Ver el código de «Urine toxicology screen»

==Background==
*Urine drug screen (UDS / UTOX) is typically ordered in trauma, psych, and altered mental status patients where the results can assist inpatient management.
*Cooperative psych patients do not require Utox as part of the ED screen<ref>Lukens, TW, et al. Clinical Policy: Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department. Annals of Emergency Medicine. 2006; 47(1):79-99.</ref> (unless local policy dictates)
*Routine testing of activated traumas is reasonable, but discretionary testing of nonactivated traumas should be adopted<ref>Dunham CM, Chirichella, TJ. Trauma Activation Patients: Evidence for Routine Alcohol and Illicit Drug Screening. PLoS ONE. 2012; 7(10): e47999.</ref>
*Unlikely to have any significant impact on the management of ED patients<ref>Tenenbein M. Do you really need that emergency drug screen? Clin Toxicol (Phila). 2009 Apr;47(4):286-91. PMID:19514875</ref>
*Drug testing alone never significantly better than history<ref>Perrone J, De Roos F, Jayaraman S, Hollander JE. Drug screening versus history in detection of substance use in ED psychiatric patients. Am J Emerg Med. 2001 Jan;19(1):49-51. PMID: 11146019.</ref>
*Appropriate in pediatric altered mental status workup, determining brain death, management of psychiatric disease (dual diagnosis treatment), and in trauma victim patients (substance abuse counseling).

==Detection Interval==
This is the estimated time a drug is detectable on urine drug screen after last use.<ref>Courtesy Kishan Kapadia and UMEM derived from Goldfrank's Toxicologic Emergencies, 9th ed; Table 6-10</ref>
{| class="wikitable"
|-
! Screen !! Interval (Prolonged Use)
|-
| [[Amphetamines]] || 1-2 d (2-4 d)
|-
| [[Barbiturates]] || 2-4 d
|-
| [[Benzodiazepines]] || 1-30 d
|-
| [[Cannabinoids]] || 1-3 d (>1 mo)
|-
| [[Cocaine]] || 2 d (1 wk)
|-
| [[Opiates]] || 1-4 d (<1 wk)
|-
| [[Phencyclidine]] || 4-7 d (>1 mo)
|}

==Cross Reactivity==
Many non-illicit drugs cross react with common drugs screened on the traditional urine drug screen <ref>Standridge, JB, et al. Urine Drug Screening: A Valuable Office Procedure. Am Fam Physician. 2010; 81(5):635-640.</ref><ref>Brahm N. et al.Commonly prescribed medications and potential false-positive urine drug screens Am J Health Syst Pharm August 15, 2010 67:1344-1350;</ref> 
{| class="wikitable"
|-
! Screen !! Drugs
|-
| [[Amphetamines]] || [[Amantadine]], [[bupropion]], [[chlorpromazine]], desipramine. [[fluoxetine]], L-[[methamphetamine]], [[labetalol]], [[methylphenidate]], phentermine, [[phenylephrine]], phenylpropanolamine, [[promethazine]], [[pseudoephedrine]], ranitidine, thioridazine, [[trazodone]]
|-
| [[Benzodiazepines]] || Oxaprozin, sertraline
|-
| [[Cannabinoids]] || Dronabinol, [[nonsteroidal anti-inflammatory drugs]], [[proton pump inhibitor]]s
|-
| [[Cocaine]] || Topical anesthetics containing cocaine
|-
| [[Opiates]] || [[Dextromethorphan]], [[diphenhydramine]], [[fluoroquinolones]], poppy seeds, [[quinine]], [[rifampin]], [[verapamil]]
|-
| [[Phencyclidine]] || [[Dextromethorphan]], [[diphenhydramine]], [[ibuprofen]], imipramine, ketamine, meperidine, thioridazine, [[tramadol]], [[venlafaxine]]
|}

==True Positives and False Negatives==
*Most benzodiazepine screens look for oxazepam which is a metabolite of diazepam and chlordiazepoxide. Therefore, lorazepam, alprazolam, and clonazepam are commonly missed.
{| class="wikitable"
|-
! Screen !! TP !! FN
|-
| '''[[Amphetamines]]''' ||   || MDA & MDMA
|-
| '''[[Benzodiazepines]]''' ||Oxazepam, temazepam, diazepam, alprazolam, triazolam || Lorazepam, clonazepam, midazolam
|-
| '''[[Cannabinoids]]''' ||  || Synthetics
|-
| '''[[Cocaine]]''' ||  || Unlikely
|-
| '''[[Opiates]]''' || Morphine, Codeine, Heroin || Fentanyl, tramadol, meperidine, methadone, oxycodone, buprenorphine, hydrocodone, hydromorphone
|-
| '''[[Phencyclidine]]''' || New screens are very specific || 
|}

==See Also==
*[[Drugs of abuse]]

==External Links==
*[http://www.ncbi.nlm.nih.gov/pubmed/19514875 Clinical Toxicology: Do you really need that emergency drug screen?]

==References==
<references/>

[[Category:Toxicology]]
[[Category:Labs]]