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Poisoning monographs

General background

Teaching outlines

Topic structure

wikitox:entire_curriculum

Entire Curriculum

1.0 Principles of Toxicology

1.1 Pharmacology/Toxicology

  • 1.1.4 Interactions
    • 1.1.4.1 Xenobiotic-Environment
    • 1.1.4.2 Xenobiotic-Food
    • 1.1.4.3 Xenobiotic-Xenobiotic (eg. drug-drug)
  • 1.1.5 Proteomics
  • 1.1.6 Tolerance and Withdrawal
    • 1.1.6.1 Behavioral Tolerance
    • 1.1.6.2 Biologic Tolerance
  • 1.1.7 Immunologic Response
  • 1.1.8 Pharmacogenomics Toxicogenomics (eg. xenobiotic response, gene expression profiling)
  • 1.1.9 Organ toxicity
    • 1.1.9.1 Renal toxicity

1.2 Molecular Components and Mechanisms

  • 1.2.1 Glycolysis and Oxidative Phosphorylation
  • 1.2.2 Other Metabolic Pathways (eg. amino acids and urea cycle)
  • 1.2.3 Membranes
  • 1.2.4 Enzymes and Transport Proteins (eg. methaemoglobin, G6PD)
  • 1.2.5 Channels and Pumps
  • 1.2.6 Signal Transduction
    • 1.2.6.1 Receptor Isoforms and Subtypes
    • 1.2.6.2 Regulation and Messengers
    • 1.2.6.3 Neurotransmitters

1.3 Cytotoxic Mechanisms (eg. apoptosis, microtubular dysfunction)

1.4 Mutagenesis and Carcinogenesis

  • 1.4.2 Development of Neoplasia
    • 1.4.2.1 Initiation (eg. genotoxic mechanisms)
    • 1.4.2.2 Procarcinogens and Conversion to Carcinogens
    • 1.4.2.3 Progression (eg. growth, invasiveness)
    • 1.4.2.4 Promotion (eg. nongenotoxic mechanisms biotransformation)
  • 1.4.3 Inhibition of Carcinogenesis-Modulating Factors
  • 1.4.4 Interactive Carcinogenesis
    • 1.4.4.1 Xenobiotic: Gene Interactions
    • 1.4.4.2 Xenobiotic: Physical Interactions
    • 1.4.4.3 Xenobiotic: Radiation Interactions
    • 1.4.4.4 Xenobiotic: Viral Interactions

1.5 Adverse Reproductive and Developmental Outcomes

  • 1.5.1 Conception Impairment, Mutagenesis, and Teratogenesis
    • 1.5.1.1 Chromosomal and Gene Abnormalities
    • 1.5.1.2 Effects on Gametogenesis and Gametes
    • 1.5.1.3 Effects on Gonads
    • 1.5.1.4 Spontaneous Abortion and Perinatal Death
  • 1.5.2 Factors Determining Fetal or Infant Exposure to Agents
    • 1.5.2.1 Breast Milk Transfer
    • 1.5.2.2 Placental Transfer
    • 1.5.2.3 Xenobiotic Disposition (eg. maternal xenobiotic disposition, fetal pharmacokinetics)
  • 1.5.3 Offspring Effects
    • 1.5.3.1 Cancer
    • 1.5.3.2 Congenital Anomalies and Malformations
    • 1.5.3.3 Development of Infant/Child
    • 1.5.3.4 Genetic Mutations

2.0 Toxins and Toxicants

2.1 Drugs

  • 2.1.2 Antimicrobials
    • 2.1.2.1 Antibiotics
    • 2.1.2.2 Antifungals
    • 2.1.2.3 Antimycobacterials
    • 2.1.2.4 Antiparasitics
    • 2.1.2.5 Antiprotozoals
    • 2.1.2.6 Antiretrovirals
    • 2.1.2.7 Antiseptics
    • 2.1.2.8 Antivirals
    • 2.1.3.1 Alkylators
    • 2.1.3.2 Antimetabolites
    • 2.1.3.3 Hormones
    • 2.1.3.4 Natural Drugs, (eg. vinca alkaloids, antibiotics)
    • 2.1.3.5 Miscellaneous (eg. platinum, hydroxyurea)
  • 2.1.8 Drugs That Affect the Gastrointestinal System
    • 2.1.8.1 Antidiarrhoeals
    • 2.1.8.2 Antiemetics
    • 2.1.8.3 Drugs Used for Biliary and Pancreatic Diseases (eg. bile salts, pancreatic enzymes)
    • 2.1.8.4 Drugs Used for Inflammatory Bowel Disease
    • 2.1.8.5 Drugs Used to Treat Acid-Peptic Diseases
    • 2.1.8.6 Laxatives
    • 2.1.8.7 Promotilic
  • 2.1.9 Drugs That Affect the Hematologic System
    • 2.1.9.2 Antifibrinolytics
    • 2.1.9.3 Antiplatelet Drugs
    • 2.1.9.4 Blood-Stimulating Drugs (eg. erythropoietin)
    • 2.1.9.5 Drugs Used to Treat Bleeding (eg. clotting factors, antiplasmin drugs
    • 2.1.9.7 Thrombolytics

2.2 Industrial, Household, and Environmental Toxicants

  • 2.2.1 Airborne Solids
    • 2.2.1.2 Coal Dust
    • 2.2.1.3 Organic Dust
    • 2.2.1.4 Silica
    • 2.2.1.5 Other Minerals (eg. man-made mineral fibers)
    • 2.2.2.1 Acids
    • 2.2.2.2 Alkali
    • 2.2.2.3 Bleach
    • 2.2.2.4 Detergents and Soaps
    • 2.2.2.5 Disinfectants and Topical Anti-infectives
    • 2.2.2.6 Swimming Pool Products
  • 2.2.3 Food Additives (eg. monosodium glutamate, sulfites)
  • 2.2.4 Household Products
    • 2.2.4.1 Aquarium Products
    • 2.2.4.2 Art Products
    • 2.2.4.3 Batteries
    • 2.2.4.4 Cosmetics
    • 2.2.4.5 Dental Products
    • 2.2.4.6 Hair Products
    • 2.2.4.7 Personal Hygiene Products
    • 2.2.5.1 Aldehydes
    • 2.2.5.3 Aliphatic Hydrocarbons
      • 2.2.5.3.1 Hexane and congeners
      • 2.2.5.3.2 Mixtures (eg. gasoline, kerosene)
    • 2.2.5.4 Aromatic Hydrocarbons
      • 2.2.5.4.1 Benzene
      • 2.2.5.4.2 Polycyclic aromatic hydrocarbons
      • 2.2.5.4.3 Toluene
    • 2.2.5.5 Halogenated Hydrocarbons
      • 2.2.5.5.1 Carbon tetrachloride
      • 2.2.5.5.2 Chloroform
      • 2.2.5.5.3 Methylene chloride
      • 2.2.5.5.4 Perchloroethylene
      • 2.2.5.5.5 Trichloroethylene
      • 2.2.5.5.6 Vinyl chloride
    • 2.2.5.6 Hydrazines
    • 2.2.5.7 Ketones
    • 2.2.5.8 Peroxides
    • 2.2.5.9 Terpenes
  • 2.2.8 Pollutants
    • 2.2.8.1 Air Pollutants (eg. respirable particulates)
    • 2.2.8.2 Persistent Organic Pollutants (eg, polychlorinated biphenyls, dibenzodioxins)
    • 2.2.8.3 Water Pollutants (eg. trihalomethanes)
  • 2.2.10 Miscellaneous Toxicants
    • 2.2.10.1 Acrolein
    • 2.2.10.2 Acrylamides
    • 2.2.10.3 Acrylates
    • 2.2.10.4 Amines
    • 2.2.10.5 Aniline Compounds
    • 2.2.10.6 Azides
    • 2.2.10.7 Bromide Compounds
    • 2.2.10.8 Butadienes
    • 2.2.10.9 Carbon Disulfide
    • 2.2.10.10 Chlorates
    • 2.2.10.11 Coal Tar Products
    • 2.2.10.12 Diamines
    • 2.2.10.13 Dibromochloropropane (DBCP)
    • 2.2.10.14 Dimethylacetamide (DMAC)
    • 2.2.10.15 Dimethylformamide (DMF)
    • 2.2.10.16 Dinitrobenzene
    • 2.2.10.17 Dinitrotoluene (DNT)
    • 2.2.10.18 Epichlorohydrin
    • 2.2.10.19 Ethylene Dibromide (EDB)
    • 2.2.10.20 Ethylenediamine (EDA)
    • 2.2.10.21 Fluoride Compounds
    • 2.2.10.22 Fuels
    • 2.2.10.23 Hexachloro-1,3-Butadiene (HCBD)
    • 2.2.10.24 Isocyanates (eg, toluene diisocyante)
    • 2.2.10.25 Maleic Anhydride
    • 2.2.10.26 Mercaptans
    • 2.2.10.27 Methylene Diamine (MDA)
    • 2.2.10.28 Nitriles
    • 2.2.10.29 O-Phenylenediamine (OPD)
    • 2.2.10.31 Phthalates
    • 2.2.10.32 Polymers
    • 2.2.10.33 Resins
    • 2.2.10.34 Styrene
    • 2.2.10.35 Trimellitic Anhydride
    • 2.2.10.36 Triorthocresylphosphate (TOCP)
    • 2.2.10.37 Xylidine
  • 2.2.11 Syndromes Attributed to the Environment, Not Specified Elsewhere
    • 2.2.11.1 Event-Specific Syndromes (eg. Gulf War syndrome, World Trade Center cough)
    • 2.2.11.2 Mold
    • 2.2.11.3 Multiple Chemical Sensitivity Syndrome
    • 2.2.11.4 Tight Building Syndrome

2.3 Natural Products

  • 2.3.2 Fungi
    • 2.3.2.1 Mushrooms
    • 2.3.2.2 Other Fungal Toxins (eg. aflatoxins, trichothecene mycotoxins)

2.4 Warfare, Terrorism, and Riot Control Agents

    • 2.4.1.1 Bacteria (eg. anthrax, plague)
    • 2.4.1.2 Toxins (eg. botulinum, staphylococcus B)
    • 2.4.1.3 Viruses (eg. smallpox)
    • 2.4.2.1 Acetylcholinesterase Inhibitors (eg. sarin, soman, VX)
    • 2.4.2.2 Blister Agents (eg. mustard)
    • 2.4.2.3 Incapacitating Agents (eg. calmatives, BZ [3-quinuclidinyl benzilate])
    • 2.4.2.4 Tear Gases (eg. pepper spray)

2.4.3 Nuclear/Radiological

3.0 Therapeutics

3.1 ABCs Resuscitation

3.2 Initial Management

3.3 Pharmacological Basis of Antidote Use

  • 3.3.1 Antagonize Effects of Poison
    • 3.3.1.1 Enzyme Inhibitors (eg. physostigmine)
    • 3.3.1.2 Enzyme Reactivators (eg. pralidoxime)
    • 3.3.1.3 Physiological Antagonists (eg. calcium, glucagon)
    • 3.3.1.4 Receptor Antagonists (eg. atropine, flumazenil, naloxone)
    • 3.3.1.5 Reducing Agent (eg. methylene blue, N-acetylcysteine)
  • 3.3.2 Dispositional Agents
    • 3.3.2.1 Alcohol Dehydrogenase Antagonists
    • 3.3.2.2 Antivenoms/Antibodies
    • 3.3.2.3 Chelators
    • 3.3.2.4 Cyanide Antidotes
    • 3.3.2.5 Enzyme/Cofactor Replacement (eg. folinic acid, pyridoxine)
    • 3.3.2.6 Oxygen/Hyperbaric Oxygen

3.4 Supportive and Other Care

3.5 Drug & Alcohol Syndromes

4.0 Assessment and Population Health

4.1 Criteria for Causal Inference

  • 4.1.1 Biological Plausibility
  • 4.1.2 Consistency
  • 4.1.3 Dose-Response Relationship (biological gradient)
  • 4.1.4 Specificity (of exposure or outcome)
  • 4.1.5 Strength of Association
  • 4.1.6 Temporal Relationship

4.2 Information

  • 4.2.1 Consultation Resources (eg. databases, National Library of Medicine)
  • 4.2.2 Surveys and Surveillance (eg. poison center data, National Report on Human Exposures

4.3 Monitoring

  • 4.3.1 Biological Monitoring and Biomarkers (eg. population norms, indicators of excessive exposure)
  • 4.3.2 Environmental Sampling/Exposure Monitoring

4.4 Occupational Assessment and Prevention

  • 4.4.1 Medical Surveillance
  • 4.4.2 Personal Protective Equipment
  • 4.4.3 Preemployment Screening
  • 4.4.4 Workplace Safety Engineering

4.5 Principles of Epidemiology and Statistics

  • 4.5.1 Statistical Concepts (eg. interpretation of Pvalue, power calculation)
  • 4.5.2 Study Design
    • 4.5.2.1 Basic Types (eg. case series, randomized controlled trial)
    • 4.5.2.2 Basics of Validity/Generalizability (eg. bias, confounding, randomisation
    • 4.5.2.3 Measurements (eg. sensitivity, predictive value, limits of detection)
    • 4.5.2.4 Measures of Association (eg. odds ratios)

4.6 Regional Poison Centers

  • 4.6.1 Administration/Organization
  • 4.6.2 Consultation at a Distance
  • 4.6.3 Education
  • 4.6.4 Prevention
  • 4.6.5 Surveillance/Interaction With Other Professional Health Organizations
  • 4.6.6 Triage

4.7 Response to Hazardous Materials (Hazmat) Incidents, Including Terrorism

  • 4.7.1 Chemical Weapons Convention and Other Treaties
  • 4.7.2 Decontamination (eg. patients and responders)
  • 4.7.3 Incident Command System, Site Safety, and Control Zones
  • 4.7.4 Incident Response Planning and Emergency Preparedness
  • 4.7.5 National Pharmaceutical Stockpile: Deployment
  • 4.7.6 National Response Team: Federal Agency Coordination
  • 4.7.7 Regulatory and Legal Background (eg. Hazardous Waste Operations

4.8 Risk

  • 4.8.1 Risk Assessment
    • 4.8.1.1 Carcinogenicity Testing
    • 4.8.1.2 Extrapolation From High to Low Dose
    • 4.8.1.3 Extrapolation of Animal Studies to Humans
    • 4.8.1.4 Human Epidemiological Studies in Risk Assessment
    • 4.8.1.5 Interpretation of Key Terms (eg, recommended exposure limit [REL])
    • 4.8.1.6 No Observed and Lowest Observed Adverse Effect Levels (NOAEL, LOAEL)
    • 4.8.1.7 Role of Risk Assessment in Formulating Regulations
    • 4.8.1.8 Target Risks (eg. 10 or 10 )
    • 4.8.1.9 “Uncertainty Factors” (reasons for them, approximate values)
  • 4.8.2 Risk Perception and Risk Communication

4.9 Role of Federal and International Agencies in Toxicology

  • 4.9.1 Agency for Toxic Substances and Disease Registry (ATSDR)
  • 4.9.2 Centers for Disease Control and Prevention (CDC)
  • 4.9.3 Consumer Product Safety Commission (CPSC)
  • 4.9.4 Environmental Protection Agency (EPA)
  • 4.9.5 Food and Drug Administration (FDA)
  • 4.9.6 Health Resources and Services Administration (HRSA)
  • 4.9.7 National Institute of Occupational Safety and Health (NIOSH)
  • 4.9.8 Occupational Safety and Health Administration (OSHA)
  • 4.9.9 World Health Organization (WHO)

4.10 Toxic Outbreaks of Historical Significance

5.0 Analytical and Forensic Toxicology

5.1 Assay Methods and Interpretation

  • 5.1.1 Clinical Drug Testing
    • 5.1.1.1 Confirmatory Tests
      • 5.1.1.1.1 Atomic Absorption
      • 5.1.1.1.2 Gas Chromatography/Mass Spectrometry (GC/MS)
      • 5.1.1.1.3 High-Pressure Liquid Chromatography (HPLC)
    • 5.1.1.2 Screening Tests
      • 5.1.1.2.1 Gas Chromatography (GC)
      • 5.1.1.2.2 Immunoassays (eg, enzyme-multiplied immunoassay technique EMIT
      • 5.1.1.2.3 Colorimetric Tests (eg, color tests, thin layer chromatography)
    • 5.1.1.3 Serum/Blood Drug Levels and Interpretation
    • 5.1.1.4 Urine Drug Testing
      • 5.1.1.4.1 Interpretive Challenges (eg, benzodiazepines, opioids)
      • 5.1.1.4.2 Adulteration Techniques
      • 5.1.1.4.3 Analytical Limitations and Interferences
  • 5.1.2 Hair Analysis
  • 5.1.3 Laboratory Issues
    • 5.1.3.1 Point of Care Testing
    • 5.1.3.2 Quality Assurance/Quality Control
  • 5.1.4 Special Toxicology Testing
    • 5.1.4.1 Heavy Metal Screens
    • 5.1.4.2 Cholinesterase Determinations
  • 5.1.5 Therapeutic Drug Monitoring

5.2 Laboratory and Other Diagnostic Assessments

  • 5.2.2 Blood Gases and Co-oximetry
  • 5.2.3 Electrolytes
  • 5.2.4 Hematologic and Coagulation Abnormalities
  • 5.2.5 Liver Function Tests
  • 5.2.6 Osmolality
  • 5.2.7 Renal Manifestations (eg. urine color, crystals)
  • 5.2.8 Other Supportive Testing
    • 5.2.8.1 Diagnostic Imaging
    • 5.2.8.2 Electroencephalography
    • 5.2.8.3 Electrocardiography
    • 5.2.8.4 Electromyography/Nerve Conduction Studies

5.3 Forensics

  • 5.3.1 Chain of Custody
  • 5.3.2 Clandestine Laboratories
  • 5.3.3 Definition and Scheduling of Controlled Substances
  • 5.3.4 Interpretation of Postmortem Drug Levels
  • 5.3.5 Necrokinetics
  • 5.3.6 Selection of Postmortem Specimens
  • 5.3.7 Special Issues
    • 5.3.7.1 Meconium
    • 5.3.7.2 Vitreous Humor

5.4 Legal Ethanol

  • 5.4.1 Alcohol and the Law
  • 5.4.2 Alcohol-Induced Psychomotor Impairment
  • 5.4.3 Blood and Urine Alcohol Analysis
  • 5.4.4 Breath Alcohol Analysis
  • 5.4.5 Collection and Storage of Alcohol Specimens
  • 5.4.6 Disposition of Alcohol
  • 5.4.7 Saliva and Other Media

5.5 Medical Legal Issues (eg. role of expert witness)

5.6 Workplace Drug Test Interpretation

  • 5.6.1 Cutoffs
  • 5.6.2 Guidelines for Federal Workplace Drug Testing Programs
  • 5.6.3 Role of Medical Review Officer (MRO)

6.0 Poisons Centre Operations

wikitox/entire_curriculum.txt · Last modified: 2018/09/01 09:01 (external edit)