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