PADIS and post mortem Flashcards
Difference of forensic and clinical toxicology
forensic = criminal or civil cases that testify in court
clinical = TDM testing done when TREATMENT neeeded
are lab techs regular or expert witnesses
regular
T/F Medical examiners must be a physician
T
T/F Coroners must be a physician
F - they do NOT have to be a physician except in Ontario
cause vs manner of death
cause - blunt trauma, opioid
manner - suicidal, accidental
what is the main cause of accidental deaths
opioid crisis
Common myth of overdose autopsy
overdoses do NOT show pill fragments - instead autospies rule our natural disease or truama
why do we use whole blood more than serum or plasma for autopsies
cells are hemolyzed after death
what are the fluid samples possible to get
blood - most abundant
vitreous humor - limited volume (3mL)
urine - not always available
injection site - NOT USEFUL as drugs are distrubted to all tissues
testing pro/cons for blood, vireous humor, and urine
blood- NOT good for biochemicals
vitrous humor - VERY good for alcohol and drugs
Urine- good for drugs
can you correlate drug [] in URINE with degree of impariment
NO
problems with liver sample lab testing post mortem
need to homogenize sample
high protein and lipid interferes
pros and cons of stomach sample
pro = interprets the TOTAL AMOUNT (not concentration) of drug
cons = presence of drug does NOT prove oral use
what is postmortem redistribution mechanism
-lungs and liver release drugs into blood after death
-pH decreases around lungs and liver
-basic drugs with >5L/kg will demonstrate the most redistribution
-cardiac increases redistribution
what causes delayed death
depressants (acetaminohen) with alcohols cause brain hypoxia
impaired metabolism for imiprimine (SSRI) enzyme
CYP2D6 and CYP3A4
what enzymes metabolize imiprimine
CYP2D6 - turns into hydroxyimprimaine CYP3A4 - turns into desparmine
Both switch enzymes to turn into hydroxydesimprimine
T/F you can detemine toxicity based off blood level values
F - tolerance exists
opiate vs opioid
opioid = activates mu-receptors of CNS
opiates = opium derived
what is a reversing agent for opioids
Narcan
how does narcan work
competetive antagoist binds to mu receptors = no activation
T/F repeated naloxone is needed for fent OD
T - halflife of fent is longer than naloxone
best way to administer naloxone
intravenous or intramuscular
oral is poor
what is one drug not reversed by nalaxone
benzodiazapines
