Alcohol/ Ethanol/ Ethyl alcohol

Drug Name  Alcohol/ Ethanol/ Ethyl alcohol

Indication Alcohol is the single most abused drug. Whole blood values are required for legal use.
Do not prepare vein puncture site with an alcohol swab. Quantitation of alcohol level for
medical or legal purposes, screen unconscious person to diagnose alcohol intoxication
and to determine appropriate therapy.
Physiology The half life and effectiveness of certain drugs are increased in the presence of
ethanol. Urine alcohol is measured by immunoassay and gas chromatography and is
used to screen drug for abuse.
Normal Blood: Negative value : Values < 10 mg/dL (<2 mmol/L) considered as negative value.
Values Intoxication signs observed at values of 50-100 mg/dL (10.9-21.7 mmol/L). Urine:
Negative: < 10 mg/dL is considered negative.
Critical Fatal Concentration: > 400 mg/dL (> 66.8 mmol/L). Coma: 300 mg/dL (65.1 mmol/L).
Values 100 mg/dL are considered unsafe for driving. Possible Panic Range: > 300 mg/dL (>
65.1 mmol/L)
Test Method
Enzymatic analysis, Gas chromatography.

Related Anion Gap, Drugs of Abuse Testing, Osmolality, Phosphorous, Uric Acid
Drugs
 Cannabinoids

Drug Name  Cannabinoids

Indication Present as an active component in Marijuana , it is metabolized to THC-carboxylic acid
which is detected in the urine. It is a DEA schedule I drug and a widely used drug of
abuse
Physiology A marijuana cigarette is made from the dried particles of the plant, Cannabis sativa.
The immediate effects of smoking marijuana include a faster heartbeat and pulse rate,
bloodshot eyes, and a dry mouth & throat.
Normal
Negative (less than cutoff)
Values
Critical
> 100 ng/mL
Values
Test Method Enzyme Immunoassay, Gas chromotography
Interpretation A positive screen test for cannabinoids indicates that the presence of cannabinoid
metabolites.
Side effects The drug can impair memory, and the ability to concentrate.
 Cocaine

Drug Name  Cocaine

Indication Cocaine is detected in urine as its metabolite, benzoylecgonine. The test is used to
evaluate cocaine.
Physiology Benzoylecgonine is a metabolite of Cocaine and is measured in urine. Cocaine is a
heavily abused drug which has medical use in ENT procedures. Cocaine is a central
nervous system stimulant. It is a fine crystal powder which is the sulfate salt and inhaled
through the nose. This is currently a very prevalent form of the drug.
Normal
Negative (less than cutoff)
Values
Critical
> 300 ng/mL
Values
Test Method Immunoassay, GC/MS, GC.
Interpretation The effect of the drug begin within minutes.
Side effects It causes side effects of dilated pupils, increased blood pressure, heart rate, breathing
rate, and body temperature. The danger of the use of cocaine depends on the dose, and
the individual status. It causes restlessness, irritability, anxiety, and sleeplessness. In
some cases it causes psychological problems in low doses leading to cocaine psychosis.
Related Drugs Drugs of Abuse Testing, Myoglobin

Read more: Cocaine

http://medindia.net/drugs/drug_toxicity/Cocaine.htm#ixzz0opQLnShW
 Barbiturates

Drug Name  Barbiturates

Indication The test is used to detect barbiturate as a drug of abuse
Physiology Barbiturates are nonselective CNS depressants that may be used as sedative
hypnotics or anticonvulants.
Normal
Less than cut off value
Values
Critical
greater than 300 ng/mL
Values
Test Method Enzyme Immunoassay, Gas chromotography
Interpretation The presence of barbiturates in urine at a level >300 ng/mL indicates abuse of
barbiturates. The most commonly used barbituraes are secobarbital, pentobarbital &
amobarbial.
Side effects They are capable of producing all levels of CNS mood effects from sedation to hypnosis
to deep coma anesthesia.
Related Phenobarbital
Drugs
Read more: Barbiturates
http://medindia.net/drugs/drug_toxicity/Barbiturates.htm#ixzz0opR0Hmzz
 Benzodiazepines

Drug Name  Benzodiazepines

Indication The drug is chemically related to central nervous depressants used as a sedative
hypnotics to treat sleep disorders, anxiety, alchol, seizure disorders.
Normal
Negative
Values
Critical
> 300 ng/mL
Values
Test Method Immunoassay, High Performance Liquid Chromatography (HPLC), Gas
Chromatography (GC).
Side effects The drug in low doses can cause sedation, drowsiness, blurred vision, fatigue, mental
depression, and loss of coordination. In higher doses causes confusion, slurred
speech, hypotension, and diminished reflexes.
Related
Diazepam
Drugs
 Phencyclidine

Drug Name  Phencyclidine

Indication Widely used drug of abuse which was formerly used as a veterinary tranquilizer.
Normal Values Negative
Critical Values > 25 ng/mL
Test Method Immunoassay, Gas chromatography.
 Propoxyphene

Drug Name  Propoxyphene

Indication Propoxyphene is a narcotic analgesic and a drug of abuse
Physiology Propoxyphene is an analgesic structurally similar to methadone
Normal Values 0.1-0.4 µg/mL (0.3-1.2 µmol/L)
Critical Values 0.5 µg/mL (>1.5 µmol/L)
Test Method Immunoassay, Gas chromatography.
Side effects Nausea, vomiting, and progressive central nervous system depression.
 Amphetamines/ Bennies/ Ice

Drug Name  Amphetamines/ Bennies/ Ice

Indication Amphetamine and methamphetamine are major drugs of abuse.
Physiology Amphetamines are stimulants that tend to increase alertness and physical activity. Some
drivers use amphetamines to counteract the drowsiness or ‘down feeling’ caused by
sleeping pills or alcohol. Abusers also sniff the crystals, make a solution and inject it, or
smoke the form known as “ice”. Can be detected in urine 3 hours after use.
Amphetamines increase the heart and breathing rate and also blood pressure, dilate the
pupils, and decrease appetite.
Normal Values Negative (less than cutoff)
Critical Values Screen – 1000 ng/mL; Confirmation: 500 ng/mL.
Test Method Radio Immunoassay (RIA), Enzyme Immunoassay (EIA), Gas Chromatography (GC), Thin
Layer Chromatography (TLC), High Performance Liquid Chromatography (HPLC)
Side effects The patient can feel dry mouth, sweating, headache, blurred vision, dizziness,
sleeplessness, and anxiety. Extremely high doses can cause people to flush or become
pale, and they can cause a rapid or irregular heartbeat, tremors, loss of coordination, and
even physical collapse. People who use a large dose over a long period of time may
develop an amphetamine psychosis: seeing, hearing, and feeling things that do not exist,
having irritating thoughts or beliefs and feelings that people are out to get them.
Related Drugs Drugs of Abuse Testing
 Opiates
Drug Name  Opiates
Indication The test detects urine opiates and is used almost exclusively to show presence of drugs
of abuse in this class. Opiates in general are a group of drugs 'nacrotics' which are used
medically to relieve pain, but which also have a high potential for abuse. Some opiates
come from a resin taken from the seed pod of the Asian poppy. This group includes
opium, morphin, and codeine. Opium appears as dark bron chunks or as a powder, and
is usually smoked or eaten.
Physiology Morphine is a prescribed drug for pain relief, a metabolite of heroin, a metabolite of
codeine, and a consitutents of poppy seeds. The intake of heroin by the user can only
be proved by the detection of 6-O-acetyl morphine by the urine confirmatory test.
Normal
Negative
Values
Critical
> 300 ng/mL
Values
Test Method High Performance Liquid Chromatography (HPLC), Gas Chromatography (GC).
Side effects side effects - restlessness, nausea, and vomiting, cold skin, breathing slows down and
death may occur.
 Caffeine

Drug Name  Caffeine

Indication Caffeine is present in coffee and tea. It is a metabolite of theophylline in infants.
Physiology Caffeine is one of the most widely used mind altering substances and is found in
numerous beverages (Cocoa, coffee, cola, tea) and prescription and nonprescription
medications.
Normal
None present
Values
Critical
> 30 µg/mL (>155 micromole/L)
Values
Test Method High Performance Liquid Chromatography (HPLC)
Related
Theophylline
Drugs
 Methadone

Drug Name  Methadone

Indication Methadone is a morphine substitute and used for detoxification of opiate addicts.
Physiology Methadone is highly addictive. Methadone is used in the management of severe
pain and in nacrotic detoxification.
Normal
Negative
Values
Critical
>200 ng/mL
Values
Test Method Thin Layer chromatography, Enzyme immunoassay
Side effects Adverse effects are CNS and respiratory depression, nausea and vomiting
hypotension, miosis, psychological dependence.
 Morphine

Drug Name  Morphine

Indication Morphine is widely used therapeutically as an analgesicMorphine has two
derivatives, heroin and codeine which are used as a drug of abuse.
Physiology Morphine, the major phenathrene alkaloid of powdered opium is used for relief or
moderate to severe acute and chronic pain after non-narcotic analgesics have
failed. It is also used as preanesthetic medication, to relieve the pain of myocardial
infarction and to relieve the dyspnea of acute left ventricular failure and pulmonary
edema.
Normal Values Negative
Critical Values > 300 ng/mL
Test Method Gas liquid chromatography
Side effects CNS depression, nausea and vomiting, hypotension, bradycardia, histamine
release, increased intracrainal pressure, antidiuretic hormone release, and
physical and psychological dependence.
 Mercury

Drug Name  Mercury

Indication Mercury is toxic in all its form - elemental, inorganic and
organic.
Normal
.020-.080 µg/mL (0.10-0.80 µmol/L)
Values
Critical
>0.10 µg/mL
Values
Test Method Electrothermal attomic absorption spectrometry.
 Arsenic, Blood/ Heavy Metal Screen

Drug Name  Arsenic, Blood/ Heavy Metal Screen

Indication Arsenic is a toxic heavy metal. The largest source of human exposure is arsenic
present in food. Blood arsenic is for diagnosis of acute poisoning.
Normal
<5 mg/dL (<93.5 nmol/g).
Values
Critical Chronic poisoning – 10-50 mg/dL (133.5-667.5 nmol/g). Acute poisoning - > 60
Values mg/dL (> 801 nmol/g).
Test Method Electro-thermal atomic absorption spectrometry
Related Arsenic Test, Heavy Metal Screen
Drugs
 Arsenic Hair. Nails/ Arsenic, Hair/ Arsenic, Nails

Drug Name  Arsenic Hair. Nails/ Arsenic, Hair/ Arsenic, Nails

Indication Arsenic is a toxic heavy metal that is incorporated into hair and nails. Presence of
arsenic in hairs and nails.
Physiology Arsenic accumulates in bones, hair, and nails and is used to detect chronic
exposure, since arsenic is laid down in keratin soon after ingestion.
Normal
Hair: up to 65 mg/100 g (8.7 nmol/g). Nail: 90-180 mg/100 g (12-24 nmol/g).
Values
Critical
values >100 mg/100 g (> 13.4 nmol/g)
Values
Test Method Electro-thermal atomic absorption spectrometry (AA)
Related Arsenic, Heavy Metal Screen, Urine.
Drugs
 Arsenic, Urine/ Quantitative Urine.

Drug Name  Arsenic, Urine/ Quantitative Urine.

Indication Toxic heavy metal appears in urine, and its excretion rate is used to determine
toxicity. The test evaluates recent exposure to arsenic, arsenic toxicity.
Normal
0-50 mg/L (0-0.65 mmol/L)
Values
Critical
Toxic > 850 mg/L (> 11.3 mmol/L)
Values
Related Arsenic, Hair, Nails. Heavy Metal Screen, Blood and Urine.
Drugs
 Cadmium

Drug Name  Cadmium

Indication Cadmium toxic metal is used in industry in alloys & metal platings
Physiology Inhalation of cadmium fumes produces an acute pneumonitis. Long term exposure
may lead to emphysmea.
Normal
Non smokers: <1µg/L (8.9 nmol/L)
Values
Critical
> 10 µg/L (88.97 micromole/L)
Values
Test Method Atomic absorption spectrophotometry (AA)
Interpretation Inhalation of cadmium fumes causes acute pneumonitis. Long term exposure -
emphysema
Side effects Increased cadmium may cause hypertension & prostatic cancer.
Related Heavy metal screen
Drugs
 Lead

Drug Name  Lead

Indication Blood lead concentrations are used to detect lead exposure.
Physiology Lead can be measured in tissue and urine. Another test that may be used to
evaluate lead intoxication is free erythrocyte protoporphyrin, is a more specific
indicator of lead toxicity.
Normal
< 20 µg/dL (< 0.97 µmol/L)
Values
Critical
> 80 µg/dL (> 3.86 µmol/L)
Values
Test Method Electrothermal attomic absorption spectrometry.
Interpretatio Blood lead assay is the test for detecting acute exposure. Blood lead
n concentrations are evidence of recent exposure.
Related
Porphobilinogen, Protoporphyrin, Uric acid
Drugs