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Clinics in Laboratory Medicine

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https://www.readbyqxmd.com/read/27842795/drug-testing-and-toxicology-redefining-the-plague-of-darkness
#1
EDITORIAL
Martin H Bluth
No abstract text is available yet for this article.
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27842794/clinical-toxicology-and-its-relevance-to-asthma-and-atopy
#2
REVIEW
Rauno Joks, Martin H Bluth
Although both the prevalence of asthma and the prescription drug use, notably the opiate analgesic class, epidemics are increasing, there is a complex interplay between both disorders, with both protective and exacerbating factors involved in the effect of opiates on asthma pathogenesis and clinical severity. This review examines the airway effects, both immunologic and neurologic, of opiates, which may interact and result in protection or exacerbation of asthma.
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27842793/use-of-the-clinical-laboratory-in-psychiatric-practice
#3
REVIEW
Christopher Aloezos, Jonathan M Wai, Martin H Bluth, Howard Forman
In this review, the authors address the general principles of prescribing psychiatric medications and discuss how the clinical laboratory can be used to guide prescribing practices. Treatment considerations in different settings and for different medications are discussed. Because the clinical laboratory is advancing in its technology, so should the clinician's knowledge of how to use the clinical laboratory. The authors propose recommendations and a simple algorithm for how to use medication levels in blood and other fluids to guide care in medications without well-defined therapeutic windows...
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27842792/drug-toxicities-of-common-analgesic-medications-in-the-emergency-department
#4
REVIEW
Mateusz Ciejka, Khoa Nguyen, Martin H Bluth, Elizabeth Dubey
About 75% of patients present to the emergency department with a complaint of pain. There are multiple prescribed and over-the-counter medications that are available for the treatment of pain. Acetaminophen, opioids, and aspirin are commonly used agents that are available as single agents or in combination with other medications. However, all of these agents are susceptible to toxic overdose, which requires prompt recognition through clinical and laboratory assessment modalities and initiation of therapy to reduce the risk of morbidity and mortality...
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27842791/forensic-toxicology-an-introduction
#5
REVIEW
Michael P Smith, Martin H Bluth
This article presents an overview of forensic toxicology. The authors describe the three components that make up forensic toxicology: workplace drug testing, postmortem toxicology, and human performance toxicology. Also discussed are the specimens that are tested, the methods used, and how the results are interpreted in this particular discipline.
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27842790/otolaryngology-concerns-for-illicit-and-prescription-drug-use
#6
REVIEW
Nathan J Gonik, Martin H Bluth
Concern for illicit and restricted drug use in otolaryngology is similar to other surgical specialties with a few notable exceptions. Many illicit drugs are consumed transnasally. Repeated nasal exposure to stimulants or narcotics can cause local tissue destruction that can present as chronic rhinosinusitis or nasoseptal perforation. Further, the Food and Drug Administration has taken a stance against codeine for pediatric patients undergoing adenotonsillectomy. They have identified an increased risk of death postoperatively with these medications...
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27842789/ketamine-a-cause-of-urinary-tract-dysfunction
#7
REVIEW
Frank Anthony Myers, Martin H Bluth, Wellman W Cheung
Drug addiction as a result of improper use of prescribed and illicit use has been on the increase globally. The effects of such use have implications in the urologic disease space. To this end, Ketamine has been reported to affect urologic function, causing a number of voiding symptoms. It may also confound the differential diagnosis of urologic diseases, such as interstitial cystitis, among others.
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27842788/toxicology-in-reproductive-endocrinology
#8
REVIEW
Roohi Jeelani, Martin H Bluth, Husam M Abu-Soud
Fertility relies on a series of time dependent events, which are largely regulated by hormones. Concentration and function of these hormones can be altered by exposure of consumed and environmental toxins. It is of important to consider the dose and timing of toxin exposures in assessing the impact of them on reproductive health, however the utility of laboratory assessment in this regard is not well established. General laboratory assessment of reproduction and infertility includes hormone evaluation (hCG, prolactin, TSH, free thyroxin, FSH, LH and androgens among others) and treatment is via various assisted reproductive technologies...
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27842787/precision-medicine-in-toxicology
#9
REVIEW
Daniel A Schwarz, M P George, Martin H Bluth
Precision medicine applies primarily to pharmacokinetics in toxicology. Mastering hepatic metabolism through an understanding of the genetics behind Phase I, or oxidation/reduction and some Phase II, or conjugation, enhances the scientific and clinical application of common drug toxicology. This review includes basic hepatic metabolism, the common substrates, inducers and inhibitors of cytochrome P450 along with genetic variants behind the enzymes. Detailed metabolism of commonly measured opioids in clinical practice is provided...
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27842786/toxicology-in-addiction-medicine
#10
REVIEW
Daniel A Schwarz, M P George, Martin H Bluth
Toxicology testing in addiction medicine varies across the spectrum, yet remains a powerful tool in monitoring addictive patients. There are many reference laboratories offering toxicology testing, and physicians should have some understanding of laboratory, methodology, testing portfolio, and customer support structure to aid them in selecting the best toxicology laboratory for their patients. Consultation with a clinical pathologist/toxicologist in conjunction with the consideration of monitoring large numbers of illicit and psychoactive drugs in the addictive patient may provide important clinical information for their treatment...
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27842785/toxicology-in-pain-management
#11
REVIEW
Daniel A Schwarz, M P George, Martin H Bluth
Toxicology testing in pain management has become the standard of care. The Center for Disease Control and Prevention published guidelines including urine drug testing prior to initiating opioid therapy and for monitoring prescription and illicit drugs. Physicians must know indications for toxicology testing, and the frequency based upon risk stratification. This includes personal and family history of alcohol or substance related disorders, mental illness and smoking. Knowledge of opioid metabolism and various matrices to test are described...
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27842784/common-interferences-in-drug-testing
#12
REVIEW
Michael P Smith, Martin H Bluth
Interferences relating to laboratory toxicology testing refer to results which differ from their true value and are often encountered in the setting of a drug screen compared with confirmatory testing. Such interferences fall into two general categories; those that cause false positive results (when a drug screen is positive but confirmatory testing is negative) and those that cause false negative results (when a drug screen is negative when in reality the sample donor has ingested the tested substance). Such interferences can result from differences in laboratory testing methodology, reagent and analyte cross reactivity, limits of analyte detection, instrument resolution, reporting cutoff, sample processing, tissue type and sample adulteration among others...
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27842783/liquid-chromatography-tandem-mass-spectrometry-an-emerging-technology-in-the-toxicology-laboratory
#13
REVIEW
Yan Victoria Zhang, Bin Wei, Yu Zhu, Yanhua Zhang, Martin H Bluth
In the last decade, liquid chromatography-tandem mass spectrometry (LC-MS/MS) has seen enormous growth in routine toxicology laboratories. LC-MS/MS offers significant advantages over other traditional testing, such as immunoassay and gas chromatography-mass spectrometry methodologies. Major strengths of LC-MS/MS include improvement in specificity, flexibility, and sample throughput when compared with other technologies. Here, the basic principles of LC-MS/MS technology are reviewed, followed by advantages and disadvantages of this technology compared with other traditional techniques...
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27842782/narcotic-analgesics-and-common-drugs-of-abuse-clinical-correlations-and-laboratory-assessment
#14
REVIEW
Martin H Bluth, Matthew R Pincus
Pain management is an evolving discipline. New formulations mature with promises of improved pain control, better dosing, and fewer side effects. These agents also have an equal risk for abuse. Street chemists are adept at manipulating drugs to more potent versions and creating new compositions of matter. The clinical assessment of the patient is paramount to developing an index of suspicion of overdose, toxicity, or illicit drug use; the clinical laboratory can be a resource to support investigations and guide therapy...
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27514471/preface
#15
EDITORIAL
Kristen K Reynolds, Roland Valdes
No abstract text is available yet for this article.
September 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27514470/extracellular-vesicles-move-toward-use-in-clinical-laboratories
#16
REVIEW
Lindsay N Strotman, Mark W Linder
Extracellular vesicles (EVs) are membranous particles found in a variety of biofluids that encapsulate molecular information from the cell, which they originate from. This rich source of information that is easily obtained can then be mined to find diagnostic biomarkers. This article explores the current biological understanding of EVs and specific methods to isolate and analyze them. A case study of a company leading the charge in using EVs in diagnostic assays is provided.
September 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27514469/understanding-the-food-and-drug-administration-s-jurisdiction-over-laboratory-developed-tests-and-divisions-between-food-drug-and-cosmetic-act-regulated-and-clinical-laboratory-improvement-amendments-of-1988-regulated-activities
#17
REVIEW
Bradley Merrill Thompson, Bonnie I Scott, James A Boiani
The scope of FDA's jurisdiction over laboratory-developed tests (LDTs), and whether FDA has such jurisdiction at all, has been a heavily debated issue over the past several years. If FDA moves forward with its guidance, or Congress takes action to reform LDT and IVD regulation, a fundamental question that needs to be answered is how to divide activities regulated by FDCA from those regulated by CLIA. In this article, we consider FDA's authority to regulate LDTs and the policy implications of regulation, and discuss an idea for a fact-driven framework to distinguish FDCA- and CLIA- activities...
September 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27514468/the-future-of-precision-medicine-in-oncology
#18
REVIEW
Lori M Millner, Lindsay N Strotman
Precision medicine in oncology focuses on identifying which therapies are most effective for each patient based on genetic characterization of the cancer. Traditional chemotherapy is cytotoxic and destroys all cells that are rapidly dividing. The foundation of precision medicine is targeted therapies and selecting patients who will benefit most from these therapies. One of the newest aspects of precision medicine is liquid biopsy. A liquid biopsy includes analysis of circulating tumor cells, cell-free nucleic acid, or exosomes obtained from a peripheral blood draw...
September 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27514467/the-pharmacist-s-perspective-on-pharmacogenetics-implementation
#19
REVIEW
Frederick Weitendorf, Kristen K Reynolds
The future for pharmacogenetics will continue to expand. Pharmacists can apply and incorporate drug knowledge in collaboration with other health providers using pharmacogenetics. Patients benefit with enhanced therapeutic outcomes that could lead to more streamlined drug approaches, fewer follow-up visits, cost savings, and shorter times to achieve therapeutic outcomes. As more drug-gene pathways are discovered and use of this knowledge increases, the potential for algorithm development for medication use will occur, resulting in better patient outcomes, higher standard of care, and reflect evidence-based medicine...
September 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27514466/clinical-utility-and-economic-impact-of-cyp2d6-genotyping
#20
REVIEW
Kristen K Reynolds, Beth A McNally, Mark W Linder
Pharmacogenetics examines an individual's genetic makeup to help predict the safety and efficacy of medications. Practical application optimizes treatment selection to decrease the failure rate of medications and improve clinical outcomes. Lack of efficacy is costly due to adverse drug reactions and increased hospital stays. Cytochrome P450 2D6 (CYP2D6) metabolizes roughly 25% of all drugs. Detecting variants that cause altered CYP2D6 enzymatic activity identifies patients at risk of adverse drug reactions or therapeutic failure with standard dosages of medications metabolized by CYP2D6...
September 2016: Clinics in Laboratory Medicine
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