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32 Cards in this Set
- Front
- Back
Department of transportation tests only five things: (5)
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Opiates
Amphetamines Cocaine Marijuana PCP |
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Detection periods, and non-obvious pros and cons:
blood: oral fluid: urine: sweat: hair: |
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. |
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Sweat can be used to detect:
(7) |
1) Ethanol
2) Nicotine/Cotinine 3) Morphine 4) Amphetamine/Methamphetamine 5) PCP 6) Methadone 7) Cocaine |
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Two part process to drug screen:
step 1: step 2: |
1) Immunoassay Screen
• Cross reactivity 2) GC/MS confirmation |
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Breakdown products of Heroin
(2) |
Heroin → Mono-acetyl morphine (aka 6-am?) → morphine
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Breakdown products of Codeine
(2) |
Codeine →
Morphine and Nor-codeine |
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Reasons for positive (morphine/codeine) urine test: (4)
Reasons for positive 6-acetylmorphine (6-AM) test? |
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 |
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What level of the following generally indicates abuse?
morphine: codeine: |
>5000 ng/mL → morphine abuse.
>300ng/mL with a morphine/codeine ratio of <2 → codeine abuse. |
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Breakdown products of Cocaine: (1)
Specific to cocaine: ? |
Cocaine (Methylbenzoylecgonine) → Benzoylecgonine
Yes. Other "caines" (eg. lidocaine) structurally unrelated. No cross-reactivity. |
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Metabolism of methamphetamine:
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Methamphetamine → amphetamine
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Amphetamine
isomers: (2) |
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. |
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Cannabis
metabolism: other positive results due to: |
∆9-THC → 11 hydroxy THC
Dronabinol (legal THC for chemo) Passive inhalation |
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Phencyclidine
cross reactivity on screening test: |
(PCP)
-Dextromethorphan (eg: Robitussin) |
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Alcohol:
short term tests for: speed of metabolism: long term tests for: |
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. |
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Detectability in Urine Stimulants (time after use)
Amphetamine: Methamphetamine: MDMA Cocaine Benzoylecgonine (cocaine metabolite): |
Amphetamine: 2-3 days
Methamphetamine: 48 hours MDMA: 30-48 hours Cocaine: 6-8 hours Benzoylecgonine (cocaine metabolite): 2-3 days |
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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) |
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 |
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Detectability in Urine: Opioids
Methadone (maintenance dosing): Codeine/morphine: 6-monoacetyl morphine: Morphine glucuronides: Codeine glucuronides: Propoxyphene/Norpropoxyphene: Dihydrocodeine: Buprenorphine: Buprenorphine conjugates: |
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 |
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Detectability in Urine: Cannabinoids
Single Use: Moderate Use: Heavy Use (daily): Chronic Heavy Use: |
Single Use
3 days Moderate Use 4 days Heavy Use (daily) 10 days Chronic Heavy Use Up to 36 days |
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Detectability in Urine
Methaqualone: PCP: LSD: Nicotine: Cotinine (Nicotine metabolite): |
Methaqualone: 7 days or more
PCP: 8 days LSD: 24 hours Nicotine: 12 hours Cotinine (Nicotine metabolite): 2-3 days |
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Alcohol intoxication:
receptor system affected: effect: |
GABA
depressant |
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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 |
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) |
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Treatment for alcohol intoxication/overdose:
Treatment for alcohol withdrawal: |
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 |
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Alcohol withdrawal:
Stage 1 Stage 2 Stage 3 |
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. |
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Alcohol withdrawal seizures
when: type: |
Can occur in any stage
-90% within first 48 hours -Generalized tonic, clonic -Status epilepticus rare -First episode requires workup |
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Alcohol withdrawal
important vitamins to give: |
Thiamine (prevent precipitation of wernicke syndrome before giving glucose)
Folic acid Magnesium: cardiac arrhythmias. Multivitamin: |
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Sedative withdrawal
tx: |
-give substitution theray, prolong wtihdrawal
-carbamazepine -valproic acid |
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Opioid intoxication:
symptoms: death due to: (3) tx: |
1) respiratory depression
2) aspiration pneumonia 3) non-cardiogenic pulmonary edema Supportive (ABC) + Naloxone 0.4-2.0mg |
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Opioid withdrawal
heroin- timing: methadone- timing: symptoms caused by: |
heroin 4-6 hours
methadone 36 hours Hyperadrenergic activity in the locus ceruleus? |
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Opioid withdrawal
tx:(5) |
tx:
1) replacement (methadone, buprenorphine) 2) clonidine 3) benzodiazepines 4) NSAIDS 5) Dicyclomine |
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Opioid withdrawal symptoms: (11)
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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 |
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Stimulant intoxication symptoms: (5)
treatment: withdrawal: (2) |
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 |
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Cannabis
intoxication: withdrawal from long term use: |
(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. |