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1.
Expert Rev Clin Pharmacol ; 16(5): 453-465, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37147189

RESUMO

INTRODUCTION: Immunoassay urine drug screen (UDS) is frequently used in clinical practice for initial screening process, being generally available, fast, and inexpensive. Exposure to widely prescribed drugs might determine false-positive UDS amphetamines, leading to diagnostic issues, wrong therapeutic choices, impairment of physician-patient relationship, and legal implications. AREAS COVERED: To summarize and comment on a comprehensive list of compounds responsible for UDS false positives for amphetamines, we conducted a literature review on PubMed along with a comparison with Real-World Data from the Food and Drug Administration Adverse Event Reporting System (FAERS) database analysis between 2010 and 2022. Forty-four articles and 125 Individual Case Safety Reports (ICSR) involving false-positive amphetamine UDS in psychiatric patients were retrieved from FAERS. EXPERT OPINION: False-positive results were described in literature for antidepressants, atomoxetine, methylphenidate, and antipsychotics, but also for non-psychiatric drugs of common use, such as labetalol, fenofibrate, and metformin. Immunoassay method is usually responsible for false-positive results, and in most cases, mass spectrometry (MS) does not eventually confirm the UDS positivity. Physicians should be aware of immunoassays' limitations and when turning to a confirmatory test. Any new cross-reaction should be reported to pharmacovigilance activities.


Assuntos
Farmacovigilância , Detecção do Abuso de Substâncias , Estados Unidos , Humanos , United States Food and Drug Administration , Detecção do Abuso de Substâncias/métodos , Anfetaminas/efeitos adversos , Anfetaminas/urina , Imunoensaio/métodos
2.
J Anal Toxicol ; 47(3): 263-270, 2023 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-36367744

RESUMO

Immunoassays are routinely used to provide rapid urine drug screening results in the clinical setting. These screening tests are prone to false-positive results and ideally require confirmation by mass spectrometry. In this study, we have examined a large number of urine specimens where drugs other than amphetamines may have caused a false-positive amphetamine immunoassay screening result. Urine drug screens (12,250) in a clinical laboratory that used the CEDIA amphetamine/ecstasy method were reviewed for false-positive results over a 6-year period (2015-2020). An additional 3,486 referred samples, for which confirmatory--mass spectrometry was requested, were also reviewed. About 86 in-house samples and 175 referral samples that were CEDIA false-positive screens were further analyzed by an LC-QTOF general unknown screen. Potential cross-reacting drugs were identified, and their molecular similarities to the CEDIA targets were determined. Commercial standards were also analyzed for cross-reactivity in the amphetamine/ecstasy CEDIA screen. Positive amphetamine results in 3.9% of in-house samples and 9.9% of referred tests for confirmatory analysis were false positive for amphetamines. Of these false-positive specimens, on average, 6.8 drugs were detected by the LC-QTOF screen. Several drugs were identified as possible cross-reacting drugs to the CEDIA amphetamine/ecstasy assay. Maximum common substructure scores for 70 potential cross-reacting compounds were calculated. This was not helpful in identifying cross-reacting drugs. False-positive amphetamine screens make up to 3.9-9.9% of positive amphetamine screens in the clinical laboratory. Knowledge of cross-reacting drugs may be helpful when mass spectrometry testing is unavailable.


Assuntos
N-Metil-3,4-Metilenodioxianfetamina , Detecção do Abuso de Substâncias , Detecção do Abuso de Substâncias/métodos , Anfetaminas/urina , Anfetamina , Imunoensaio/métodos , Espectrometria de Massas
3.
Molecules ; 25(22)2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33182534

RESUMO

The rapid sensing of drug compounds has traditionally relied on antibodies, enzymes and electrochemical reactions. These technologies can frequently produce false positives/negatives and require specific conditions to operate. Akin to antibodies, molecularly imprinted polymers (MIPs) are a more robust synthetic alternative with the ability to bind a target molecule with an affinity comparable to that of its natural counterparts. With this in mind, the research presented in this article introduces a facile MIP-based dye displacement assay for the detection of (±) amphetamine in urine. The selective nature of MIPs coupled with a displaceable dye enables the resulting low-cost assay to rapidly produce a clear visual confirmation of a target's presence, offering huge commercial potential. The following manuscript characterizes the proposed assay, drawing attention to various facets of the sensor design and optimization. To this end, synthesis of a MIP tailored towards amphetamine is described, scrutinizing the composition and selectivity (ibuprofen, naproxen, 2-methoxphenidine, quetiapine) of the reported synthetic receptor. Dye selection for the development of the displacement assay follows, proceeded by optimization of the displacement process by investigating the time taken and the amount of MIP powder required for optimum displacement. An optimized dose-response curve is then presented, introducing (±) amphetamine hydrochloride (0.01-1 mg mL-1) to the engineered sensor and determining the limit of detection (LoD). The research culminates in the assay being used for the analysis of spiked urine samples (amphetamine, ibuprofen, naproxen, 2-methoxphenidine, quetiapine, bupropion, pheniramine, bromopheniramine) and evaluating its potential as a low-cost, rapid and selective method of analysis.


Assuntos
Anfetaminas/urina , Corantes/química , Polímeros Molecularmente Impressos , Polímeros/química , Detecção do Abuso de Substâncias/métodos , Urina/química , Anfetamina/urina , Bromofeniramina/urina , Bupropiona/urina , Relação Dose-Resposta a Droga , Técnicas Eletroquímicas , Reações Falso-Positivas , Humanos , Ibuprofeno/urina , Limite de Detecção , Impressão Molecular , Naproxeno/urina , Feniramina/urina , Piperidinas/urina , Pós , Fumarato de Quetiapina/urina
4.
J Chromatogr Sci ; 58(6): 569-575, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32390045

RESUMO

A simple and rapid pipette-tip solid-phase extraction (PT-SPE) procedure with derivatization prior to gas chromatography triple quadrupole mass spectrometry analysis is developed for the simultaneous determination of amphetamine (AMP), methamphetamine (MA), 3,4-methylenedioxyamphetamine (MDA) and 3,4-methylenedioxymethamphetamine (MDMA) in urine samples. The PT-SPE procedure using self-made sorbent could extract drugs within 6 min from 100-µL urine samples, requiring low solvent-consumption (<2.0 mL). Besides, the self-made pipette tip could be reused at least five times. Under optimized conditions, the recoveries of four amphetamines at spiked levels (low, medium and high) ranged from 87.7 to 110.4%, with relative standard deviations < 9.5%. The limit of detections and limit of quantifications for AMP, MA, MDA and MDMA were in the range of 2.52-8.25 ng⋅mL-1 and 8.4-27.5 ng⋅mL-1, respectively. Validation results show that the proposed method is suitable for the quantitation of amphetamines and has been successfully applied in the urine samples of suspected drug abusers.


Assuntos
Anfetaminas/urina , Cromatografia Gasosa-Espectrometria de Massas/métodos , Extração em Fase Sólida/métodos , Espectrometria de Massas em Tandem/métodos , Anfetaminas/química , Anfetaminas/isolamento & purificação , Desenho de Equipamento , Humanos , Limite de Detecção , Modelos Lineares , Reprodutibilidade dos Testes , Extração em Fase Sólida/instrumentação
5.
Anal Bioanal Chem ; 411(29): 7889-7897, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31732788

RESUMO

The present paper describes an original method for the online preconcentration and analysis of ring-substituted amphetamines in urine samples, used on the integration of robot-assisted hollow fiber liquid-phase microextraction (HF-LPME), high-performance liquid chromatography (HPLC), and fluorescence detection (FLD). A lab-made autosampler, actuating a 100-µL syringe and equipped with a three-way solenoid microvalve, allowed the acceptor phase to flow through and be withdrawn from the lumen fiber, enabling the automated online transference of the enriched acceptor phase for chromatographic analysis, through a six-port switching valve. The developed online HF-LPME-LC/FLD method demonstrated high analytical throughput and confidence, facilitating the efficient extraction and determination of the target analytes, with minimal solvent consumption and sample manipulation, in a straightforward way. Sample cleanup, analyte uptake, and analysis were carried out in 14.5 min. Under optimal conditions, automated online HF-LPME showed excellent linearity, precision, and trueness, obtaining intraday RSDs between 2.9 and 9.2% (n = 6) and interday RSDs between 5.3 and 9.3% (n = 6). Enrichment factors (EFs) ranged between 14.2 and 15.7, extraction recoveries (ERs) ranged between 17.7 and 19.5%, and the limits of detection (S/N = 3) were 2.0, 3.0, and 3.0 µg L-1 for MDA, MDMA, and MDEA, respectively. The method proved to be an effortless, rapid, reliable, and environment-friendly approach for the determination of drug abuse in urine samples. Graphical abstract.


Assuntos
Anfetaminas/urina , Cromatografia Líquida de Alta Pressão/métodos , Microextração em Fase Líquida/métodos , Anfetaminas/química , Humanos , Limite de Detecção , Reprodutibilidade dos Testes , Espectrometria de Fluorescência/métodos
6.
Compr Psychiatry ; 94: 152126, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31518847

RESUMO

There has been only a few reports regarding aripiprazole causing false positive urine amphetamine drug screens, exclusively on children accidently ingesting aripiprazole. Herein, we present the first reported case of a 40 year old woman affected by Bipolar I Disorder, treated with aripirazole at therapeutic oral dose ranging from 15 mg/day to 30 mg/day, in the context of a depressive episode with mixed and psychotic features, showing a false positive urine amphetamine drug screen. We document the relationship between aripiprazole-dose, plasma concentration and amphetamines values in toxicologic urine examinations over time. Awareness of potential false positive urine amphetamine drug screens during aripiprazole treatment can condition therapeutic choices and prevent legal implications.


Assuntos
Anfetaminas/urina , Antipsicóticos/urina , Aripiprazol/urina , Transtorno Bipolar/urina , Detecção do Abuso de Substâncias/estatística & dados numéricos , Adulto , Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Reações Falso-Positivas , Feminino , Humanos
7.
Drug Alcohol Depend ; 204: 107461, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31521952

RESUMO

BACKGROUND: Substance use during pregnancy is a major medical and public health concern. Determination of the most appropriate screening protocol remains a clinical conundrum. Interviews and/or laboratory drug screens may be costly, inaccurate, and are frequently inadequate to identify patterns of substance use for a given population or geographic area. We compared commercially available urine "dip cup" toxicology screens obtained in the clinic to university hospital drug toxicology results. METHODS: 267 observed urine samples were collected from pregnant women with known substance use disorders enrolled in a specialized treatment program that included access to buprenorphine medication-assisted treatment. Each urine sample was tested by commercial dip cup with temperature confirmation and then sent to the university hospital laboratory for analyses. The number of substances detected and cost for each screening method were compared. RESULTS: Uniformly, the dip cup had comparable detection of amphetamines, barbiturates, cocaine, methadone, opiates, and tetrahydrocannabinol to the university hospital laboratory with the exception of benzodiazepines. In addition, the dip cup detected use of buprenorphine (a commonly misused opiate receptor ligand not included in the hospital screen) and was significantly less expensive. CONCLUSIONS: Commercially available urine dip cups are cost-effective, equally comparable to hospital based screening, and provide 'real time' results germane to clinical care and treatment planning.


Assuntos
Complicações na Gravidez/diagnóstico , Complicações na Gravidez/urina , Detecção do Abuso de Substâncias/normas , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/urina , Urinálise/normas , Anfetaminas/urina , Analgésicos Opioides/urina , Benzodiazepinas/urina , Buprenorfina/urina , Cocaína/urina , Feminino , Humanos , Laboratórios Hospitalares/normas , Metadona/análise , Metadona/urina , Gravidez , Complicações na Gravidez/epidemiologia , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Urinálise/métodos
10.
Forensic Sci Int ; 290: 49-55, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30015279

RESUMO

Carbon nanotubes (CNTs) have attracted a lot of attention as effective sorbents due to their strong sorption properties and several potential applications in many fields. In this work, the acid oxidized multiwalled carbon nanotubes (MWCNTs-COOH) was coated onto a stainless steel wire by a simple physical adhesion approach to develop solid-phase microextraction (SPME) fibers. By combination of the MWCNTs-COOH coated fiber-based headspace SPME and gas chromatography-mass spectrometry (GC-MS), the developed method demonstrates a good enhancement factor (288-651), low limits of detection (LODs, 0.2-1.3µg/L) for determination of amphetamine-type stimulant drugs (ATSs) in urine samples. The recoveries of the spiked ATSs (5, 50 and 500µg/L) were in the range of 88-107%, the calibration curve was linear for concentrations of analytes in the range from 0.5 to 1000µg/L (R=0.963-0.999). Furthermore, single fiber repeatability and fiber-to-fiber reproducibility were in the range of 2.3%-6.2% (n=6) and 5.7%-9.8% (n=3), respectively. The MWCNTs-COOH coated fiber is highly thermally stable and can be used over 150 times. The method was successfully applied to the forensic determination of amphetamine (AMP) and methamphetamine (MAMP) in human urine samples and satisfactory results were achieved.


Assuntos
Anfetaminas/urina , Nanotubos de Carbono , Microextração em Fase Sólida , Toxicologia Forense , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Limite de Detecção , Reprodutibilidade dos Testes , Detecção do Abuso de Substâncias/métodos
11.
Talanta ; 188: 111-123, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30029353

RESUMO

Among the emerging new psychoactive substances (NPS), compounds carrying an N-ortho-methoxybenzyl substituent, the so-called NBOMes, represented a highly potent group of new hallucinogens. Recently, 3,4-dimethoxyamphetamine (3,4-DMA)-NBOMe and 4-methylmethamphetamine (4-MMA)-NBOMe occurred, but no data on their pharmacokinetics were available. According to other NBOMes, they are expected to be extensively metabolized. For detection and identification of their phase I and II metabolites, nano liquid chromatography coupled to high resolution tandem mass spectrometry (nanoLC-HRMS/MS) was used. Rat urine was prepared by simple dilution and incubation mixtures with pooled human liver S9 fraction by precipitation. Furthermore, the results concerning detectability using the new nanoLC approach were compared to those obtained by conventional ultra-high performance LC (UHPLC). In addition, the detectability of the compounds by standard urine screening approaches (SUSAs) routinely used by the authors with UHPLC-HRMS/MS, LC-MSn, and GC-MS was tested. Both NBOMes were extensively metabolized mainly by O-demethylation and conjugation with glucuronic acid (3,4-DMA-NBOMe) or oxidation of the tolyl group to the corresponding carboxylic acid (4-MMA-NBOMe). The developed nanoLC-HRMS/MS approach was successfully applied for identification of 38 3,4-DMA-NBOMe metabolites and 33 4-MMA-NBOMe metabolites confirming its detection power. Furthermore, the solvent saving nanoLC system showed comparable results to the UHPLC-HRMS/MS approach. In addition, an intake of an estimated low common user's dose of the compounds was detectable by all SUSAs only via their metabolites. Suggested targets for urine screening procedures were O-demethyl- and O,O-bis-demethyl-3,4-DMA-NBOMe and their glucuronides and carboxy-4-MMA-NBOMe and its glucuronide and N-demethyl-carboxy-4-MMA-NBOMe.


Assuntos
Anfetaminas/urina , Metanfetamina/análogos & derivados , Metanfetamina/urina , Anfetaminas/metabolismo , Animais , Cromatografia Líquida/métodos , Glucuronídeos/urina , Humanos , Fígado/química , Masculino , Metanfetamina/metabolismo , Ratos Wistar , Espectrometria de Massas em Tandem/métodos
12.
J Anal Toxicol ; 42(9): 605-616, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29982540

RESUMO

Despite the efforts to prevent the spread of new psychoactive substances (NPS) such as synthetic amphetamine derivatives, it is apparent that newer types of NPS are still emerging on the market in recent years. Due to high potential for their abuse, reliable analytical methods are required to determine these substances in biological samples. The objective of this study was to develop and validate the gas chromatography-mass spectrometric (GC-MS) method for the simultaneous determination of 13 amphetamine-related NPS (amphetamine; AP, 4-fluoroamphetamine; 4FA, methamphamine; MA, 4-fluoromethamphetamine; 4FMA, 4-chloroamphetamine; 4CA, para-methoxyamphetamine; PMA, 4-chloromethamphetamine; 4CMA, 6-(2-aminopropyl)benzofuran; 6APB, 4-methylenedioxyamphetamine; MDA, para-methoxymethamphetamine; PMMA, 6-(2-methylaminopropyl)benzofuran; 6MAPB, 3,4-methylenedioxymethamphetamine; MDMA, 5,6-methylenedioxy-2-aminoindane; MDAI) in urine. The analytes were extracted at pH 7.4 by liquid-liquid extraction prior to their trifluoroacetyl derivatives and then analyzed by GC-MS. The validation parameters included selectivity, linearity, lower limits of quantification (LLOQ), intra and interday precision and accuracy, recovery and stability. The linear ranges were 2-100 ng/mL for AP, 4FA, 4FMA, 4CA, PMA, 6APB, MDA, and MDAI, 2-250 ng/mL for 4CMA, PMMA, and 6MAPB and 25-1,000 ng/mL for MA and MDMA, with acceptable coefficients of determination (r2 > 0.9963). The intra and interday precision were within 11.9 and 12.5%, while the intra and interday accuracies ranged from -10.6% to 13.0% and -11.0% to 6.8% for the nominal concentration at all studied levels, respectively. The LLOQs for each analyte were 2.0-25 ng/mL. The recoveries ranged from 69.3% to 96.4%. The short- and long-term variations of the analytes in urine were lower than 8.5 and 12.7%, indicating that the analytes are stable at least for 16 h at room temperature and for 7 days at 4°C, respectively. The applicability of the method was examined by analyzing urine samples from drug abusers and was determined to be effective for detecting multiple drug use.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/urina , Anfetaminas/urina , Drogas Desenhadas/análise , Toxicologia Forense/métodos , Psicotrópicos/urina , Detecção do Abuso de Substâncias/métodos , Toxicologia Forense/instrumentação , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Limite de Detecção , Reprodutibilidade dos Testes , Detecção do Abuso de Substâncias/instrumentação
13.
Talanta ; 182: 574-582, 2018 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-29501195

RESUMO

Monitoring of amphetamine-type stimulant (ATS) confronts clinical labs with a high number of samples involving a variety of biological matrices. Liquid chromatography-tandem mass spectrometry (LC-MS/MS), routinely used for confirmation of ATS abuse, requires of laborious and matrix-dependent sample treatment methods, this increasing analysis time and cost. In this work, a universal and single-step sample treatment, based on supramolecular solvents (SUPRAS), was proposed for simplifying ATS confirmation in seven biological matrices. The SUPRAS was synthesized in situ in the sample (900 µL of basified oral fluid, urine, serum, sweat or breast milk or 50 mg of digested hair or fingernails) by the addition of hexanol (200 µL) and tetrahydrofuran (900 µL). The mixture was vortex-shaken and centrifuged and the SUPRAS extract was subsequently analyzed by positive ion mode electrospray LC-MS/MS. The method was fully validated for amphetamine (AMP), methamphetamine (MA), 3,4-methylenedioxyamphetamine (MDA), N-ethyl-3,4-methylenedioxyamphetamine (MDEA) and N-methyl-3,4-methylenedioxyamphetamine (MDMA). Maximum ion suppression or enhancement was 9% and 7%, respectively, and extraction recoveries (87-111%) and within- (0.1-6.7%) and between-day (0.3-9.7%) CVs were all within required values. The lower limits of quantification (LLOQ) for biological fluids (5 ng/mL), and hair and fingernails (100 ng/g) were all well below the cut-offs established by worldwide organizations. Confirmation of MDA was carried out in five urine samples that tested positive for ATS by immunoassay. The SUPRAS-LC-MS/MS methodology succeeded in developing a hitherto unexplored and universal tool for quantifying ATS in a comprehensive pool of biological matrices of interest in forensic and clinical samples.


Assuntos
Anfetaminas/urina , Estimulantes do Sistema Nervoso Central/urina , Furanos/química , Hexanóis/química , Extração Líquido-Líquido/métodos , Detecção do Abuso de Substâncias/métodos , Anfetaminas/sangue , Anfetaminas/classificação , Estimulantes do Sistema Nervoso Central/sangue , Estimulantes do Sistema Nervoso Central/classificação , Cromatografia Líquida , Cabelo/química , Humanos , Hidrólise , Limite de Detecção , Leite Humano/química , Unhas/química , Saliva/química , Suor/química , Espectrometria de Massas em Tandem
14.
Ther Drug Monit ; 40(1): 135-139, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29194289

RESUMO

BACKGROUND: The number of reports of serious adverse effects and intoxication after the use of the new drug 4-fluoroamphetamine (4-FA) increases. At the Emergency Department of the OLVG-Oost Hospital in Amsterdam, an on-site drug test, the Triage TOX Drug Screen, is available to assist in a rapid diagnosis. In less urgent cases, an EMIT II Plus immunoassay is used to determine semiquantitatively the presence of drugs of abuse (DOA). The antibodies in these immunoassays are designed to detect classic DOA and its urinary metabolites. Amphetamine-like drugs that may cause serious toxicity or impairment may not cross-react with the available immunoassay kits, and therefore may stay undetected. The question arises as to whether 4-FA and paramethoxymethamphetamine (PMMA) are detectable in the toxicological screening procedures commonly used for testing in urine. METHODS: Synthetic urine was spiked with the drug under investigation to create spiking standards of 50, 100, 250, 500, 2500, and 5000 ng/mL. Urine drug screens were performed on the automated analyzer Biosite Triage MeterPro using the Triage TOX Drug Screen test and on a Siemens Drug Testing System Viva-E using the EMIT II Plus Ecstasy Assay and the EMIT II Plus Amphetamines Assay. RESULTS: In this concentration range, the EMIT II Plus did not screen positive for PMMA, but there was some cross-reactivity for PMMA on the EMIT II Plus Ecstasy assay. The Triage TOX Drug Screen did test positive for PMMA at a concentration of 2500 ng/mL. The EMIT II Plus Amphetamines did test positive for 4-FA at a concentration of 5000 ng/mL, whereas the Ecstasy [3,4-methylenedioxymethamphetamine (MDMA)] assay only showed low cross-reactivity for 4-FA. The Triage TOX Drug Screen did not test positive for 4-FA. CONCLUSIONS: The available immunoassays lack sensitivity to detect 4-FA and PMMA in lower urine concentrations. Awareness of the fact that novel DOA may lead to false-negative urinary drug tests is of great importance.


Assuntos
Anfetaminas/urina , Imunoensaio/métodos , Metanfetamina/análogos & derivados , Sensibilidade e Especificidade , Detecção do Abuso de Substâncias/métodos , Reações Cruzadas/efeitos dos fármacos , Metanfetamina/urina
16.
J Clin Sleep Med ; 12(12): 1633-1640, 2016 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-27655451

RESUMO

STUDY OBJECTIVES: Multiple sleep latency testing (MSLT) and the maintenance of wakefulness test (MWT) are gold-standard objective tests of daytime sleepiness and alertness; however, there is marked variability in their interpretation and practice. This study aimed to determine the incidence of positive drug screens and their influence on MSLT, MWT, and polysomnographic variables. METHODS: All patients attending Eastern Health Sleep Laboratory for MSLT or MWT over a 21-mo period were included in the study. Urinary drug screening for amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, and opiates was performed following overnight polysomnography (PSG). Demographics and PSG variables were compared. RESULTS: Of 69 studies, MSLT (43) and MWT (26), 16% of patients had positive urinary drug screening (7 MSLT; 4 MWT). Drugs detected included amphetamines, cannabinoids, opiates, and benzodiazepines. No patient self-reported use of these medications prior to testing. No demographic, MSLT or MWT PSG data or overnight PSG data showed any statistical differences between positive and negative drug screen groups. Of seven MSLT patients testing positive for drug use, one met criteria for the diagnosis of narcolepsy and five for idiopathic hypersomnia. On MWT, three of the four drug-positive patients had a history of a motor vehicle accident and two patients were occupational drivers. CONCLUSIONS: These findings indicate drug use is present in patients attending for daytime testing of objective sleepiness and wakefulness. These data support routine urinary drug screening in all patients undergoing MSLT or MWT studies to ensure accurate interpretation in the context of illicit and prescription drug use.


Assuntos
Anfetaminas/urina , Benzodiazepinas/urina , Canabinoides/urina , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Alcaloides Opiáceos/urina , Vigília/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Distúrbios do Sono por Sonolência Excessiva/urina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Adulto Jovem
17.
Electrophoresis ; 37(21): 2875-2881, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27611343

RESUMO

A sensitive and rapid CZE-UV method was developed to determine drugs and their metabolites' presence in human urine. Ten drugs of abuse were analyzed including four amphetamines, cocaine, cocaethylene, heroin, morphine, 6-monoacetylmorphine, and 4-methylmethcathinone. An MSS (micelle to solvent stacking) approach was evaluated to enhance method sensitivity. This method considers composition of the micellar sample solution matrix and the injection time. Several analytical conditions influencing the resolution of the drugs mixture as pH and buffer concentration, organic solvent content, were also investigated. The base-line separation of all studied analytes in the same run was achieved within 18 min in an uncoated fused silica capillary (50 µm id × 60 cm) using a background solution containing 50 mM phosphate buffer pH 2.5 and 30% ACN v/v. Other experimental parameters such as applied voltage and capillary temperature were set up at 20 kV and 20°C, respectively. LOD values ranging between 15 and 75 ng/mL for all studied compounds were obtained. From a comparison with conventional CZE, the proposed method provides an increase of sensitivity (39- to 55-fold enhancement factor). Under optimal MSS-CZE conditions, good linearity was achieved (R2 ≤ 0.9998). The method was finally applied to the analysis of urine samples spiked with a standard mixture after a sample pretreatment, reaching satisfactory recovery values.


Assuntos
Eletroforese Capilar/métodos , Drogas Ilícitas/urina , Anfetaminas/urina , Cocaína/urina , Humanos , Limite de Detecção , Modelos Lineares , Micelas , Reprodutibilidade dos Testes
18.
J Anal Toxicol ; 40(9): 726-731, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27550994

RESUMO

Urine drug testing (UDT) has become an essential component in the management of patients prescribed opioid analgesics for the treatment of chronic non-malignant pain. Several laboratory methods are available to monitor adherence with the pharmacological regimen and abstinence from illicit or unauthorized medications. Immunochemical screening methods are rapid and economical, but they have limitations, including lack of specificity, and confirmatory methods are often necessary to verify presumptive positive results. We analyzed the results of confirmatory assays in an outpatient setting to determine the predictive value of presumptive positive urine drug screen results using an automated immunoassay for eight common drugs or drug classes. Positive predictive values (PPVs), in descending order, were as follows: cannabinoids (100%), cocaine (100%), opiates (86.8%), benzodiazepines (74.6%), oxycodone (67.6%), methadone (44.1%) and amphetamines (9.3%). The number of positive barbiturate results was too small to be included in the statistical analysis.


Assuntos
Analgésicos Opioides/análise , Analgésicos Opioides/urina , Avaliação Pré-Clínica de Medicamentos/métodos , Estudos Prospectivos , Anfetaminas/análise , Anfetaminas/urina , Analgésicos Opioides/economia , Barbitúricos/análise , Barbitúricos/urina , Benzodiazepinas/análise , Benzodiazepinas/urina , Canabinoides/análise , Canabinoides/urina , Dor Crônica/tratamento farmacológico , Cocaína/análise , Cocaína/urina , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Imunoensaio , Metadona/análise , Metadona/urina , Alcaloides Opiáceos/análise , Alcaloides Opiáceos/urina , Oxicodona/análise , Oxicodona/urina , Espectrometria de Massas em Tandem
19.
Forensic Sci Int ; 265: 81-8, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26836147

RESUMO

A gas chromatography-mass spectrometry method for the determination of amphetamines in urine samples by means of liquid-phase microextraction was validated, including calculation of measurement uncertainty. After extraction in the three-phase mode, acceptor phase was withdrawn from the fiber and the residue was derivatized with trifluoroacetic anhydride. The method showed to be very simple, rapid and it required a significantly low amount of organic solvent for extraction. The limits of detection were 10 and 20µg/L for amphetamine and methamphetamine, respectively. The calibration curves were linear over the specified range (20µg/L to 1400µg/L; r(2)>0.99). The method showed to be both precise and accurate and a relative combined uncertainty of 2% was calculated. In order of importance, the factors which were more determinant for the calculation of method uncertainty were: analyte concentration, sample volume, trueness and method precision.


Assuntos
Anfetaminas/urina , Drogas Ilícitas/urina , Toxicologia Forense , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Microextração em Fase Líquida , Reprodutibilidade dos Testes , Detecção do Abuso de Substâncias/métodos , Urinálise
20.
J Chromatogr B Analyt Technol Biomed Life Sci ; 1012-1013: 162-8, 2016 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-26828152

RESUMO

The counter current salting-out homogenous liquid-liquid extraction (CCSHLLE) joined with the dispersive liquid-liquid microextraction based on solidification of floating organic drop (DLLME-SFO) has been developed as a high preconcentration technique for the determination of different drugs in urine samples. Amphetamines were employed as model compounds to assess the extraction procedure and were determined by high performance liquid chromatography-ultraviolet detection (HPLC-UV). In this method, initially, NaCl as a separation reagent is filled into a small column and a mixture of urine and acetonitrile is passed through the column. By passing the mixture, NaCl is dissolved and the fine droplets of acetonitrile are formed due to salting-out effect. The produced droplets go up through the remained mixture and collect as a separated layer. Then, the collected acetonitrile is removed with a syringe and mixed with 30.0µL 1-undecanol (extraction solvent). In the second step, the 5.00mLK2CO3 solution (2% w/v) is rapidly injected into the above mixture placed in a test tube for further DLLME-SFO. Under the optimum conditions, calibration curves are linear in the range of 1-3000µgL(-1) and limit of detections (LODs) are in the range of 0.5-2µgL(-1). The extraction recoveries and enrichment factors ranged from 78 to 84% and 157 to 168, respectively. Repeatability (intra-day) and reproducibility (inter-day) of method based on seven replicate measurements of 100µgL(-1) of amphetamines were in the range of 3.5-4.5% and 4-5%, respectively. The method was successfully applied for the determination of amphetamines in the actual urine samples. The relative recoveries of urine samples spiked with amphetamine and methamphetamine are 90-108%.


Assuntos
Anfetaminas/urina , Distribuição Contracorrente/métodos , Extração Líquido-Líquido/métodos , Adulto , Anfetaminas/isolamento & purificação , Feminino , Humanos , Concentração de Íons de Hidrogênio , Limite de Detecção , Modelos Lineares , Masculino , Reprodutibilidade dos Testes , Adulto Jovem
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