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MLSCI 466 Final > PADIS and post mortem > Flashcards

PADIS and post mortem Flashcards

1
Q

Difference of forensic and clinical toxicology

A

forensic = criminal or civil cases that testify in court

clinical = TDM testing done when TREATMENT neeeded

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2
Q

are lab techs regular or expert witnesses

A

regular

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3
Q

T/F Medical examiners must be a physician

A

T

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4
Q

T/F Coroners must be a physician

A

F - they do NOT have to be a physician except in Ontario

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5
Q

cause vs manner of death

A

cause - blunt trauma, opioid

manner - suicidal, accidental

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6
Q

what is the main cause of accidental deaths

A

opioid crisis

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7
Q

Common myth of overdose autopsy

A

overdoses do NOT show pill fragments - instead autospies rule our natural disease or truama

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8
Q

why do we use whole blood more than serum or plasma for autopsies

A

cells are hemolyzed after death

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9
Q

what are the fluid samples possible to get

A

blood - most abundant
vitreous humor - limited volume (3mL)
urine - not always available
injection site - NOT USEFUL as drugs are distrubted to all tissues

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10
Q

testing pro/cons for blood, vireous humor, and urine

A

blood- NOT good for biochemicals

vitrous humor - VERY good for alcohol and drugs

Urine- good for drugs

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11
Q

can you correlate drug [] in URINE with degree of impariment

A

NO

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12
Q

problems with liver sample lab testing post mortem

A

need to homogenize sample

high protein and lipid interferes

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13
Q

pros and cons of stomach sample

A

pro = interprets the TOTAL AMOUNT (not concentration) of drug

cons = presence of drug does NOT prove oral use

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14
Q

what is postmortem redistribution mechanism

A

-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

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15
Q

what causes delayed death

A

depressants (acetaminohen) with alcohols cause brain hypoxia

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16
Q

impaired metabolism for imiprimine (SSRI) enzyme

A

CYP2D6 and CYP3A4

17
Q

what enzymes metabolize imiprimine

A

CYP2D6 - turns into hydroxyimprimaine CYP3A4 - turns into desparmine

Both switch enzymes to turn into hydroxydesimprimine

18
Q

T/F you can detemine toxicity based off blood level values

A

F - tolerance exists

19
Q

opiate vs opioid

A

opioid = activates mu-receptors of CNS

opiates = opium derived

20
Q

what is a reversing agent for opioids

A

Narcan

21
Q

how does narcan work

A

competetive antagoist binds to mu receptors = no activation

22
Q

T/F repeated naloxone is needed for fent OD

A

T - halflife of fent is longer than naloxone

23
Q

best way to administer naloxone

A

intravenous or intramuscular

oral is poor

24
Q

what is one drug not reversed by nalaxone

A

benzodiazapines

25
Q

what is the most common substance combined w fent that causes unintentional death

A

alcohol and fent

26
Q

upcoming drug more potent than fent

A

nitazenes (20x stronger)
carfent (100x stronger)

27
Q

limitation to cardiac glycosides or digoxin testing in GC/MS

A

immunoassay are not definitive

GC injection port breaks down digoxin

28
Q

best testing for digoxin

A

LC/MS

29
Q

can pancuronium and succinylcholine be tested using LC/MS/MS

A

pancuronium (Stable) can be tested

succinylcholine (unstable) cannot

30
Q

can heavy metals undergo postmortem redistribution

A

yes - eg. cadmium

therfore we cannot use referene ranges postmortem

31
Q

PADIS definition

A

poison and drug information services

32
Q

role of PADIS

A

helpline for those who need information of substance ingestion or doctors call them for help aka toxocoviligance

33
Q

what questions do PADIS ask?

A
  1. clinical status?
  2. what/when/how much did they take?
  3. physical exam
34
Q

What is included in a tox workup

A
  1. tox panel for LACTATE
    2.ECG
  2. Chest Xray
35
Q

T/F Urine is good for tox screen

A

F - immuno assay is not effective as they are just screening and has cross reactivities

36
Q

does charcoal adsorb or absorb toxins

A

adsorbs

37
Q

what are toxic drugs that cause hot and bothered symtpoms

A
  1. cocaine
  2. antidepressants
  3. ETC UNCOUPLERS (aspirin)
38
Q

T/F - give tylenol for high temp

A

F - cool the body rapily with ice, or cooling/fanning

MLSCI 466 Final (4 decks)

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