CC - Trace Metals, Drugs, Toxicology

chromium

part of glucose tolerance factor

manganese

helps regulate cholesterol synthesis

molybdenum

involved in xanthine and hypoxanthine synthesis

aluminum

associated with Alzheimer’s disease

VMA

nore/epinephrine

HVA

dopamine

5-HIAA

serotonin

morphine

heroine

benzoylecgonine

cocaine

half life: 0.5-1 hr (or 1-2 hr)

THC

marijuana

NAPA

procainamide

Nortriptyline

amitriptyline

phenobarbital

primidone

heparin

anticoagulant of choice in TDM

EDTA

anticoagulant of choice in cyclosporine and tacrolimus

Specimen collection

single most important factor in TDM is the accurate timing of:

trough level

drawn right before the next dose

lowest level in the blood and ensure the drug is in the therapeutic range

30 mins

peak level: IV

1 hr

peak level: intramuscular

1-2 hrs

peak level: oral

ethanol

most common abused drug

methanol

blindness and death

converted into formalin and formic acid

ethylene glycol

increased monohydrate CaOx in urine

isopropanol

causes CNS depression and hypertension

carbon monoxide

measured in ppm (parts per million)

produces carboxyhemoglobin = decreased O2 delivery to tissue

cyanide

odor of bitter almonds

pesticide

decrease in cholinesterase

arsenic

strong affinity to keratin

odor of garic breath

cadmium

(+) GGT in urine

lead

basophilic stippling in RBC

mercury

environmental pollutant (organic)

0.01-0.05

no obvious impairment

0.03-0.12

mild euphoria

0.09-0.25

decreased CRIM: critical judgement, reaction time, inhibitions, memory

0.18-0.30

confusion, dizziness, slurred speech

0.27-0.40

unable to stand, vomit, impaired consciousness

0.35-0.50

coma and death