Tag Archives: Toxicology

Maryland Pearl Tox Screen

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I hope everyone suscribes to the UMEM pearls.

Title: Drug Abuse Screens
Author: Kishan Kapadia
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Performance Characteristics of Common Drug Abuse Screening Immunoassays
Drug/Class
Detection Interval (***)
Comments
Amphetamines
1-2 days (2-4 days)
Decongestants, ephedrine,l-methamphetamine, selegilene & bupropion metabolites may give False (+) results; MDA & MDMA are variably detected
Barbiturates
2-4 days
Phenobarbital may be detected for up to 4 weeks
Benzodiazepines
1-30 days
Benzos vary in reactivityand potency; False (+) results may be seen with oxaprozin
Cannabinoids
1-3 days (>1 month)
Screening assays detect inactive and active cannabinoids; Confirmatory assays detects inactive metabolite THCA (tetrahydrocannabinoic acid)
Cocaine 
2 days (1 week)
Screening & confirmatory assays detect inactive metabolite BE (benzoylecgonine); False (+) results are unlikely
Opiates
1-2 days; 2-4 days (<1 week)
Semisynthetic opiates derived from morphine show variable cross-reactivity; Fully synthetic opioids (e.g., fentanyl, meperidine, methadone, propoxyphene, tramadol) have minimal cross reactivity; Quinolone may cross-react
Methadone
1-4 days
Doxylamine may cross-react
Phencyclidine
4-7 days (>1 month)
Dextromethorphan, diphenhydramine, ketamine, & venlafaxine may cross react
Propoxyphene
3-10 days
Duration of positivity depends on cross reactivity of metabolite norpropoxyphene
(***)Values are after typical use; values in parentheses are after heavy or prolonged use.
References

Adapted from Goldfrank’s Toxicologic Emergencies, 9th ed; Table 6-10.

A Solution to Everyone’s Problems

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Can’t get pain meds after KASPER exposed your nasty habit, so you turned to your old friend heroin? Or you can still get your pain meds, just haven’t learned when enough is enough? Is the fear of stopping breathing really putting a damper on your narcotic addiction? Have no fear, Evzio is here.

This is old news as it was FDA approved in April, and my friend from NY says it is already being used there, but I hadn’t heard anyone talking about it. Evzio is similar to an EpiPen, but delivers a single dose of 0.4mg of naloxone instead. Once it is turned on, it gives verbal instructions in how to use it. It is now available by prescription only.

Has anyone written a prescription for this, or do you see yourself doing so in the near future? Obs your heroin addictions, give them a prescription, and out the door? Not sure how much it costs, but I saw one report that it may cost as much as $500. Goodrx.com lists the price as $591 for one kit of 2 autoinjectors, with a coupon.

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm391465.htm

http://www.nytimes.com/2014/04/04/health/fda-approves-portable-drug-overdose-treatment.html

Wellens’ Or Not?

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A middle aged male presented for evaluation of AMS; he had agitation, confusion, and tremors. He has a history of Bipolar disease and schizophrenia as well as HTN.  Vital signs were all stable on presentation and within normal limits.  On exam he was oriented only to name, but not place or time. Neurological exam was normal, with the exception of tremors.  Med list includes Haldol Injection, Lithium, Benztropine, Olanzapine, and Propranolol.  At this point, I was not quite sure what is going on with him, so I had a bit of a shotgun approach.  Initial EKG revealed the EKG below.

20140325_223727

It appears to be similar to Wellens’ syndrome but not consistent with my gentlemen’s symptoms.

A quick literature search revealed a case report showing lithium induced EKG changes, similar to his EKG above.  Further supporting his lithium induced changes in this scenario is no clinical findings to suggest ACS, and a negative troponin 3x.  He was ultimately admitted and treated for lithium toxicity, without any cardiac complications.

EKG changes seen in lithium toxicity:
– ST elevations (1 other single case report)
– QT prolongation
– non-specific ST segment changes/T-wave abnormalities