidosis
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4
Q

Barbiturates

A

CNS depression

Cause respiratory acidosis

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5
Q

Drugs screened for in urine

A
  • Amphetamines, 2 days
  • Barbiturates, 9 days (phenobarbital)
  • Benzodiazepines
  • THC, clears in 5 days
  • Cocaine (Metabolized to benzoylecoginine in 3.5min, test is for BE), 2 days
  • Opiates (Morphine)
  • PCP, 7 days
  • Propoxyphene
  • Opiates, 1-2 days
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6
Q

PCP

A
  • Produces stimulant, depressant, anesthetic, and hallucinogenic effects
  • Distributes to lipophilic tissue, elimination depends on Liver metabolism, filtered by kidneys
  • Detectable in urine for 7-30 days following chronic use
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7
Q

Opiates

A

Used for anesthetic/sedative properties

Respiratory depressant causing respiratory acidosis

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8
Q

Screening Methods

A
  • All based on Immunoassy
  • 20 ng/mL
  • Confirmed with GC/MS
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9
Q

Causes of False Neg/Pos in screening

A
  • Cross reactivity with other drugs
  • Chemical interferences
  • Actual Drug not abused
  • Dilution/Substitution
  • Adulteration
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10
Q

Adulteration

A
  • Adding water/bleach/Visine/Urinaid/Joy Soap to urine for masking; commonly in THC testing
  • Checking for Adulterants, Adulta Check 4
  • Regent Test Strips for Nitrate, Glutaraldehyde, Creatinine, pH
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11
Q

False Positives in Opiates

A

Poppy Seeds

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12
Q

False Positives in Methamphetamine

A
  • Vick’s Inhaler with I-methamphetamine
  • Can be used to treat narcolepsy and problems focusing
  • Detected by immunoassays and GC
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13
Q

HCG in Sports

A
  • HCG 22 is produced by the placenta
  • When injected into males, causes testosterone production and inhibits its shut down (counteracts anabolic steroids)
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14
Q

Codeine Conversion

A
  • Converted to morphine by cytochrome
  • 10% people cannot convert due to a genetic polymorphism
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15
Q

EMIT

A

Drug Ab-enzyme, patient drug replaces enzyme on Ab and starts NADH reaction

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16
Q

ELISA

A

Drug Ab binds drug and drug conjugate inproportion to patient drug level in sample

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17
Q

FPIA

A

Drug Ab binds drug and drug-FITC conjugate, changing fluorescence polarization directly proportional to conjugate bound

18
Q

Pharmacological Actions of Barbiturates

A

Anticonvulsant, with sedation in most doses except phenobarbital

High doses cause muscle relaxation, overdose causes medullary depression, respiratory arrest, hypotension, and cardiovascular collapse

19
Q

Drug Groupings based on addiction potential

A
  • I, no known medical use (LSD, Peyote, marijuana, GHB)
  • II, Opium, morphine, codeine, oxycodone, amphetamines, barbiturates
  • III, barbiturates and narcotics in limited amounts
  • IV, benzodiazepines, chloral hydrate, phenobarbital
  • V, Antitussives, antidiarrheals in very limited amounts
20
Q

General Structure of Alcohols

A
  • Methanol, HO-CH3
  • Ethanol, HO-CH2-CH3
  • Propanol, HO-CH2-CH2-CH3, used as GC standard
  • Isopropanol, HO-CH3-CH-CH3, rubbing alcohol
  • Ethylene Glycol, HO-CH2-CH2-OH, antifreeze
21
Q

Alcohol metabolism

A
  • ADH (alcohol dehydrogenase) oxidizes ethanol to acetylaldehyde, then oxidized to acetate by AcDH
  • These reactions also reduce NAD+ to NADH
  • Aceytlaldehyde and acetate are toxic and cause side effects of alcohol consumption
22
Q

Adverse Effects of Alcohol

A
  • Loss of NAD+ limits energy production
  • LDH (lactate dehydrogenase) is produced more due to increased NADH
  • Reduces capacity of liver to deliver glucose to blood
23
Q

Specimen Requirements

A
  • Venous blood
  • Reported in g/dL (%)
  • Breath analysis, # grams per 210L of breath (%)
24
Q

Signs/Symptoms/Diagnosis of Alcoholism

A

BAC >150mg/dL with no evidence of intoxication, systemic diseases/organ dysfunctions

25
Q

Systemic Effects of ETOH

A
  • Liver
  • Early: replacement of hepatocytes by adipocytes
  • Late: CT replaces liver cells
  • Vascular: hypertension, arteriosclerosis, hemorrhage, acidosis
  • Kidneys: dehydration, high electrolytes, urates
  • Muscle/CNS: protein denaturation, low coenzymes
26
Q

Metabolic Pathway Alteration

A

Liver damage, shown by liver enzyme elevations, inability to conjugate bilirubin, increased lipogenesis and ketone body synthesis, decreased glycolysis, glucogenesis and protein biosynthesis

27
Q

Predisposition to Alcoholism

A
  • ADH deficiency
  • Genetics, AcDH deficiency in Asian pop.
  • Gender, Females can lack ADH
  • Body mass/size, smaller people affected sooner
  • Drinking history
28
Q

Alcohol reactions with Drugs

A
  • Increase drug absorption in GI
  • Liver enzymes that degrade drugs may speed up catabolism of drug
  • May increase ratio of free:bound drug
29
Q

Ca Legal Limit

A

0.08g/dL

30
Q

Zero Order Elimination (alcohol)

A

10mL ethanol oxidized per hour

31
Q

Analytical Methods for BAC

A
  • Enzymatic, enzyme + NAD+ and ADH gives acetaldehyde + NADH
  • Kinetic, ethanol oxidase and Clark Electrode to monitor change in PO2
  • GC, differentiates and quantifies different alcohols
  • Osmolality and Osmolar Gap
  1. Osmolar gap >10, ethylene glycol is likely
  2. Osmolar Gap = measured osmolality – calculated osmolality
  3. Calculated osmolality = 1.86(Na) + Glucose/18 + BUN/28 + 9
32
Q

Osmolar Gap Calculation

A

Osmolar Gap = measured osmolality – calculated osmolality

33
Q

Calculated Osmolality Calculation

A

Calculated osmolality = 1.86(Na) + Glucose/18 + BUN/28 + 9

34
Q

Liver Function Tests

A
  • Bilirubin
  • AST
  • ALT
  • ALP
  • GGT
35
Q

Antifreeze Biotransformation to toxic metabolite

A

Converted to Oxalic Acid crystals which lead to renal failure by causing metabolic acidosis

36
Q

Ethylene Glycol

A
  • Distinguish from Ethanol with Blood Test
  • Diagnosed by metabolic acidosis, anion gap, osmolar gap, urinary calcium oxalate crystals
  • General Lab Results: pH 7.3, pCO2 13, CO2 6.2, osmolality 314, anion gap 33
  • Treatment: ethanol IV and 3 doses fomepizole at 10mg/kg
37
Q

Anion Gap

A

Na – [C + HCO3]

[Na + K] – [Cl + HCO3]

Outside range indicates Lab error or metabolic acidosis

38
Q

Methanol Effects

A

Severe acidosis, blindness, and death upon conversion to formaldehyde then formic acid

39
Q

Isopropanol Effects

A

Similar to Ethaonl, but persist for longer because it is metabolized to acetone

40
Q

Ethylene glycol Effects

A

Severe metabolic acidosis and renal tubular damage

41
Q

(Meth)Amphetamine

A

May be used to treat narcolepsy and disorders involving focus

Clinical Chemistry (38 decks)

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