Exam III
If it bites you and you die, it's considered ______
venemous
Imodium + grapefruit juice/cimetidine can lead to __________
ventricular dysrhythmia
What drug are urine samples good at detecting?
6-mono-acetyl morphine (heroin)
What happened in 1984 toxicologically?
A sick patient was given Demerol and died with a fever of 107. She was taking cocaine and died of cardiac arrest. This led to a change in work hour rules.
Lead exposure can cause _____. Chronic exposure can lead to ____
Abdominal pain or encephalopathy. Anemia, neuropathy, cognitive decline.
Acute exposure to arsenic leads to _____, chronic exposure leads to _______.
Abdominal pain, encephalopathy, and cardiac conduction issues. Hyperkeratosis, Mee's Lines (in nails).
What is ADME?
Absorption Distribution Metabolism Elimination
Most drug-related deaths are classified as ___
Accidents
Mercury exposure can lead to ____
Acrodynia (Pink disease: rash and sweaty)
What are some medical complications of long-term methamphetamine use?
Acute lead poisoning (due to byproducts of lantern fuel), increased BP, rapid HR, damage to dopamine producing cells, etc.
Methamphetamine degrades _____ tissue
Adipose
What is the onset of cocaine? How long does it last?
Almost immediate. 20-40 minutes
Fentanyl
An Adulterant used in heroin for additive effects.
Levimasole
An adulterant used in cocaine, which can cause vasculitis of ears and nose. Originally used as a veterinary anti-helminthic.
Adulterant
Anything added to a drug supply to increase the supply or increase the high.
What was the largest mass poisoning in history?
Arsenic in Bangladeshi water wells (1993).
Rendered-safe procedures
Avoid any risk for the sake of evidence
What are the most common cocaine metabolites?
Bezoylecgonine and Cocaethylene
Immunoassay
Biochemical test which tests for specific metabolites of drugs. It is only a screening technique and may show false positives.
Positive Blast pressure wave
Blast wave (1 inch) that radiates outward
Negative blast pressure wave
Blast wave that radiates inwards. Can last 3x longer and is more destructive. Can draw back debris.
Methamphetamine
CNS stimulant usually smoked. Effects last 6-8 hours. Often used by biker gangs. Requires cold medicine with ephedrine, matches and road flares (phosphorus). Effects include stroke, psychosis, violence, incessant talking, dilated pupils, repetitive behavior, anxiety, etc. Very toxic if injected.
Early Decomposition
Cadaver is bloating due to gas buildup internally
fresh decomposition
Cadaver looks fresh externally but is decomposing internally due to bacteria/parasites
Advanced Decomposition
Cadaver's flesh has creamy consistency, tissue is black. Gas escapes.
What is the triad of symptoms for opioid death?
Cerebral edema, pulmonary edema, and urinary retention.
Organophosphates
Chemicals found in insecticides, Sarin, etc. They are acetylcholinesterase inhibitors. Symptoms are the Killer B's (bronchorrhea, bronchospasm, bradycardia). Treated by giving Atropine. Physical symptoms are SLUDGE (wet).
Where did marijuana come from?
China and Middle East, spread to Europe in the 19th century
What drug can maggots detect especially well?
Cocaine
Which drug never shows a false positive?
Cocaine
What is needed to make Methamphetamine?
Cold medicine (ephedrine/Sudaphed), matches and road flares (red phosphorus), anhydrous nitrate, lithium, antifreeze, and lantern fuel.
Dimercaprol (BAL)
Compound used to treat acute mercury, lead, or arsenic exposure
Succimer
Compound used to treat chronic mercury, lead, or arsenic exposure
Toxidrome
Constellation of signs/symptoms based on drugs taken (ie; opioid toxidrome includes pinpoint pupils)
What happened in 1982 toxicologically?
Cyanide was put in Tylenol causing people to die in Chicago
Pan Disruptor
Device used to prevent an unexploded bomb from detonating while also preserving evidence. The rounds should always be sent to the lab afterwards
How is Arsenic treated?
Dimercaprol (BAL) if acute, Succimer if chronic
How is mercury exposure treated?
Dimercaprol (BAL) if acute, Succimer if chronic
Dr. Percival Pott (1775)
Doctor who associated soot exposure with scrotal cancer. First to demonstrate that cancer can be due to environmental exposure.
Evzio/Narcan/Naloxone
Drug antagonist used for opioid overdoses. Can cause withdrawal symptoms, which include diarrhea, vomiting, etc. Half-life is 30-60 minutes. Usually used intranasally.
Ipepac
Drug previously used to vomit out drugs continuously. Not used anymore
Magic Mushrooms (Psilobycin)
Drug that gives an LSD-like effect. Bruises blue when handled.
What are some opiate lesions?
Endocarditis, myocardial fibrosis, CAD, pulmonary edema, constipation, nontraumatic rhabdomyolysis, focal glomerulonephritis, amyloidosis, and necrotizing angiitis
What drugs are vitreous humor samples useful in detecting?
Ethanol and cyanide
Where does most of the ecstasy in the US come from?
Europe
American Academy of Clinical Toxicology is for _____
Everybody
Morbis Artificum (1700)
Guidebook for occupational health written by Bernardino Ramazzini. It described hydrocarbon poisoning in painters, mercury poisoning in mirror makers, and pulmonary disease in miners
What was cocaine originally used for?
Headaches. Found in Coca-Cola.
What toxicologic samples are nails useful at detecting?
Heavy metal use
What can cadaver canines be proofed off of?
Human urine
What symptom of ecstasy is life threatening?
Hypoglycemia
What is the onset of marijuana?
Immediate if smoked, 1-2 hours if eaten.
What does it mean to "chase the dragon"?
Inhale heroin
Hydrogen Sulfide
Knockdown gas that has a rotten egg smell and causes olfactory fatigue. It causes discoloration of silver jewelry. It is highly lipid soluble.
Which dogs make good cadaver canines?
Labrador Retriever, German Shepherd, and Belgian Malinois
What are the Anion gap toxins?
MUDPILES (aka CUTE DIMPLES)
Cocaethylene
Metabolite of cocaine, which is metabolically active and has a larger half-life
Benzoylecgonine (BE)
Metabolite of cocaine, which is not metabolically active.
6-MAM (6-Monoacetylmorphine)
Metabolite of heroin best detected in urine, vitreous, and CSF due to lack of esterases.
If someone is repetitively picking at their skin, what drug are they likely abusing?
Methamphetamine
Which labs are sent out for drug analysis?
Methanol, Ethylene Glycol, and Serum Blood Levels.
Where is most of the marijuana produced/smuggled in from?
Mexico
8-ball
Most common size of cocaine (1/8 ounce)
What does cocaine smell like?
Musk
What reverses the effects of opioids?
Narcan/Naloxone
What are signs of cocaine abuse?
Nasal septum injury, callous thumb (crack thumb), cornea inflammation (keratitis), etc
Opiates
Naturally occurring alkaloids derived from poppy plants (Papaver somniferus). Includes morphine/codeine.
What drugs are bile samples used to detect?
Opiates and Benzodiazepines
What is characteristic of Ecstasy users?
Pacifiers/lollipops and teeth grinding. Rave drug.
How long are the effects of marijuana?
Peaks at 20 minutes, lasts 1-2 hours (3-4 if eaten)
Opioids
Pharmacologic drug that includes natural opiates, as well as (semi)synthetic ones like heroin. Cause a feeling of euphoria.
What happened in 1962 toxicologically?
Phthalamide was given to young mothers for morning sickness, but that led to newborn babies with limbs that were not fully developed.
American College of Medical Toxicology is for ____
Physician
If you bite it and you die, it's considered _______
Poisonous
Krokodil
Poor man's heroin used in Russia that peels skin and is highly addictive. Average lifespan of an addict is 1-2 years.
Ecstasy (MDMA)
Psychedelic amphetamine. It causes release of catecholamines, feelings of empathy, hyperthermia, rhabdomyolysis, hypoglycemia (life-threatening), dehydration, increased sex drive, impotence, and Bruxism (teeth grinding). Has recently been used in PTSD treatment. Associated with raves.
Explosion
Rapid chemical reaction in confinement resulting in heat, fire, and noise.
White Paper Report on Excited Delirium Syndrome
Report that states you should look for pain tolerance, tachypnea, sweating, agitation, hyperthermia, uncooperation, and stamina/strength. If it's not treated, the patient's pH may decrease and they may have seizures and die.
Rawn/Wissinger Research
Research that showed there is a 50-50 chance to collect DNA in any scenario
What are the stages of methamphetamine use?
Rush (20-40 minutes) High (3 days) Binge Crash
THC (tetrahydrocannabinol)
Schedule I drug (illegal to buy, sell, etc) substance that gives the desired effects of marijuana. Easily found by canines.
Cocaine
Schedule II drug, Naturally derived CNS Stimulant extracted from the Coca plant, found in South America. It inhibits reuptake of (nor)epinephrine, dopamine, and serotonin. It leads to increased sympathomimetic/chronotropic activity (increased heart rate, etc). Most deleterious effects are cardiovascular, including hypertension, arrhythmia, contraction band necrosis, CAD, etc. Can also cause barotrauma, parenchymal disease, and lung inflammation. Originally used for headaches
What is the number 1 safety issue in post-blast crime scene investigations?
Secondary devices
Cyanide induces ______
Seizure/Coma/Death
Heroin
Semisynthetic derivative of morphine with no FDA approved medical use. Has a rapid mechanism of action and is usually injected. It is very lipid soluble and can cross the BBB. It causes respiratory depression, pulmonary edema (foam cone), coma, etc. It decreases oxygen saturation and causes urinary retention. Decedent usually snore very loudly. This drug is rarely detectable in blood, since it is almost immediately metabolized into 6-MAM. Often heated over a spoon to dissolve, making it impure, and is injected very hot.
Cocaine has a ___ half-life than methamphetamine
Shorter
Crystal meth
Snorted form of methamphetamine
What are cyanide pearls made of?
Sodium Nitrate and Sodium Thiosulfate
What should blood samples be stored in for toxicology specimens?
Sodium fluoride
What can cadaver canines indicate besides a decomposing body?
Soil pipes, septic pools, diapers, medical waste, etc
What is dilated pupils associated with?
Stimulant intoxication (ie; meth)
Why was 1938 the biggest toxicologic event in history?
Sulfanilamide was used in cough medicine, and diethylene glycol was used as the diluent, which caused renal damage and death. This led to the FDA
K2
Synthetic cannabinoid
Bath Salts (Mephedrone)
Synthetic cathinone, which comes from Khat plants in Africa, usually found as white crystal powder. Commonly used in child soldiers. Symptoms include increased energy, aggression, hyperthermia, delirium, etc.
What is characteristic of heroin abuse?
Syringes, bottle caps, cotton balls, looped belt/rubber bands, burnt/bent spoons, "chor-boy"
GHB
Tasteless, odorless depressant often used for date-rape. OD of this can be life-threatening. Difficult to pick up on drug screens, since it is naturally produced in the body. Dose range is very narrow.
GC-MS
Technique used to be specific and definitive in identifying drugs
Filler
The exploding material of a bomb
Paracelsus (1532)
The father of Modern Toxicology
Toxicology
The study of the adverse effects of drugs, chemicals, and biologic agents on people, animal, and environment
What are the 3 methods of bomb initiation?
Time, Action, and Command
What are signs of IVDA skin lesions?
Track marks, lymphedema of hands, and skin popping
Which drugs show specific markers on EKG's?
Tricyclic antidepressants
What are the best samples to detect Heroin (6-MAM)?
Urine, Vitreous humor, and CSF due to lack of esterases.
What should bomb residues be collected in?
Vapor-tight containers
Adipocere Formation
Variation of putrefaction. Cadaver has malodorous cheesy smell. Common in bodies found under water or in damp areas.
Which sample is more stable? Vitreous or blood sample?
Vitreous Sample
In 1986, all the residents and livestock of the village at Lake Nyos, Cameroon were killed. Why?
Volcanic gases, with H2S and CO2.
Fuze
What initiates the bomb
When does a true OD of cocaine occur?
When drug mules swallow packets of them and 1 bursts
Post-mortem Redistribution
When someone dies and drugs move out of the periphery and into the blood stream, leading to a higher blood drug concentration after death.
What color is pure heroin?
White
How is iron exposure treated?
Whole Bowel Irrigation and Deferoxamine
How is lead exposure treated?
Whole Bowel Irrigation, Succimer, Dimercaprol, or CaNa2EDTA.
What are the 5 stages of acute iron exposure?
Wretching, Recover, Recurrence, Response, and Resolution
Crack cocaine
a concentrated, smokable form of cocaine
Killer B's
bradycardia, bronchospasm, bronchorrhea. Symptoms for acetylcholinesterase inhibitors, like Organophosphates.
Mummification
fossilized remains of an organism found in very dry places. Fluid lost via evaporation. Skin is hard and leathery.
Marinol
synthetic THC which is a Schedule III drug