Interpretation of Postmortem Toxicology Results

................................................................................................................................. 8 INTRODUCTION........................................................................................................................... 9 REVIEW OF THE LITERATURE ................................................................................................... 10 1 Interpretation of Postmortem Forensic Toxicology Results................................................ 10 1.1 Blood Samples .............................................................................................................. 10 1.1.1 Toxicological Tables ............................................................................................ 11 1.2 Other Matrices .............................................................................................................. 12 1.3 Postmortem Changes .................................................................................................... 12 1.4 Metabolites.................................................................................................................... 13 1.5 Alcohol Toxicity ........................................................................................................... 13 1.6 Drug Toxicity................................................................................................................ 13 1.6.1 Fatal Toxicity Index ............................................................................................. 14 1.6.2 Other Measures of Toxicity.................................................................................. 15 1.6.3 Sources of Bias in Toxicity Indices...................................................................... 15 2 Pharmacogenetics ................................................................................................................ 16 2.1 Drug-Metabolizing Enzymes........................................................................................ 16 2.1.1 Cytochrome P450 System .................................................................................... 16 CYP2D6 ............................................................................................................... 17 CYP2C19 ............................................................................................................. 19 2.2 Studies on Drug Metabolism ........................................................................................ 19 2.2.1 Tramadol Metabolism .......................................................................................... 19 2.2.2 Amitriptyline Metabolism .................................................................................... 20 2.3 Clinical Pharmacogenetics............................................................................................ 21 2.4 Postmortem Pharmacogenetics ..................................................................................... 22 3 Drug-Alcohol Interaction .................................................................................................... 23 3.1 Alcohol Effects and Anesthetic Action ........................................................................ 23 3.1.1 γ-Aminobutyric Acid Receptor Type A ............................................................... 24 3.2 Animal Studies.............................................................................................................. 24 3.3 Postmortem Studies ...................................................................................................... 25 AIMS OF THE STUDY................................................................................................................. 26