• Difference Between Clinical Toxicology Tests and Therapeutic Drug Management Screening?

    Clinical toxicology specializes in ways to treat poisoned individuals and focuses on determining and understanding the toxic effects of medicines and simple over-the-counter drugs. Two of the traditional clinical toxicology services known in the medical field are Emergency toxicology and Therapeutic Drug Monitoring.

    Emergency toxicology is focused on providing clinically useful toxicology test results to support the needs of the poisoned or intoxicated patients in the emergency department. It analyzes agents, such as drugs and chemicals, in body fluids for the purpose of patient care. Many of these agents are usually given to individuals in order to give relief for symptoms or to treat and prevent diseases. Additionally, it focuses on the diseases associated with short-term and long-term exposure to various toxic chemicals. On the other hand, therapeutic drug monitoring is geared at the measurement of serum drug concentrations to aid in optimizing drug therapy.

    In the United States, nearly 82 people die every day due to unintentional poisoning, and another 1,941 are treated in emergency departments. Unintentional poisoning includes the use of drugs or chemicals for recreational purposes, such as in the case of “overdose.” Similarly, an individual who gets excessive exposure to certain drugs or chemical for non-recreational purposes is also likely to become victim of unintentional poisoning, such as children who accidentally ingest prescription medications. An emergency toxicology test may be required by a physician to assist in the diagnosis and treatment of poisonings or drug overdoses in the patient.

    In the recent years, the increasing abuse of drugs has placed additional demands on clinical toxicology laboratories. As a result, a handful of clinical toxicology lab are now routinely conducting urine testing of drugs of abuse for other clinical services (e.g. drug rehabilitation centers, pain clinics, and psychiatry facilities) in order to help manage patients for their drug abuse or compliance, rather than just for drug intoxication.

    Urine is still a very common specimen used in clinical toxicology and therapeutic drug management screening due to ease of collection. Likewise, the relatively high drug concentrations make detection and quantitation possible without the high cost.

    The table below shows some of the clinical toxicology/therapeutic drug management tests that a professional health care may recommend to a patient to identify, diagnose, and treat a condition resulting from exposure to drugs or chemicals. The specimen required is either in the form of urine or serum. The methods used to perform the test range from immunoassay to Liquid chromatography/mass spectrometry (LC/MS) to Gas chromatography coupled with mass spectrometry (GC/MS) to Inductively Coupled Plasma/Mass Spectrometry (ICP-MS).

    Therapeutic Drug Related Test

    Chemical Related Test

    • Acetohexamide
    • Aripiprazole (Abilify)
    • Aripiprazole (Abilify), urine
    • n-acetylprocainamide (NAPA®, Acecainide)
    • Ibuprofen (Motrin®, Advil®, Nuprin®), serum
    • Zolpidem (Ambien), urine
    • Amikacin (Amikin®)
    • Amobarbital (Amytal®)
    • Nortriptyline (Aventyl®)
    • Amiodarone (Cordarone®) and Desethylamiodarone
    • Acetazolamide (Diamox®)
    • Amitriptyline (Elavil®) and Nortriptyline
    • Alcohol, Methyl
    • Antipsychotic Drug Screen, Whole blood
    • Antihistamine Screen
    • Atomoxetine (Strattera®), serum
    • Amantadine (Symmetrel®)
    • Antidepressant Drug Screen, Qualitative
    • Antidepressant Drug Screen, Quantitative
    • Antidepressant Drug Screen,Ur, Quantitative
    • Alprazolam (Xanax®), serum
    • Alfentanil (Alfenta®), urine-Forensic
    • Aluminum, random urine
    • Aluminum, serum
    • Metal Panel(As,Hg,Pb): Clinical Monitoring,Blood #60177
    • Metal Panel(As,Hg,Pb): random urine #62625
    • Arsenic, blood
    • Arsenic, random urine
    • Arsenic, serum
    • Aromatic Solvents, serum

    • Aromatic Solvents, urine

    Reasons for Performing Clinical Toxicology Test

    Clinical toxicology test is typically ordered by a physician if a patient shows signs and symptoms of drug overdose and abuse. Other scenarios wherein the procedure may be required include:

    • Exposure to industrial chemical products and environmental hazards
    • Intentional or unintentional overdose of prescription medications
    • Envenomation and exposure to other natural toxins
    • Individuals placed on therapeutic drug regimen

    Pros and Cons of Clinical Toxicology Test

    The primary purpose of clinical toxicology tests is to aid in the treatment of an intoxicated patient. Different clinical toxicology tests are prescribed depending on the data that the physician seeks to achieve: toxicity for a suspected drug overdose or exposure, abstinence in drug abuse treatment, and compliance in pain management. When done right, the clinical toxicology test will provide efficient way to diagnose and treat conditions resulting from exposure to harmful agents, such as drugs or chemicals. Similarly, it effectively helps in determining the factors that usually lead to drug overdose and poisoning.

    The disadvantages are often associated with the type of specimen used; and in some cases, themethod of drug testing. Most clinical drug testing activities are still based on urine, which is easy to collect and pain-free. However, urine’s window of detection of 1 to 7 days only reflects recent substance use and the specimen is easy to adulterate by individuals who want to escape detection of their drug use. To address this drawback, many lab test providers are implementing vigorous collection protocols designed to deter adulteration and tampering of specimens, which consequently are raising the issue of invasion of privacy.

    In the case of therapeutic drug management, a clinical toxicology test may be required to observe the clinical reactions of a patient taking the drug for treatment purposes, identifies the effect of drug interactions, and helps to tailor dosages to fit the current needs of the specific patient. The frequency of testing required depends on the drug and on the needs of the patients.






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