Toxicology (part 2)
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therapeutic drugs that undergo toxicology
Salicylates Acetaminophen
aka Salicylates
Acetylsalicylic acid or Aspirin
Common analgesic (relieves pain), antipyretic (anti-fever), anti-inflammatory and anticoagulant
Salicylates
Mechanism of salicylates as anticoagulant
blocks cyclooxygenase reducing thromboxane and prostaglandins
Adverse effects of Salicylates
Platelet aggregation inhibition GI function interference Rye Syndrome (in children) Viral infection
Treatment for Salicylates toxicity
Neutralization and elimination Maintain electrolyte imbalance
Salicylates intoxication value
Serum lvl: >90 mg/dL 6 hrs after ingestion
Effects of acute ingestion of Salicylates (high doses)
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
Methods for Salicylate measurement
Gas Chromatography Liquid Chromatography Chromogenic Assay (Trinder Reaction)
Has the highest analytical sensitivity for salicylates
Liquid Chromatography
A method for salicylate measurement that uses ferric nitrate to form a colored complex measured using spectro
Chromogenic Assay (Trinder Reaction)
aka Acetaminophen
Paracetamol
a common analgesic
Acetaminophen
Common brand (US) of Acetaminophen
TYLENOL
predicts acetaminophen-induced hepatic damage based on serum conc. of acetaminophen at a known time after ingestion (graphical representation)
Rumack-Matthew Nomogram
Rumack-Matthew Nomogram must not be used in these individuals
px. with ethanol abuse (metabolizes acetaminophen at rapid rate)
Rumack-Matthew Nomogram is used for predicting?
acetaminophen-induced hepatic damage
Effect of Acetaminophen overdose
severe hepatotoxicity
Acetaminophen overdose value
300 ug/mL 2 hours after ingestion
Acetaminophen measurement methods
Immunoassay – commonly used HPLC – reference method
DRUGS OF ABUSE assessed in toxicology
Amphetamines Ecstasy Anabolic Steroid Cannabinoids Cocaine (crack) Opiates Phencyclidine Sedatives-Hypnotics OTHERS: Lysergic Acid Diethylamide (LSD) Piperazines Methaqualone (Quaalude) Tryptamines
can cross the placenta
arsenic cocaine
Most common Amphetamines
SHABU
drug of abuse with ↓ therapeutic dose; very close to toxic dose
Amphetamines