Forensic Pharmacology Medicines, Mayhem, and Malpractice

, by Ferner, R. E.; Norman, Elizabeth; Rawlins, M. D.

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ISBN: 9780198548263 | 0198548265
Cover: Hardcover
Copyright: 2/22/1996

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Forensic Pharmacology offers a unique and comprehensible account of pharmacological methods and knowledge, and how to use them to solve problems in crimes from drunken driving to murder. It also deals with negligence in giving drugs, and adverse reactions to drugs. The text is enlivened bycases from the literature and from the authors' experience. Appendices give detailed examples of pharmacological problems and their solutions; tables and equations for alcohol calculations; and data for medicines encountered in forensic work. Experts do not always understand what lawyers want of them, and lawyers fail to appreciate that experts in medicine and pharmacology may not be experts in the law. The section entitled 'legal considerations' was written by a barrister with wide experience of using expert evidence and explainsclearly the legal principles. It also contains some helpful hints on how to deal with court procedure and adversarial lawyers.

Introduction

(2)

Part 1 General considerations

(68)

1 Drugs, their behaviour and their effects on the body

(32)

1.1 The different sorts of agent

(15)

1.1.1 Some definitions

(3)

1.1.2 Systems of therapeutics

(9)

1.1.3 Medicines licensed under the Medicines Act 1968

(3)

1.2 Pharmacokinetics

(4)

1.2.1 The dosage of a drug

(1)

1.2.2 Concentration

(1)

1.2.3 Volume of distribution

(1)

1.2.4 Drug disappearance

(2)

1.3 Pharmacodynamics

(15)

1.3.1 History

(1)

1.3.2 Sites of drug action

(3)

1.3.3 Toxicity

(1)

1.3.4 Adverse effects

(12)

2 Analyses of drugs and drug concentrations in blood and other body compartments

(18)

2.1 Samples and sample collection

(4)

2.1.1 Blood samples

(1)

2.1.2 Contamination of samples

(1)

2.1.3 Blood sampling sites

(1)

2.1.4 Changes in drug concentrations after death

(2)

2.1.5 The identification, transfer and storage of samples

(1)

2.2 Analytical methods

(9)

2.2.1 Spectrophotometric methods

(2)

2.2.2 The techniques of chromatography

(3)

2.2.3 Immunoassay

(3)

2.3 Interpreting the results of analysis

(4)

2.3.1 Calibration

(1)

2.3.2 Scatter, or dispersion

(1)

2.3.3 Accuracy and quality control

(1)

2.4 Summary

(1)

3 Legal considerations

(16)

E. Norman

3.1 "What am I doing here?"

(1)

3.2 Proof

(3)

3.2.1 Who needs to prove what?

(2)

3.2.2 The standard or proof

(1)

3.3 The expert witness

(6)

3.3.1 The role of the expert before trial

(1)

3.3.2 Expert advice

(3)

3.3.3 The expert in court

(3)

3.4 Homicide and related matters

(5)

3.4.1 Murder and manslaughter

(1)

3.4.2 Diminished responsibility

(1)

3.4.3 Some general defences

(3)

3.5 Summary

(2)

Part 2 Specific problems

(40)

4 Effects of drugs on behaviour

(6)

4.1 The defendant's behaviour

(2)

4.1.1 Drug-induced hypoglycaemia

(1)

4.1.2 Other drug-induced mental changes

(1)

4.1.3 Is the behaviour due to a disease or a drug?

(1)

4.1.4 Pathological intoxication

(1)

4.2 Drugs which cause aggression

(1)

4.3 Drug-induced depression

(1)

4.4 Hallucination

(2)

4.5 Summary

(1)

5 Effects of drugs on the victims of crime

(11)

5.1 Some history

(2)

5.2 Crime and death by poisoning

(2)

5.3 Child abuse by poisoning

(4)

5.3.1 Common salt (NaCl)

(1)

5.3.2 Medicines used in psychiatry

(2)

5.3.3 Laxatives and emetics

(1)

5.3.4 Insulin

(1)

5.4 Effects of drugs on the state of mind of the victim

(2)

5.4.1 Administration of a drug to alter the victim's behaviour

(1)

5.4.2 Drugs lead the complainant to perceive that a crime has been committed

(1)

5.5 Summary

(1)

6 Negligence and medicines

(21)

6.1 The manufacture of medicines

(5)

6.1.1 Testing a new drug or formulation

(3)

6.1.2 Making medicines

(1)

6.1.3 The packaging and storage of medicines

(1)

6.1.4 Failure by the manufacturer to provide information on medicines

(1)

6.1.5 The monitoring of adverse effects of medicines by the manufacturer

(1)

6.2 The prescriber

(9)

6.3 Dispensing errors

105

(1)

6.4 Errors in drawing up and giving medicines

106

(4)

6.5 Summary

110

(1)

Part 3 Specific drugs of forensic importance

111

(74)

7 Ethanol

113

(27)

7.1 Measurement of ethanol

113

(3)

7.1.1 Sample collection

113

(1)

7.1.2 Measurement of ethanol concentrations by gas chromatography

114

(1)

7.1.3 Infra-red breath ethanol measurement

115

(1)

7.1.4 Fuel cells

115

(1)

7.2 The pharmacology of ethanol

116

(15)

7.2.1 Exposure to ethanol

116

(1)

7.2.2 Pharmacokinetics

117

(14)

7.3 Specific medicolegal problems with ethanol

131

(8)

7.4 Summary

139

(1)

8 Benzodiazepines

140

(8)

8.1 History

140

(1)

8.2 The drugs

140

(1)

8.3 Acute effects

141

(4)

8.4 Longer-term effects

145

(1)

8.5 Abuse

146

(1)

8.6 Summary

147

(1)

9 Insulin

148

(5)

9.1 Control of blood glucose concentration

148

(1)

9.2 Hypoglycaemia

148

(1)

9.3 Diabetes mellitus (`sugar diabetes')

149

(1)

9.4 Types of insulin

150

(1)

9.5 Insulin poisoning

150

(2)

9.6 Summary

152

(1)

10 Potassium chloride and other potassium salts

153

(7)

10.1 Potassium concentration in plasma

153

(1)

10.2 Potassium concentration after death

154

(1)

10.3 Spuriously high plasma potassium concentration

154

(1)

10.4 The effects of an increase in plasma potassium concentration

155

(1)

10.5 Negligence

156

(1)

10.6 Murder

157

(1)

10.7 Suicide

158

(1)

10.8 Summary

159

(1)

11 The antipsychotic drugs: phenothiazines, butyrophenones and other agents

160

(6)

11.1 Problems with adverse effect of antipsychotic agents

161

(1)

11.2 Cause and effect

162

(1)

11.3 Neuroleptic malignant syndrome

163

(1)

11.4 Sudden deaths with phenothiazines

163

(1)

11.5 Clozapine-induced disorders of the white blood cells

164

(1)

11.6 Remoxipride-induced disorders of the blood

164

(1)

11.7 Psychiatric effects of antipsychotic drugs

164

(1)

11.8 Summary

165

(1)

12 Opiates and related drugs

166

(6)

12.1 Opioids in therapeutic doses

166

(1)

12.2 Negligence

167

(1)

12.3 Deliberate overdosage

167

(1)

12.4 Addiction to opioids

168

(1)

12.5 Body-packers

169

(1)

12.6 Murder with opioids

170

(1)

12.7 Summary

171

(1)

13 Vaccines

172

(4)

13.1 Recommended immunization

172

(1)

13.2 Vaccine-damaged children

173

(1)

13.2.1 Pertussis vaccine

173

(1)

13.2.2 Legal actions over pertussis-induced brain damage

173

(1)

13.3 Vaccines other than pertussis

174

(1)

13.4 Compensation for vaccine-induced damage

175

(1)

13.5 Summary

175

(1)

14 Paracetamol (acetaminophen in the United States)

176

(4)

14.1 Therapeutic dosages of paracetamol

176

(1)

14.2 Overdosage of paracetamol

176

(2)

14.2.1 The antidotes to paracetamol poisoning

177

(1)

14.2.2 Significant poisoning

177

(1)

14.2.3 Patients at increased risk

178

(1)

14.3 Forensic problems

178

(1)

14.4 Summary

179

(1)

15 Anabolic androgens (anabolic steroids)

180

(5)

15.1 The drugs

180

(1)

15.2 Therapeutic use of anabolic androgens

180

(1)

15.3 Abuse of anabolic androgens

181

(1)

15.4 Physical adverse effects of high doses of anabolic androgens

181

(1)

15.5 Psychiatric effects of anabolic androgens

182

(1)

15.6 The forensic importance of anabolic androgens

182

(2)

15.7 Summary

184

(1)

Appendix A Pharmacokinetic calculations

185

(5)

A.1 Some further details of the dosage of drugs

185

(1)

A.2 Concentration in calculations

186

(1)

A.2.1 Calculating amount from concentration

186

(1)

A.2.2 Calculating volume from concentration

186

(1)

A.3 Calculations using volume of distribution

186

(2)

A.3.1 Using volume of distribution and concentration to estimate dose

186

(1)

A.3.2 A forensic example

187

(1)

A.4 The calculations of drug disposition

188

(1)

A.4.1 First-order kinetics

188

(2)

Appendix B Detailed aspects of measurement of ethanol and calculations based on ethanol concentration

190

(10)

B.1 Peak-height ratios in gas chromatography

190

(1)

B.2 Watson's equations for total body water (TBW) in human subjects

190

(1)

B.3 The use of Watson's formula and the Widmark equation

191

(1)

B.4 Back-calculation of ethanol concentration

191

(2)

B.5 Calculations in the hip-flask defence

193

(3)

B.6 Calculations in the lacing defence

196

(1)

B.7 The ethanol content of alcoholic drinks

197

(3)

Appendix C Brief details of some drugs of forensic importance

200

(17)

C.1 Introduction

200

(1)

C.2 Amitriptyline

200

(1)

C.3 Amylobarbitone (Amobarbital in the United States)

201

(1)

C.4 Buspirone

201

(1)

C.5 Chlordiazepoxide

202

(1)

C.6 Chlormethiazole

202

(1)

C.7 Chlorpromazine

203

(1)

C.8 Clozapine

204

(1)

C.9 Dexamphetamine, D-amphetamine

205

(1)

C.10 Diamorphine, heroin

205

(1)

C.11 Diazepam

206

(1)

C.12 Fluoxetine

207

(1)

C.13 Fluphenazine

208

(1)

C.14 Haloperidol

209

(1)

C.15 Insulin

210

(1)

C.16 Lorazepam

210

(1)

C.17 Morphine

210

(1)

C.18 Pethidine (meperidine in the United States)

211

(1)

C.19 Temazepam

212

(1)

C.20 Thiopentone (thiopental in the United States)

212

(1)

C.21 Thioridazine

213

(1)

C.22 Triazolam

214

(1)

C.23 Vincristine

214

(1)

C.24 Warfarin (warfarin sodium)

215

(1)

References

217

(20)

Index

237

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Forensic Pharmacology Medicines, Mayhem, and Malpractice

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