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Clinical Chemistry 2 - CEUMLS > Toxicology (part 2) > Flashcards

Toxicology (part 2) Flashcards

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1
Q

therapeutic drugs that undergo toxicology

A

Salicylates
Acetaminophen

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2
Q

aka Salicylates

A

Acetylsalicylic acid or Aspirin

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3
Q

Common analgesic (relieves pain), antipyretic (anti-fever), anti-inflammatory and anticoagulant

A

Salicylates

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4
Q

Mechanism of salicylates as anticoagulant

A

blocks cyclooxygenase reducing thromboxane and prostaglandins

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5
Q

Adverse effects of Salicylates

A

Platelet aggregation inhibition
GI function interference
Rye Syndrome (in children)
Viral infection

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6
Q

Treatment for Salicylates toxicity

A

Neutralization and elimination
Maintain electrolyte imbalance

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7
Q

Salicylates intoxication value

A

Serum lvl: >90 mg/dL 6 hrs after ingestion

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8
Q

Effects of acute ingestion of Salicylates (high doses)

A

Metabolic acidosis (salicylates are acid)

Respiratory alkalosis (direct stimulation of the respiratory center, causing hyperventilation)

Inhibits Kreb’s cycle (increases lactate
and pyruvate formation → muscle cramps)

Ketone formation

Death

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9
Q

Methods for Salicylate measurement

A

Gas Chromatography
Liquid Chromatography
Chromogenic Assay (Trinder Reaction)

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10
Q

Has the highest analytical sensitivity for salicylates

A

Liquid Chromatography

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11
Q

A method for salicylate measurement that uses ferric nitrate to form a colored complex measured using spectro

A

Chromogenic Assay (Trinder Reaction)

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12
Q

aka Acetaminophen

A

Paracetamol

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13
Q

a common analgesic

A

Acetaminophen

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14
Q

Common brand (US) of Acetaminophen

A

TYLENOL

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15
Q

predicts acetaminophen-induced hepatic damage based on serum conc. of acetaminophen at a known time after ingestion (graphical representation)

A

Rumack-Matthew Nomogram

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16
Q

Rumack-Matthew Nomogram must not be used in these individuals

A

px. with ethanol abuse

(metabolizes acetaminophen at rapid rate)

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17
Q

Rumack-Matthew Nomogram is used for predicting?

A

acetaminophen-induced hepatic damage

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18
Q

Effect of Acetaminophen overdose

A

severe hepatotoxicity

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19
Q

Acetaminophen overdose value

A

300 ug/mL 2 hours after ingestion

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20
Q

Acetaminophen measurement methods

A

Immunoassay – commonly used
HPLC – reference method

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21
Q

DRUGS OF ABUSE assessed in toxicology

A

Amphetamines
Ecstasy
Anabolic Steroid
Cannabinoids
Cocaine (crack)
Opiates
Phencyclidine
Sedatives-Hypnotics

OTHERS:
Lysergic Acid Diethylamide (LSD)
Piperazines
Methaqualone (Quaalude)
Tryptamines

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22
Q

can cross the placenta

A

arsenic
cocaine

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23
Q

Most common Amphetamines

A

SHABU

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24
Q

drug of abuse with ↓ therapeutic dose; very close to toxic dose

A

Amphetamines

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25
Q

drugs that develops tolerance (HIGH POTENTIAL ABUSE)

A

Amphetamines
Cannabinoids
Opiates

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26
Q

Amphetamines is a tx for

A

narcolepsy (uncontrolled sleeping)
attention deficit disorder

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27
Q

Drug for reducing weight (induces anorexia nervosa)

A

Amphetamines

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28
Q

Blocks dopamine receptors in the brain causing initial effects

A

Amphetamines

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29
Q

Examples of Amphetamines

A

Amphetamines
Methamphetamines (Shabu/Ice, Poor Man’s Ecstasy)
Methylphenidate (Tx: hyperactive children)
Benzphenidate
Diethylpropion

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30
Q

Amphetamine-like compounds

A

Ephedrine
Pseudoephedrine
Phenylpropanolamine

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31
Q

content of Chinese drug said to be effective against COVID-19 (Lianhua Qingwen); may induce hypertension

A

Ephedrine

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32
Q

INITIAL EFFECTS of Amphetamines

A

Increased mental and physical capacity

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33
Q

ADVERSE/TOXIC EFFECTS of Amphetamines

A

Restlessness
Irritability
Psychosis

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34
Q

An amphetamine derivative

A

Ecstasy

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35
Q

Ecstasy is a derivative of

A

3,4-methylenedioxymethamphetamine

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36
Q

A designer drug (modified form of the available drug of abuse)

A

Ecstasy

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37
Q

INITIAL EFFECTS of Ecstasy

A

Hallucinations
Euphoria
Emphatic and emotional response
Increased visual and tactile sensitivity

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38
Q

ADVERSE EFFECTS of Ecstasy

A
  • Headaches
  • Nausea
  • Vomiting
  • Anxiety
  • Agitation
  • Impaired memory
  • Violent behavior
  • Tachycardia
  • Hypertension
  • Respiratory depression
  • Seizure
  • Hyperthermia
  • Multiple organ toxicity
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39
Q

Testosterone derivatives

A

Anabolic Steroid

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40
Q

Anabolic Steroid is initially a tx for

A

male hypogonadism

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41
Q

↑ muscle mass (used by athletes)

A

Anabolic Steroid

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42
Q

Chronic use of Anabolic Steroid causes

A
  • Toxic hepatitis
  • Accelerated atherosclerosis
  • Abnormal plt aggregation
  • Cardiomegaly
  • Testicular atrophy
  • Sterility
  • Impotence
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43
Q

Group of psychoactive compounds found in marijuana

A

Cannabinoids

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44
Q

Cannabinoids is naturally derived from

A

Cannabis sativa leaves

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45
Q

drugs of abuse that are CNS stimulants

A

Cannabinoids
Cocaine (crack)

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46
Q

most potent and abundant compound of marijuana

A

Tetrahydrocannabinoid (THC)

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47
Q

A hallucinogen; a lipophilic substance; Rapidly distributed to hydrophobic compartments (brain, fats); Reaches brain w/n 30 sec upon exposure

A

Tetrahydrocannabinoid (THC)

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48
Q

MAJOR URINARY METABOLITE of Cannabinoids

A

11-nor-deltatetrahydrocannabinol-9-carboxylic acid (THC-COOH)

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49
Q

11-nor-deltatetrahydrocannabinol-9-carboxylic acid (THC-COOH) is detected in urine with SINGLE THC use for

A

3-5 days

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50
Q

11-nor-deltatetrahydrocannabinol-9-carboxylic acid (THC-COOH) is detected in urine with CHRONIC use for

A

4 weeks (or 45 days)

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51
Q

T/F

Cannabinoids accumulates in adipose tissue; not readily excreted in urine (slow elimination) – only eliminated when fats are metabolized

A

T

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52
Q

INITIAL EFFECTS of Cannabinoids

A

Sense of well-being
Euphoria

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53
Q

THC Adverse effects

A

memory and intellectual impairment

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54
Q

Toxic Effects of Cannabinoids

A
  • Paranoia
  • Disorientation
  • Altered physical senses
  • Bronchopulmonary dse
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55
Q

Methods for Cannabinoids

A

IA (screening)
GC-MS (confirmatory)

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56
Q

An alkaloid salt (in the form of ecgonine)

A

Cocaine (crack)

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57
Q

Cocaine (crack) is naturally derived from

A

Coca-plant (Erythroxylon coca)

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58
Q

Effective local anesthetic for nasopharyngeal surgery

A

Cocaine

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59
Q

NOT a TRUE ADDICTIVE DRUG (fails to develop dependence)

A

Cocaine

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60
Q

Potent CNS stimulator

A

Cocaine

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61
Q

METABOLITE of Cocaine

A

Benzoylecgonine

62
Q

single use of cocaine can be detected for

A

3 days

63
Q

chronic use of cocaine can be detected for

A

20 days

64
Q

INITIAL EFFECTS of cocaine

A

Excitement
Euphoria

65
Q

Cocaine overdose causes

A

violent behavior

66
Q

Adverse/toxic effects of cocaine

A
  • Hypertension, arrythmias, seizure, MI
  • Uterine malformation
  • Mental retardation, slow mental development and drug dependence (newborns)
  • Sudden death (due to direct toxicity to myocardium
67
Q

drug of abuse that can cause sudden death (due to direct toxicity to myocardium)

A

cocaine

68
Q

Capable of analgesia, sedation and anesthesia

A

Opiates

69
Q

Opiates is derived from

A

opium poppy plant

70
Q

Types of opiates

A

Naturally occurring
Chemically modified
Synthetic

71
Q

Naturally occurring opiates

A

Opium
Morphine
Codeine

72
Q

powerful analgesic; relieves excruciating pain (burn, cancer); a heroin metabolite

A

Morphine

73
Q

Mild analgesic and antitussive (relieves cough)

A

Codeine

74
Q

Chemically modified opiates

A

Heroin
Hydromorphone (Dialudin)
Oxycodone (Percodan)

75
Q

Synthetic opiates

A

Meperidine (Demerol)
Methadone (Dolophine)
Proxyphene (Darvon)
Pentazocine (Talwin)
Fentanyl (Sublimaze)

76
Q

major drug of abuse (1960’s -70’s)

A

HEROIN

77
Q

Forms of Heroin

A

No. 4 (China white)
No. 3 (Brown sugar) –
No. 2 and 1

78
Q

purest form of heroin

A

No. 4 (China white)

79
Q

heroin form used for smoking

A

No. 3 (Brown sugar)

80
Q

unprocessed heroin

A

No. 2 and 1

81
Q

MAJOR METABOLITES of HEROIN

A

N-acetylmorphine
Morphine

82
Q

ADVERSE/TOXIC EFFECTS of Opiates

A

Respiratory acidosis
Myoglobinuria
Cardiopulmonary failure
Pupillary constriction (pinpoint pupils)

83
Q

Antidote for opiate toxicity

A

Naloxone (Narcan) – opiate inhibitor

84
Q

methods for opiate

A

IA (screening)
GC-MS (confirmatory)

85
Q

used to detect morphine and codeine; can cross react with other opiates (nonspecific)

A

IA (screening)

86
Q

aka Phencyclidine

A

angel dust
angel hair
peace dust

87
Q

Illicit drug with stimulant, depressant, anesthetic, and hallucinogenic properties

A

Phencyclidine

88
Q

Lipophilic drugs

A

Phencyclidine
Tetrahydrocannabinoid (THC)

89
Q

10-15% of this administered drug is eliminated and unchanged

A

Phencyclidine

90
Q

Initial effect of Phencyclidine

A

Hallucinations

91
Q

Adverse effects of Phencyclidine

A
  • Agitation
  • Hostility
  • Paranoia
92
Q

OVERDOSE effects of Phencyclidine

A

Stupor
Coma

93
Q

T/F

Methods for PCD det. detects the metabolite

A

F
detects parent drug – PCD itself

94
Q

PCD Chronic user can detect the drug for

A

30 days after abstinence

95
Q

methods for PCD

A

IA (screening)
GC-MS (confirmatory)

96
Q

Tranquilizers

A

Sedatives-Hypnotics

97
Q

drugs that are CNS depressant

A

Sedatives-Hypnotics

98
Q

COMMON TYPES of Sedatives-Hypnotics

A

Barbiturates
Benzodiazepines

99
Q

condensation products of urea and malonic acid

A

Barbiturates

100
Q

has higher abuse potential than benzodiazepines

A

Barbiturates

101
Q

Examples of Barbiturates

A

Phenobarbital (long acting)
Amobarbital (intermediate acting)
Secobarbital, Pentobarbital (short acting)

102
Q

treatment for cocaine addiction

A

Benzodiazepines

103
Q

most commonly found in abused and overdose situations due to wide availability

A

Benzodiazepines

104
Q

Examples of Benzodiazepines

A

Diazepam (Valium)
Chlordiazepoxide (Librium)
Lorazepam (Ativan)

105
Q

a minor tranquilizers; rapid control of acute seizure

A

Diazepam (Valium)

106
Q

Overdose effects of Sedatives-Hypnotics

A

Lethargy
Slurred speech
Coma
Respiratory depression (most serious toxicity; may
result to death)

107
Q

most serious toxicity of sedatives

A

Respiratory depression

108
Q

methods for sedatives det.

A

IA (screening)
GC-MS (confirmatory)

109
Q

a hallucinogen; one of the most potent pharmacologic material

A

Lysergic Acid Diethylamide (LSD), Lysergide

110
Q

Shows the same pleasant feeling as amphetamines

A

Piperazines

111
Q

Major derivatives of Piperazines

A

N-benzylpiperazines (BZP)
Phenylpiperazines

112
Q

Minor derivatives of Piperazines

A

1-(3,4-methylene-dioxybenzyl) piperazine (MDMP)
1-(3- trifluoromethylphenyl) piperazine (TFMPP/Molly)

113
Q

Most popular Piperazines

A

BZP
TFMPP/Molly

114
Q

2,3-disubstituted quinazoline with anesthetic, antihistamine, antitussive, and hallucinogenic properties

A

Methaqualone (Quaalude)

115
Q

a drug that is a serotonin derivative

A

Tryptamines

116
Q

Examples of Tryptamines

A

N,N-dimethyltryptamine (DMT)/Businessman’s lunch
Psilocin
Ayahuasca

117
Q

N,N-dimethyltryptamine (DMT) (a tryptamine) is aka

A

Businessman’s lunch

118
Q

a short-term hallucinogen

A

N,N-dimethyltryptamine (DMT)/Businessman’s lunch

119
Q

hallucinogen; component of magic mushrooms (Psilocybe)

A

Psilocin

120
Q

tea with tryptamines

A

Ayahuasca

121
Q

R.A. 9165 is aka

A

COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002

122
Q

COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002 is aka

A

R.A. 9165

123
Q

Head of the Laboratory

A

Pathologist
Doctor who undergone training under DOH for lab management

124
Q

Analyst of the laboratory

A

Medical technologist
Pharmacist
Chemist
Nurses

125
Q

Requirement when conducting drug testing in Remote Collection Site

A

permit from Bureau of Health Facilities and Services – Center for Health Development (BHFS-CHD/DOH) 10 days prior

126
Q

Accepted Specimens for drug testing

A

Urine (most commonly used)
Saliva
Blood
Hair
Sweat
Tissue
Nail Clippings

127
Q

type of collection that requires validity test

A

Unobserved Collection

128
Q

urine creatinine value indicating adulterated spx

A

<20 mg/dL

129
Q

SG indicating that the specimen is no longer urine

A

<1.003

130
Q

Agents used for Specimen Tampering

A

Water (most common)
Salt (2nd most common)

Others: Liquid soap, Bleach, Vinegar, Ammonia, Baking soda, Glutaraldehyde,
Potassium Nitrate, Lemon Juice, Cologne

131
Q

Documents required for drug testing

A

Consent form
Custody and Control Form
Memorandum for Record

132
Q

Screening methods for drug testing

A

Thin-layer Chromatography
Gas-liquid Chromatography
Colorimetric “spot” test

133
Q

May be used as confirmatory test for drugs detected by TLC

A

Gas-liquid Chromatography

134
Q

Confirmatory tests for drug testing

A

Enzyme Multiplied Immunoassay technique [EMIT]
Gas-Chromatography/Mass Spectrometry

135
Q

Utilizes antibodies to detect drugs

A

Enzyme Multiplied Immunoassay technique [EMIT]

136
Q

first line confirmatory and reference method; can detect low drug levels

A

Gas-Chromatography/Mass Spectrometry

137
Q

detect presence of specific compound (separation technique)

A

GC

138
Q

quantitate the compound detected by GC

A

MS

139
Q

T/F

any method is valid in the absence of GC/MS provided that it is completely different from the 1st method

A

T

140
Q

Amphetamine cut-off level (ng/mL) in URINE using EMIT

A

500

141
Q

Amphetamine cut-off level (ng/mL) in URINE using GC-MS

A

250

142
Q

Marijuana cut-off level (ng/mL) in URINE using EMIT

A

50

143
Q

Marijuana cut-off level (ng/mL) in URINE using GC-MS

A

25

144
Q

Cocaine cut-off level (ng/mL) in URINE using EMIT

A

150

145
Q

Cocaine cut-off level (ng/mL) in URINE using GC-MS

A

100

146
Q

Opiates cut-off level (ng/mL) in URINE using EMIT

A

2000

147
Q

Opiates cut-off level (ng/mL) in URINE using GC-MS

A

2000

148
Q

PCD cut-off level (ng/mL) in URINE using EMIT

A

25

149
Q

PCD cut-off level (ng/mL) in URINE using GC-MS

A

25

150
Q

Drugs with the same cut-off levels (ng/mL) in urine using EMIT and GC-MS

A

Opiates
PCD

Clinical Chemistry 2 - CEUMLS (9 decks)

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