Forensic Toxicology - Exam 3

homicide, suicide, accident, natural, undetermined

manners of death

chasing the dragon

heroin is heated on metal and a fine line of smoke evolves, the smoke is “chased” through a straw

88% heroin and 12% fentanyl

tango and cash, the serial killer of the drug world

xylazine

veterinary tranquilizer, not an opioid

krokodil (desomorphine)

synthesized from codeine, 10x more potent than morphine, causes ulcerative necrosis, gangrene, and tissue damage

purge fluid, unusual odors, abnormal colors of stomach contents, lesions, pulmonary congestion

clues of an overdose

mees lines

poisoining

skin popping

overdose

Reinsch test

dissolve blood in HCl, insert copper strip, monitor for appearance of silver or dark metallic coating (heavy metal poisonings)

0-2% COHb

non-smokers

3-8% COHb

heavy smokers

10-20% COHb

fatigue, shortness of breath, flushed skin, headache onset

20-30% COHb

impairment, memory deficits, throbbing temples

30-40% COHb

dizziness nausea, vomiting, severe headache

40-50% COHb

hallucinations, severe ataxia, tachycardia

50% and above COHb

coma, convulsions, respiratory paralysis, often fatal

inhibits cytochrome c oxidase

cyanide

blood

most important specimen, supplies the brain, presence of active drug reflects current state of impairment, used to establish recent use

postmortem redistribution

movement of drugs from one area to another by diffusion after death

simple diffusion

movement from area of high concentration to area of low concentration

vitreous humor

anatomically isolated, resistant to decomposition, good stability, urea nitrogen, glucose

gastric

oral overdose, body packers, tie off and collect contents

liver

site of drug metabolism, may be only specimen available, large amount of reference data for ODs

anesthetic, pancuronium bromide, potassium chloride

three-drug combination for lethal injections

hallucinogen

a group of drugs able to alter perception of reality

hallucination

a perception where no stimulus exists

LSD, mescaline, psilocybin, MDMA/MDA

hallucinogen examples

PCP, ketamine, DXM

dissociative anesthetic examples

hallucinations, paranoia, body tremors, poor perception of time and space, uncoordinated, flashbacks

hallucinogen symptom characteristics

flashback

a vivid recollection of a hallucinogenic experience

pupils dilated, pulse and blood pressure elevated, body temperature elevated, muscle tone may be rigid

hallucinogen DRE assessment

hallucinations, blank stare, increased pain threshold, sensory distortions, repetitive speech

dissociative anesthetic symptom characteristics

HGN and VGN present, lack of convergence, pulse and blood pressure elevated, body temp elevated, muscle tone may be rigid

dissociative anesthetic DRE assessment

dextromethorphan

cough suppressant in robitussin

mild stimulant effect

100-200mg DXM

intoxication

200-500mg DXM

mild hallucinations, dissociative effect

500-1000mg DXM

full dissociate effect

>1000mg DXM

Albert Hofmann, Timothy Leary

important names in LSD

stimulates SNS and PSNS

effects of PCP

Red skin, Enlarged pupils, Delusions, Dissociations, Amnesia, Nystagmus, Excitement, Skin dry

presenting symptoms of PCP intoxication

acute toxicity, induced depression, toxic psychosis

PCP abuse syndrome 

excited delirium

sudden death due to cardiac/respiratory arrest

GI distress, mydriasis, tachycardia, hypertension, excessive sweating, nystagmus, hallucinations, emotional instability, panic

mescaline effects

atropine, scopolamine

two alkaloids of belladonna

physostigmine

belladonna antidote

hallucinations, floating feeling, slurred speech, lack of coordination, nausea, chills

salvia divinorum effects

kappa opioid receptor agonist

salvia divinorum pharmacokinetics

cocaine

56% more prevalent in homicide cases than in non-homicide cases

sudden imminent death syndrome

SIDS

6-MAM then morphine

heroin metabolites

non-pharmaceutical fentanyls

NPFs

para-fluorofentanyl

an offshoot of fentanyl, more potent

carfentanil

one of the most potent fentanyl analogs, used to tranquilize elephants

atropine

can be used as an antidote for certain pesticide poisonings by blocking acetylcholine

scopolamine

competitive inhibitor for the parasympathetic nervous system, can be used to treat nausea or dizziness

TCAs

first generation antidepressants

maprotiline, trazodone, bupropion

second generation antidepressants

selective serotonin reuptake inhibitors

SSRIs

cardiotoxic, prolonged QRS interval, hypotension, dizziness, weight gain, blurred vision

TCA side effects

inhibit reuptake of serotonin and norepinephrine

mechanism of TCA

inhibit reuptake of serotonin

mechanism of SSRIs

“meh” zone, anxiety, insomnia

SSRI side effects

venlafaxine, nefazodone, mirtazepine, duloxetine

third generation antidepressants

inhibit serotonin and dopamine reuptake

venlafaxine

weight gain, sedation

side effects of mirtazepine (“designer” antidepressant)

nortriptyline

metabolite of amitriptyline

desmethylcitalopram

metabolite of citalopram

nordoxepin

metabolite of doxepin

desipramine

metabolite of imipramine

norsertraline

metabolite of sertraline

carbamazepine, phenytoin, phenobarbital

first generation anti-epileptics

sodium channel inhibitor

mechanism of carbamazepine and phenytoin

increase time chloride channel is open

mechanism of phenobarbital

gabapentin, oxcarbazepine

second generation anti-epileptics

breathing difficulties, loss of tolerance

gabapentin increases risk of overdose

two drugs doing the same thing

dangers of combining aspirin and warfarin

need for oxygen

dangers of combining cocaine and heroin

p450 inhibition

dangers of combining grapefruit and statins

making the liver work overtime

dangers of combining acetaminophen and alcohol