Midterm Flashcards
1
Q
Study of exogenous clinical compounds that profoundly influence bodily functions, either in a deleterious way or for therapeutic benefits
A
TOXICOLOGY
2
Q
enables physicians to adjust and optimize the dosage on an individual basis
A
Therapeutic drug monitoring (TDM)
3
Q
identify the offending drug/s (what function)
A
Identification of drugs in acute intoxication
4
Q
establish diagnosis, assess level of intoxication, suggest course of therapy (what function)
A
Identification of drugs in acute intoxication
5
Q
pre-employment and medico-legal cases (what function)
A
Urine testing for drugs of abuse
6
Q
4 areas : CLINICAL TOXICOLOGY LABORATORY
A
- drugs of abuse
- therapeutic drugs
- environmental carcinogens
- toxins
7
Q
Test animals are used
A
-Direct administration: ingestion, application to the skin, inhalation, gavage, etc.
-Indirect: test animal is exposed to the substance in its environment (H20 or air)
8
Q
Toxicity is measured as clinical “endpoints”:
A
- Mortality (death)
-Teratogenicity (cause birth defects)
-Carcinogenicity (cause cancer)
-Mutagenicity (cause changes in the DNA)
9
Q
-Received regular maintenance doses of the drug for about five half-lives of the drug (OPTIMAL TIME FOR BLOOD SPECIMENS)
A
Steady state concentration
10
Q
For most orally taken drugs (OPTIMAL TIME FOR BLOOD SPECIMENS)
A
Just before the next dose
11
Q
-Shortly after receiving the drug
- For patients who exhibit toxic symptoms
(OPTIMAL TIME FOR BLOOD SPECIMENS)
A
Peak or post-dose level
12
Q
TECHNIQUES FOR DRUG ANALYSIS
•Immunologic
A
- Enzyme immunoassay systems
- Fluorescence immunoassay
- radioimmunoassay
13
Q
TECHNIQUES FOR DRUG ANALYSIS
•Chromatographic
A
-HPLC
-GLC
-TLC
14
Q
TECHNIQUES FOR DRUG ANALYSIS
•Spectrophotometry
A
-Visible spectrum, ultraviolet spectrum and fluorescence
15
Q
–Serum + antibody + enzyme- labelled drug + substrate
A
ENZYME MULTIPLIED IMMUNOASSAY TECHNIQUE (EMIT)
16
Q
Measured enzyme activity of EMIT
A
drug concentration
17
Q
More rapid than RIA
A
ENZYME MULTIPLIED IMMUNOASSAY TECHNIQUE (EMIT)
18
Q
1st homogenous Enzyme Immunoassay
A
ENZYME MULTIPLIED IMMUNOASSAY TECHNIQUE (EMIT)
19
Q
most useful; less likely to be affected by serum constituents (in EMIT)
A
MDH (Malate dehydrogenase) & G-6-PD (glucose-6-phosphate dehydrogenase)
20
Q
Measures drugs (mg/L) & drug metabolites in biological fluids
A
EMIT
21
Q
Some drugs detected in EMIT
A
Cocaine & metabolites, cannabinoides, opiates & barbiturates
22
Q
Drug to be measured is the hapten
A
ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA)
23
Q
Specific antibodies bound to a solid state carrier
A
ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA)
24
Q
Separation of the bound drug from the unbound
A
ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA)
25
Digoxin and digitoxin tests
ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA)
26
Rodenticides, weed killers, insecticides
Arsenic
27
Interacts w/ enzyme SH (sulfhydryl) groups > disrupts multiple metabolic systems
Arsenic
28
Acute fatal dose of arsenic
120 mg
29
Toxicity manifested w/in the first hour : GI symptoms (diarrhea)
Arsenic
30
Analysis of urine, hair and nails: Ion Emission Spectroscopy
Arsenic
31
Treatment for Arsenic
- Gastric lavage or emesis
- Dimercaprol or BAL
- Hemodialysis
32
Acute poisoning common in young children
Iron
33
Toxic amount of Iron
>30mg/kg
34
Once absorbed, removal is difficult
Iron
35
Hepatic cell damage, shock, lactic acidosis
Iron
36
initial manifestation of Iron
Vomiting
others: Severe gastroenteritis, melena, abdominal pain and hematemesis
37
Diagnosis of Iron
• Serum iron concentration
• TIBC (Total Iron Binding Capacity)
38
Treatment of Iron
- Supportive treatment
- Emesis or gastric lavage
- Chelation therapy: deferoxamine
39
Forms of Mercury
1. Elemental or metallic: toxic when inhaled
2. Mercurous/ Mercuric: salt form
3. Alkyl mercury: environmental pollutants
40
Acute toxicity of Mercury
24 hr. urine levels
41
Chronic toxicity of mercury
hair analysis
42
Treatment of mercury
• Treatment: gastric lavage or emesis
- Dimercaprol and succimer
43
Organic and inorganic _____: highly toxic
lead
44
Interacts with -SH, -COOH & PO4 in proteins (e.g. enzymes)
lead
45
effect CNS (Central Nervous System) and PNS (Peripheral Nervous System)
lead
46
introduce in the body by Inhalation or ingestion
lead
47
Fatal dose of lead
0.5mg absorbed/day - chronic toxicity
0.5 g absorbed - acute toxicity
48
Acute toxicity: Signs and symptoms of lead
—CNS symptoms:
Encephalopathy (enlargement of brain), convulsions, stupor
—GI symptoms: colic
49
Chronic toxicity of lead
Accumulation in blood, soft tissues and bone
50
Low-level exposure of lead
ADHD & decrease in I.Q
51
Characteristic of lead
"wrist drop or foot drop" manifestation
52
LEAD TOXICITY
•Bone - 96% of burden
- Half-life of lead in bone is 32 years mas madami
- Reservoir for endogenous intoxication
53
•Lab. Diagnosis of lead
•basophilic stippling in RBCs
• gama ALA in urine
54
Diagnosis of lead
• AAS
•Anode stripping voltametry.
55
Treatment of lead
•Supportive
• Gastric lavage
• Dilute MgSO4 or Na2SO4
•Chelating agents: dimercaprol, calcium disodium acetate & succimer
56
esters of H3PO4 or thiophosphoric acid
•Organophosphates
57
synthetic derivatives of carbamic acid
•Carbamates
58
• Widely used as pesticides
•Interfere with neurotransmission
•Carbamates
59
•Inhibit acetylcholinesterase: ORGANOPHOSPHATE AND CARBAMATES
hydrolyzes acetylcholine after it has effected an action potential
60
excitatory neurotransmitter of ORGANOPHOSPHATE AND CARBAMATES
•Acetyl choline
61
Signs and Symptoms of ORGANOPHOSPHATE AND CARBAMATES
- Parasympathetic manifestations: salivation, lacrimation, urination and defecation
62
Autonomic manifestations of ORGANOPHOSPHATE AND CARBAMATES
-Muscular weakness, tachycardia, hypertension
63
CNS manifestations of ORGANOPHOSPHATE AND CARBAMATES
-Confusion, slurred speech, ataxia, convulsions
64
Diagnosis of ORGANOPHOSPHATE AND CARBAMATES
• Assay of cholinesterase activity
65
Treatment of ORGANOPHOSPHATE AND CARBAMATES
- Respiratory support
-Gastric lavage or emesis
-Atropine
-Pralidoxime (organophosphate)
66
aromatic compounds produced in cigarettes and in exhaust of engines → lung cancer
Benzopyrene
67
preservative of red meat → colon cancer
Nitrites
68
produced by Aspergillus; hepatocellular carcinoma
Aflatoxin
69
benzene → acute leukemia
Aromatic hydrocarbon
70
angiosarcoma
Vinyl chloride
71
multiple malignancies
Benzidine dyes
72
lung cancer and mesothelioma
Asbestos
73
used in gas chamber
Hydrogen cyanide
74
floor cleaner
Ammonia
75
industrial solvent
Toluene
76
white ant poison
arsenic
77
lighter fuel
butane
78
insecticide
DDT
79
paint stripper
acetone
80
Benzopyrene
pyrene
81
moth balls
Naphthalene
82
car batteries
Cadmium
83
car exhausts
Carbon monoxide
84
known cancer causing substance
Vinyl chloride
85
Any substance that produces physiological or psychological change within a short period of time after ingestion of a specified dose
Working Definition of a Drug
86
When an individual becomes strongly attached to a drug
Nature of Drug Dependence
87
Dependency is subdivided into two categories
physiological and psychological
88
* The body continually needs to have the drug
* A person experiences sickness if drug is discontinued
Physiological Dependence
89
* A person develops an uncontrollable "craving" (mental or emotional need) for a drug
* The craving is a desperate need to continue
Psychological Dependence
90
drug of abuse
any substance that is used for some purpose (w/ a desirable effect) other than that intended.
-the possession or supply is restricted by law because of its potential harmful effect on the user.
-Such drugs are known as controlled or scheduled substances.
91
•According to the WHO, scheduled drugs are 'abused' rather than 'misused'. T or F
T
92
Drugs of abuse may or may not lead to physical or ‘psychological dependence', a term used by the WHO in preference to 'addiction' . T OR F
T
93
taken as painkillers (analgesic)
Narcotic Drugs
94
taken to increase mental and physical energy
Stimulants
95
taken to change one's mental state
Hallucinogens
96
taken to dull one's senses, to reduce anxiety, or induce sleep
Depressants, Hypnotics, & Tranquilizers
97
taken to enhance one's enjoyment of a party or other social activities
Club Drugs
98
taken to build muscles, endurance, or enhance athletic performance
Performance Enhancing Drugs
99
Derived from Papaver somniferum
Opiates or Narcotic Drugs
100
produced from the drying resin of unripe capsules of the opium poppy
Opium
101
Use of Opiates or Narcotic Drugs
treatment of GIT pain & diarrhea for infants
102
are psychologically addictive drugs; withdrawal causes severe physiological symptoms
Opiates
103
1° active drug in opium
Morphine
104
word comes from the Greek word "Morpheus"
Morphine
105
Uses of morphine
analgesic, light anesthetic or sedative
106
Mode of administration of morphine
Intravenous
107
Street Names of morphine
M, dreamer, emma, emsel, pulbos
108
2nd most abundant component; strong painkiller and cough suppressant
Codeine
109
Street Name of codeine
Schoolboy
110
white powder (diamorphine HCI & minor amounts of opium alkaloids)
SEA
111
brown powder (diamorphine base, opium-derived alkaloids & adulterants)
SWA
112
is treated to extract the morphine & the extract is acetylated with Acetic anhydride to produce diamorphine
raw opium
113
Mode of administration of diamorphine
Injection
114
site of injection for diamorphine
Inside of arm (beginners - middle biceps to middle of forearm)
Arm toward the back of the hand
• Feet, legs, thighs & groin
115
other site of injection for diamorphine
• veins of the neck
• under the tongue
• Breast (for females)
• Dorsal veins of the penis (for males)
CLUES: Needle tracks & sclerosing of veins
116
pharmacologically related to heroin
Methadone
117
Used for treatment of heroin addiction
Methadone
118
relief of moderate pain
Propoxyphene (Darvon)
119
Abused stimulants
Amphetamine, methamphetamine, and cocaine
120
is the drug most commonly produced in clandestine labs
Methamphetamine
121
Resemble epinephrine & norepinephrine
AMPHETAMINE & METHAMPHETAMINE
122
Used for the treatment of obesity
AMPHETAMINE & METHAMPHETAMINE
123
Common adulterants for Amphetamine:
—Caffeine (increase stimulant effect or mask low levels)
—Sugars (e.g. lactose) used as diluent
124
Normally produced as amphetamine sulfate, hydrochloride or phosphate
More commonly abused in Europe
AMPHETAMINE
125
Produced as methamphetamine hydrochloride
More popular in North America and Japan
METHAMPHETAMINE
126
- derived from genus Erythroxylum
COCAINE
127
sniffed through the nose (snorting")
Cocaine HC
128
- base form; vaporized by heat in a pipe and inhaled
"Crack"
129
Local anaesthetic, vasoconstrictor & powerful psychostimulant
cocaine
130
* Cause a significantly altered mental state, often including hallucinations
* Marijuana is one of the oldest
HALLUCINOGENS
131
* Cause a significantly altered mental state, often including hallucinations
* Marijuana is one of the oldest
HALLUCINOGENS:
132
PHENCYOIDINE ROD: Street Names
Angel Dust, Angel Hair, Crystal, Keeler Weed
133
Used as surgical anaesthetic during World War I (patented by Parke-Davis in 1957 as "Sernyl")
PHENCYOIDINE ROD
134
Side-effects of PHENCYOIDINE ROD
delirium, paranoia, hallucinations & euphoria
135
Very popular as a drug of abuse in the 1960s & 1970s (hippy movement")
LYSERGIC ACID DIETHYLAMIDE (LSD)
136
starting material; derived from rye ergot fungus
Lysergic acid
137
Refers to all parts of the plant Cannabis sativa L., except the seeds & mature woody stalk material
MARIJUANA (HERBAL CANNABIS)
138
major psychoactive agent of MARIJUANA (HERBAL CANNABIS)
Delta-9-tetrahydrocannabinol
139
Effects of marijuana
euphoria & heightened sensory awareness and distortion of time, sound and color, feeling of relaxation
140
- Cannabis resin made from the flowering tops of the plant
Hashish
141
Metabolites of Marijuana:
Delta-9-carboxy-THC
111-hydroxy-delta-9-THC
142
OTHER NATURAL HALLUCINOGENS
a. Peyote - bud of a particular cactus
• Main active ingredient: "mescaline"
b. Magic mushrooms: Genus Psilocybe
Active components: psilocin and psilocybin
143
- most abused depressant in the world
Alcohol
144
- physiologically active depressants, resulting in a physical & mental state similar to alcohol-induced intoxication
Barbiturates
145
Phenobarbital (long-acting)
›anticonvulsant
Amobarbital (intermediate-acting)
Pentobarbital (short-acting)
Thiopental (ultra-short-acting) > sedative-hypnotic
Barbituric acid
146
Condensation product of urea and matonic acid
Fat soluble: easily crosses BBB
Low doses: sedation, drowsiness and sleep
Higher doses : anesthesia
Very high doses : stupor, coma and death
Toxicity: depression, cyanosis, hypothermia, hypotension
147
Most are now rarely prescribed; illicit synthesis is rare
U.S.: Lorazepam & Alprazolam (typically abused); Flunitrazepam (banned)
BENZODIAZEPINES
148
- tranquilizer drug designed to relieve anxiety
Valium
149
- a major drug of abuse at raves and the club scene
Rohypnol or "roofies"
150
prepared by clandestine labs, or obtained legally from other countries
CLUB DRUGS:
151
most common drug encountered in "ecstasy" tablets
increase in secretion & inhibition of re-uptake of serotonin, dopamine & norepinephrine in the brain
METHYLENEDIOXYMETHAMPHETAMINE (MDMA) - "love drug"
152
causes euphoria, a feeling of empathy, increased energy and tactile sensation
MDMA
153
Short-term health risks: MDMA
hypertension, hyperthermia & dehydration
154
Long-term effect: MDMA
severe depression due to permanent disruption of serotonin production in the CNS
155
Synonyms: Sodium oxybate, gamma OH, Somtomax, "GHB" and liquid ecstasy
acts as a CNS depressant and hypnotic; chemically related to GABA
Gained notoriety for its use in drug-facilitated sexual assault
GHB (gamma hydroxybutyrate) and analogues
156
- anesthetic and animal tranquilizer; causes anterograde amnesia
Ketamine
157
have been implicated in cases of drug-facilitated sexual assaults “date-rape" drugs
Rohypnol, GHB, and ketamine
158
The first drug controlled because of their abuse by athletes were
anabolic steroids
159
promote cell growth resulting in growth of muscle tissue and sometimes bone size and strength
Anabolic steroids
160
SCHEDULE OF DRUGS
* I - for research only; no approved medical use
* II - Rx drugs; special prescription; unrefillable
-I and II: high potential for abuse
* III and IV - available by prescription;
- may have 5 refills in 6 months
* V - Over the Counter (OTC)
161
Schedule
× Schedule I
• Marijuana
• Hashish
• Heroin
• LSD
× Schedule II
Opium
• Cocaine
• Amphetamine
Methamphetamine
Schedule III
Phenobarbital
• Diazepam
Anabolic steroids
162
OTHER COMMONLY ABUSED DRUGS
1. Nicotine - cigarettes, tobacco
2. Ethyl alcohol - liquor, beer, wine
3. Dextromethorphan
- cough and cold medications
4. Inhalants
- solvents (paint thinners, gasoline, glues), gases (butane, propane), nitrites
163
Republic Act No 9165: June 7,2002
- Comprehensive Dangerous Drugs Act of 2002
- repealed Republic Act No 6425 (Dangerous Drugs Act of 1972)
