Uiuc M2 2010 Fcp Drugtestingintoxication

Front 1

Department of transportation tests only five things: (5)

Back 1

Opiates
Amphetamines
Cocaine
Marijuana
PCP

Front 2

Detection periods, and non-obvious pros and cons:

blood:
oral fluid:
urine:
sweat:
hair:

Back 2

Blood: Minutes to days

Oral fluid: Minutes to days.
pro: difficult to adulterate. correlation w/impairment.
con: saliva production variable.

Urine: Hours to days

Sweat: Weeks.
pro: difficult to adulterate, noninvasive.
con: possible envir. contamination. variability.

Hair: Days to years
pro: 2nd collection capability.
con: environ. contamination. not detect recent use. few controlled studies.

Front 3

Sweat can be used to detect:

(7)

Back 3

1) Ethanol
2) Nicotine/Cotinine
3) Morphine
4) Amphetamine/Methamphetamine
5) PCP
6) Methadone
7) Cocaine

Front 4

Two part process to drug screen:

step 1:
step 2:

Back 4

1) Immunoassay Screen
• Cross reactivity

2) GC/MS confirmation

Front 5

Breakdown products of Heroin

(2)

Back 5

Heroin → Mono-acetyl morphine (aka 6-am?) → morphine

Front 6

Breakdown products of Codeine

(2)

Back 6

Codeine →
Morphine
and
Nor-codeine

Front 7

Reasons for positive (morphine/codeine) urine test: (4)

Reasons for positive 6-acetylmorphine (6-AM) test?

Back 7

1) Ingestion of poppy seeds (type of poppy seed claimed can be correlated with tests)

2) Use of codeine containing products

3) Use of morphine containing products

4) Use of heroin

6-AM: ONLY HEROIN USE

Front 8

What level of the following generally indicates abuse?

morphine:
codeine:

Back 8

>5000 ng/mL → morphine abuse.

>300ng/mL with a morphine/codeine ratio of <2 → codeine abuse.

Front 9

Breakdown products of Cocaine: (1)

Specific to cocaine: ?

Back 9

Cocaine (Methylbenzoylecgonine) → Benzoylecgonine

Yes. Other "caines" (eg. lidocaine) structurally unrelated. No cross-reactivity.

Front 10

Metabolism of methamphetamine:

Back 10

Methamphetamine → amphetamine

Front 11

Amphetamine

isomers: (2)

Back 11

Levo-amphetamine: turns screening test positive, but not confirmatory tests.
(L (think: LEGAL)-isomer metabolite of Seligiline or Vick's Inhaler)

Dextro-amphetamine: need confirmatory to test for to prove.

Front 12

Cannabis

metabolism:
other positive results due to:

Back 12

∆9-THC → 11 hydroxy THC

Dronabinol (legal THC for chemo)
Passive inhalation

Front 13

Phencyclidine
cross reactivity on screening test:

Back 13

(PCP)

-Dextromethorphan (eg: Robitussin)

Front 14

Alcohol:
short term tests for:
speed of metabolism:

long term tests for:

Back 14

Breath/Saliva/Blood testing
0.015 mg/dL per 60-90 minutes (~1 drink = 0.02-0.03mg/dL)

MCV: ↑after drinking

GGT (enzyme: ↑3-4weeks after alcohol drinking)

Ethyl glucuronide: Good for up to 7 days after heavy drinking and up to 2 days after last drink. false positives possible.

Front 15

Detectability in Urine Stimulants (time after use)

Amphetamine:
Methamphetamine:
MDMA
Cocaine
Benzoylecgonine (cocaine metabolite):

Back 15

Amphetamine: 2-3 days
Methamphetamine: 48 hours
MDMA: 30-48 hours
Cocaine: 6-8 hours
Benzoylecgonine (cocaine metabolite): 2-3 days

Front 16

Detectability in Urine: Sedatives

Barbiturates and benzos:
Ultra short acting and short acting (eg: thiopental, secobarbital):

Intermediate acting (pentobarbital):

Long-acting barbit: (phenobarbital):

Long-acting benzo: (diazepam)

Back 16

Ultra short acting and short acting (eg: thiopental, secobarbital): 24h

Intermediate acting benzo/barbit (pentobarbital)
~40-80 hours

Long-acting barbit: (phenobarbital):
16 days or more

Long-acting benzo: (diazepam):
7 days or more

Front 17

Detectability in Urine: Opioids

Methadone (maintenance dosing):
Codeine/morphine:
6-monoacetyl morphine:
Morphine glucuronides:
Codeine glucuronides:
Propoxyphene/Norpropoxyphene:
Dihydrocodeine:
Buprenorphine:
Buprenorphine conjugates:

Back 17

Methadone (maintenance dosing)
7-9 days
Codeine/morphine
24 hours
6-monoacetyl morphine
2-4 hours
Morphine glucuronides
48 hours
Codeine glucuronides
3 days
Propoxyphene/Norpropoxyphene
6-48 hours
Dihydrocodeine
24 hours
Buprenorphine
48-56 hours
Buprenorphine conjugates
7 days

Front 18

Detectability in Urine: Cannabinoids

Single Use:
Moderate Use:
Heavy Use (daily):
Chronic Heavy Use:

Back 18

Single Use
3 days
Moderate Use
4 days
Heavy Use (daily)
10 days
Chronic Heavy Use
Up to 36 days

Front 19

Detectability in Urine

Methaqualone:
PCP:
LSD:
Nicotine:
Cotinine (Nicotine metabolite):

Back 19

Methaqualone: 7 days or more

PCP: 8 days

LSD: 24 hours

Nicotine: 12 hours

Cotinine (Nicotine metabolite): 2-3 days

Front 20

Alcohol intoxication:

receptor system affected:
effect:

Back 20

GABA
depressant

Front 21

Blood alcohol levels

loss of muscular coordination begins, changes in mood and personality:

prolonged reaction time, ataxia, incoordination, mental impairment:

obvious intoxication, marked ataxia, nausea, vomiting:

hypothermia, several dysarthia, amnesia, anesthesia

onset of alcoholic coma, loss of airway protective reflexes, hypotension, decreased respirations, death

Back 21

20 - 99 mg% (.02-.09)

100 - 199 mg% (.10-.19)

200 - 299 mg% (.2-.29)

300 - 399 mg% (.3-.39)

400 - 799 mg% (.4-.49)

Front 22

Treatment for alcohol intoxication/overdose:

Treatment for alcohol withdrawal:

Back 22

No antidote: supportive ABC. do not use flamazenil.

3 stages, later stages preventable.
prevent seizures.
prevent delerium tremens.
-Use withdrawal assessment (AIWA-Ar): get tx to those who need it, don't over treat.

Benzodiazepines, Barbiturates, Clonidine, Carbamazepine

Front 23

Alcohol withdrawal:
Stage 1
Stage 2
Stage 3

Back 23

Stage 1: mild reactions. First 24 hours--may last 3-5 days.

Stage 2: alcoholic hallucinosis. Occurs within 48 hours. Hallucinations with insight

Stage 3: delerium tremens.
72 hours after last drink, Lasts 2-6 days. Hallucinations without insight
Delerium. Mortality 9-15%

Categories:
-Subjective complaints (anxiety, agitation, hallucinations)
-Objective signs: (hyperreactive reflexes, nystagmus, tremor, hyperthermia, confusion, delirium, seizures)
-hyperadrenergic state: tacycardia, HTN, diaphoresis, mydriasis.

-all three "categories" present in each stage, but ↑ in severity.

Front 24

Alcohol withdrawal seizures

when:
type:

Back 24

Can occur in any stage
-90% within first 48 hours

-Generalized tonic, clonic

-Status epilepticus rare

-First episode requires workup

Front 25

Alcohol withdrawal

important vitamins to give:

Back 25

Thiamine (prevent precipitation of wernicke syndrome before giving glucose)
Folic acid
Magnesium: cardiac arrhythmias.
Multivitamin:

Front 26

Sedative withdrawal

tx:

Back 26

-give substitution theray, prolong wtihdrawal
-carbamazepine
-valproic acid

Front 27

Opioid intoxication:

symptoms:
death due to: (3)
tx:

Back 27

1) respiratory depression

2) aspiration pneumonia
3) non-cardiogenic pulmonary edema

Supportive (ABC) +
Naloxone 0.4-2.0mg

Front 28

Opioid withdrawal

heroin- timing:
methadone- timing:

symptoms caused by:

Back 28

heroin 4-6 hours
methadone 36 hours

Hyperadrenergic activity in the locus ceruleus?

Front 29

Opioid withdrawal

tx:(5)

Back 29

tx:
1) replacement (methadone, buprenorphine)
2) clonidine
3) benzodiazepines
4) NSAIDS
5) Dicyclomine

Front 30

Opioid withdrawal symptoms: (11)

Back 30

1) Tachycardia
2) Hypertension
3) Fever
4) Restlessness, Irritability, Insomnia
5) Craving
6) Yawning
7) Pupillary dilation
8) Lacrimation, Rhinorrhea
9) Piloerection
10) Nausea, Vomiting
11) Diarrhea

Front 31

Stimulant intoxication symptoms: (5)

treatment:

withdrawal: (2)

Back 31

1) Anxiety, Agitation
2) Delusions, Psychosis
3) Hypertension, Tachycardia
4) Seizures
5) Rhabdomyolysis

Supportive:
1) Benzodiazepines for anxiety and seizures
2) Neuroleptics (haloperidol) for psychosis.
3) Vasodilators for hypertension
4) Use beta blockers with caution (don't)

Depression, suicide

Front 32

Cannabis

intoxication:
withdrawal from long term use:

Back 32

(anandamide/cannabinoid receptors)
1) depersonalization
2) altered time sense
3) acute panic
4) delerium (high dose)
no fatalities

1) irritability, restlessness, insomnia
2) anorexia
3) insomnia
4) diaphoresis
5) nausea, diarrhea, flue like syndrome
6) muscle twitches
7) tachycardia, hyperthermia, hypertension.

starts within 24 hours, lasts 1-2 weeks.