=<span style="color: rgb(48, 9, 215)"> </span>=
[[toc]]
=1.0 Principles of Toxicology=

==[[1.1 Pharmacology and Toxicology|1.1 Pharmacology/Toxicology]]==

> **[[1.1.1 Pharmacokinetics and Toxicokinetics|1.1.1 Pharmacokinetics/Toxicokinetics]]**
>> [[1.1.1.1 Bioavailability and Absorption]]
>> [[1.1.1.2 Distribution]]
>> [[1.1.1.3 Metabolism]]
>> [[1.1.1.4 Elimination]]
>> [[1.1.1.5 Clearance]]
>> [[1.1.1.6 Models (eg, compartmental, physiologic)]]
>>
> **1.1.2 Pharmacodynamics/Toxicodynamics**
>> [[1.1.2.1 Dose and Concentration Relationship to Effect|1.1.2.1 Dose/Concentration Relationship to Effect]]
>> 1.1.2.2 Structure-Activity Relationship
>> [[1.1.2.3 Receptor Agonism and Antagonism|1.1.2.3 Receptor Agonism/Antagonism]]
>> 1.1.2.4 Receptor Regulation
>>
> **[[1.1.3 Adverse Effects]]**
>> 1.1.3.1 Mechanistic (predictable)
>> 1.1.3.2 Idiosyncratic
>>
> **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)

==**1.2 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, methemoglobin, 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**==

> **1.4.1 Mutagenesis**
>> 1.4.1.1 Chromosome Aberrations (structural, numeric)
>> 1.4.1.2 Gene Mutation (oncogenes, tumor suppressor genes)
>>
> **1.4.2 Development of Neoplasia**
>> 1.4.2.1 Initiation (eg, genotoxic mechanisms)
>> 1.4.2.2 Procarcinogens and Conversion to Carcinogens (eg,
>> 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**
>> 1.4.3.1 Endogenous Factors (eg, age, sex, immune status, hormones)
>> [[1.4.3.2 Exogenous Factors]] (eg, diet, radiation)
>>
> **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, feta 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**==

> **2.1.1 Analgesics, Anti-inflammatory Drugs**
>> [[2.1.1.1 Acetaminophen]]
>> [[2.1.1.2 Nonsteroidal Anti-inflammatory Drugs]]
>> [[2.1.1.3 Opioids]]
>> [[2.1.1.4 Salicylates]]
>> [[2.1.1.5 Other Analgesics, Anti-inflammatory|2.1.1.5 Others (eg, antigout drugs, gold)]]
>>> [[2.1.1.5.1 Colchicine]]
>>
> **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 Chemotherapeutic Drugs**
>> 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)
>>
> **2.1.4 Diagnostic Drugs (eg, radionuclides)**
>>
> **2.1.5 Drugs That Affect Cholesterol and Lipids**
>>
> **2.1.6 Drugs That Affect the Cardiovascular System**
>> [[3.4.3.4 Antiarrhythmics|2.1.6.1 Antidysrhythmics]]
>>> [[2.1.6.1.1 Calcium channel blockers]]
>>> [[2.1.6.1.2 Cardiac glycosides]]
>>> 2.1.6.1.3 Potassium channel blockers
>>> 2.1.6.1.4 Sodium channel blockers
>> [[2.1.6.2 Antihypertensives]]
>>> [[2.1.6.2.1 Angiotensin system modulators]]
>>> 2.1.6.2.2 Adrenergic (and mixed , ) antagonists
>>> [[Clonidine|2.1.6.2.3 Centrally acting receptor agonists ]]Clonidine
>>> 2.1.6.2.4 Diuretics
>>> [[2.1.6.2.5 Vasodilators]] (eg, nitrates, nitrites)
>> [[2.1.6.3 Inotropes]]
>>
>>
> **2.1.7 Drugs That Affect the Endocrine System**
>> 2.1.7.1 Antidiabetic Drugs
>>> [[2.1.7.1.1 Insulin]]
>>> [[2.1.7.1.2 Sulphonylureas|2.1.7.1.2 Oral hypoglycemics]]
>>> [[2.1.7.1.3 Others (eg, metformin, glitazones)]]
>> 2.1.7.2 Bone Active Drugs (eg, calcitonin, bisphosphonates)
>> 2.1.7.3 Electrolytes and Minerals
>> 2.1.7.4 Glucocorticoids
>> 2.1.7.5 Sex Hormones, Growth Hormones, and Anabolic Steroids
>> [[2.1.7.6 Thyroid Drugs]]
>> 2.1.7.7 Vasopressin and Somatostatin Analogues
>>
> **2.1.8 Drugs That Affect the Gastrointestinal System**
>> 2.1.8.1 Antidiarrheals
>> 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**
>> [[2.2.7.5.1 Anticoagulant|2.1.9.1 Anticoagulants]]
>> 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
>> [[2.1.9.6 Iron]]
>> 2.1.9.7 Thrombolytics
>>
> **2.1.10 Drugs That Affect the Immune System**(eg, interferon, cyclophosphamide)
>>
> **2.1.11 Drugs That Affect the Nervous System**
>> 2.1.11.1 Anesthetics
>>> [[2.1.11.1.1 Inhalational and sedative anesthetics (eg, nitrous oxide, propofol)]]
>>> 2.1.11.1.2 Local anesthetics
>> [[2.1.11.2 Anticonvulsants]]
>> 2.1.11.3 Antiparkinsonism Drugs
>> 2.1.11.4 Drugs That Affect Autonomic Homeostasis
>>> [[2.1.11.4.1 Anticholinergics]]
>>> [[2.1.11.4.2 Antihistamines]]
>>> 2.1.11.4.3 Antiserotonergics
>>> 2.1.11.4.4 Cholinergics (eg, nicotine)
>>> [[2.1.11.4.5 Ergot and derivatives]]
>>> [[2.1.11.4.6 Methylxanthines]]
>>> 2.1.11.4.7 Serotonin agonists and other proserotonergics (eg, dextromethorphan)
>>> [[2.1.11.4.8 Sympathomimetics (eg, amphetamines, cocaine)]]
>> [[2.1.11.5 Ethanol]]
>> 2.1.11.6 Muscle Relaxants
>> 2.1.11.7 Neuromuscular Blockers
>> 2.1.11.8 Psychoactive Drugs and Hallucinogens (eg, marijuana, lysergic acid diethylamide [LSD])
>> [[2.1.11.9 Psychotropics]]
>>> [[2.1.11.9.1 Anxiolytics and sedative-hypnotics]]
>>> [[2.1.11.9.2 Antidepressants]]
**** [[2.1.11.9.2.1 Tricyclic Antidepressants]]
**** [[2.1.11.9.2.2 Monoamine Oxidase Inhibitors]]
**** [[2.1.11.9.2.3 Serotonin Reuptake Inhibitors]]
**** [[2.1.11.9.2.4 Other Antidepressants]] (bupropion, mirtazapine, mianserin, venlafaxine
>>> [[2.1.11.9.3 Antipsychotics]]
>>> [[2.1.11.9.4 Mood stabilizers]]
>>
> **2.1.12 Pharmaceutical Additives (eg, excipients)**
>>
> **2.1.13 Veterinary Products**
>>
> **2.1.14 Vitamins**
> **[[2.1.15 Complementary Herbal & Traditional Medicines]]**
> **[[2.1.16 Pharmacognosy]]**

==**2.2 Industrial, Household, and Environmental Toxicants**==

> **2.2.1 Airborne Solids**
>> [[2.2.1.1 Asbestos]]
>> 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 Cleansers and Caustics]]**
>> [[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 Hydrocarbons,Solvents and Fuels|2.2.5 Hydrocarbons/Solvents/Fuels]]**
>> 2.2.5.1 Aldehydes
>> 2.2.5.2 Alcohols and Glycols
>>> 2.2.5.2.1 Diethylene glycol
>>> [[2.2.5.2.2 Ethylene glycol]]
>>> 2.2.5.2.3 Glycol ethers
>>> 2.2.5.2.4 Isopropanol
>>> [[2.2.5.2.5 Methanol]]
>> 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
>>
> **[[2.2.6 Metals and Metalloids|2.2.6 Metals/Metalloids]]**
>> [[2.2.6.1 Arsenic|2.2.6.1 Arsenic (including arsine)]]
>> [[2.2.6.2 Barium]]
>> <span class="wiki_link_new"><span class="wiki_link_new">[[Beryllium|2.2.6.3 Beryllium]]</span></span>
>> [[Cadmium|2.2.6.4 Cadmium]]
>> [[2.2.6.13 Cesium]]
>>
>> [[ Chromium|2.2.6.5 Chromium]]
>> [[Cobalt|2.2.6.6 Cobalt]]
>> [[2.2.6.7 Copper]]
>> [[2.2.6.8 Lead]]
>> [[2.2.6.9 Manganese]]
>> [[2.2.6.10 Mercury]]
>> 2.2.6.11 Nickel
>> [[2.2.6.12 Thallium]]
>> [[2.2.6.13 Cesium]]
>>
> **[[2.2.7 Pesticides]]**
>> 2.2.7.1 Fumigants and Sterilants
>> 2.2.7.2 Fungicides
>> [[2.2.7.3 Herbicides]]
>>> [[2.2.7.3.1 Paraquat]]
>>> [[2.2.7.3.2 Chlorphenoxy Herbicides]]
>>> [[2.2.7.3.2 Propanil]]
>>> [[Glyphosate|2.2.7.3.2 Glyphosate]]
>> [[2.2.7.4 Insecticides and Repellents]]
>>> [[2.2.7.4.1 Carbamates]]
>>> 2.2.7.4.2 DEET
>>> [[2.2.7.4.3 Moth balls]]
>>> [[2.2.7.4.4 Organochlorines]]
>>> [[2.2.7.4.5 Organophosphates]]
>>> [[2.2.7.4.6 Pyrethrins and pyrethroids]]
>>> [[2.2.7.4.7 Neonictinoids]]
>>> [[2.2.7.4.8 Avermectins]]
>>> [[2.2.7.4.9 N-phenylpyrazole]]
>> 2.2.7.5 Rodenticides
>>> [[2.2.7.5.1 Anticoagulant]]
>>> 2.2.7.5.2 Nonanticoagulant
>> 2.2.7.6 Other (eg, molluscides)
>>
> **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)
>>
> **[[2.2.9 Toxic Gases]]**
>> 2.2.9.1 Cellular Asphyxiant Gases
>>> [[2.2.9.1.1 Carbon monoxide]]
>>> [[2.2.9.1.2 Cyanide]]
>>> [[2.2.9.1.3 Hydrogen sulfide]]
>> 2.2.9.2 Irritant Gases
>>> [[2.2.9.2.1 Chlorine]]
>>> 2.2.9.2.2 Nitrogen oxides
>>> 2.2.9.2.3 Ozone
>>> [[2.2.9.2.4 Phosgene]]
>>> 2.2.9.2.5 Sulfur oxides
>>> [[2.2.9.2.6 Arsene]]
>> 2.2.9.3 Radon
>> 2.2.9.4 Simple Asphyxiants (eg, methane, nitrogen)
>> [[2.2.9.5 Smoke Inhalation]]
>>
> **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)
>> [[2.2.10.30 Phosphorus and phosphides|2.2.10.30 Phosphorus/phosphides]]
>> 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**==

> **2.3.1 Food Poisoning**
>> 2.3.1.1 Bacterial
>> [[2.3.1.2 Marine]]
>>
> **2.3.2 Fungi**
>> 2.3.2.1 Mushrooms
>> 2.3.2.2 Other Fungal Toxins (eg, aflatoxins, trichothecene mycotoxins)
>>
> **[[2.3.3 Herbal and Dietary Supplements]]**
>>
> **[[2.3.4 Plants]]**
>> [[2.3.4.1 Cardiovascular Toxic Plants|2.3.4.1 Cardiovascular Toxic Plants (eg, Aconitum napellus,Nerium oleander)]]
>> [[2.3.4.2 Cutaneous & Mucus Membrane Toxic Plants |2.3.4.2 Cutaneous/Mucus Membrane Toxic Plants (eg, Toxicodendron sp,Dieffenbachiasp)]]
>> [[2.3.4.3 Gastrointestinal Toxic Plants|2.3.4.3 Gastrointestinal Toxic Plants (eg, Phytolacca Americana,Solanumsp)]]
>> [[2.3.4.4 Hepatotoxic Plants|2.3.4.4 Hepatotoxic Plants (eg, Bilghia sapida,Symphatumsp)]]
>> [[2.3.4.5 Multisystem Toxic Plants|2.3.4.5 Multisystem Toxic Plants (eg, Prunussp,Ricinus communis)]]
>> [[2.3.4.6 Neurotoxic Plants|2.3.4.6 Neurotoxic Plants (eg, Daturasp,Nicotiana tabacum)]]
>> [[2.3.4.7 Hallucinogenic Plants]]
>>
> **2.3.5 Toxic Envenomations**
>> [[2.3.5.1 Arthropods]]
*** 2.3.5.1.1 Spiders
*** [[2.3.5.1.2 Other Venomous Arthropods]]
>> [[2.3.5.2 Marine Creatures]]
>> [[2.3.5.3 Reptiles|2.3.5.3 Reptiles and Snakes]]
*** [[2.3.5.3.1 South East Asian Snakes]]
*** [[2.3.5.3.2 Australian Venomous Snakes]]
>> [[2.3.5.4 Amphibians]]

==**2.4 Warfare, Terrorism, and Riot Control Agents**==

> **[[2.4.1 Biological]]**
>> 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 Chemical]]**
>> 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]]**==
> ===**[[3.1.1 Hypotension]]**===
> ===**[[3.4.1 Control of Coma|3.1.2 Coma]]**===
> ===**[[3.1.3 Seizures]]**===
>
==**[[3.2 Initial Management]]**==
> ==**[[3.2.1 Assessment Skills]]**==
>> ===[[3.2.1.1 Differential Diagnosis]]===
>> ===[[3.2.1.2 Signs and Symptoms]]===
>> ===[[3.2.1.3 Toxidromes]]===
>
> ==**[[3.2.2 Decontamination Strategies]]**==
>> ===[[3.2.2.1 Dermal]]===
>> ===[[3.2.2.2 Gastrointestinal]]===
*** [[3.2.2.2.1 Emesis]]
*** [[3.2.2.2.2 Gastric lavage]]
*** [[3.2.2.2.3 Activated charcoal]]
*** [[3.2.2.2.4 Whole bowel irrigation (lavage)]]
>> [[3.2.2.3 Ocular]]
>
> ==**[[3.2.3 Enhance Elimination Techniques]]**==
>> [[3.2.3.1 Extracorporeal Removal]]
>> [[3.2.2.2.4 Whole bowel irrigation (lavage)|3.2.3.2 Gastrointestinal Dialysis]]
>> [[3.2.3.3 Urinary Approaches]]

==**[[3.3 Pharmacological Basis of Antidote Use]]**==

> **3.3.1 Antagonize Effects of Poison**
>> 3.3.1.1 Enzyme Inhibitors (eg, [[3.3.1.1.1 Physostigmine|physostigmine]])
>> [[3.3.1.2 Enzyme Reactivators (eg, pralidoxime)]]
>> 3.3.1.3 Physiological Antagonists (eg, calcium, [[3.3.1.3.2 Glucagon|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
>>
> **3.3.3 Other Antidotes**

==**3.4 Supportive and Other Care**==

> **[[3.4.1 Adjunctive Therapy]] (eg, granulocyte colony-stimulating factor)**
>
> **[[2.1.11.2 Anticonvulsants|3.4.2 Anticonvulsants]]**
>
> **[[3.4.3.4 Antiarrhythmics|3.4.3 Antidysrhythmics]]**
>
> **3.4.4 Control of Agitation**
>
> **[[3.4.5 Control of Temperature]]**
>
> **3.4.6 Correct Electrolyte and Acid-Base Disturbances**
>
> **3.4.7 Critical Care Procedures (eg, arterial catheter and central line placement-**
>
> **[[3.4.8 Fluid Resuscitation]]**
>
> **3.4.9 Patient Monitoring**
>
> **3.4.10 Pressor Agents and Control of Blood Pressure**
>
> **[[3.4.11 Protect Airway,Ventilation and Manage Airway Injury|3.4.11 Protect Airway/Ventilation/Manage Airway Injury]]**
>
> **3.4.12 Psychiatric Issues**
>
> **3.4.13 Social Issues**
>
> **3.4.14 Transplantation**
> **[[3.4.15 Rhabdomyolysis]]**
> **[[Anaphylaxis|3.4.16 Management of Anaphylaxis]]**
==**3.5 Drug & Alcohol Syndromes**==

> **<span class="wiki_link">[[Drug and Alcohol issues|3.5.1 Alcohol]]</span>**
>
> **[[3.5.2 Opioid Withdrawal |3.5.2 Opioid]]**
>
> **[[3.5.3 Sedative-Hypnotic]]**
>
> **3.5.4 Stimulant and Nicotine**
>
> **3.5.5 Mixed Pattern**

=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 &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 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 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]]**==

> **5.2.1 Anion Gap**
>
> **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=

==**[[6.1 Guidelines for training poisons centre staff]]**==