Clinical toxicology

Code: 65, study points: 3, period 3 (November: Monday and Tuesday).

Dr. S. Heemskerk, Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences,
Dr. C. Kramers, Departments of Internal Medicine and Pharmacology and Toxicology, Radboud Institute for Health Sciences,
In this course you will be introduced to clinical toxicology and much attention will be paid to the daily practice. The course will focus on the recognition and treatment of human intoxications and the design of a small-scale human toxicological study.
After a general introduction into the topic, the first 2 weeks will extensively cover the general approach of specific diagnosis and treatment of intentional and accidental intoxications and toxicokinetics and toxicodynamics of (medical) drugs. Furthermore, the need and interpretation of systematic toxicological analysis will be discussed. You will visit a morning report of the department of General Internal Medicine or Emergency Department and attend the Tox meeting to obtain knowledge on toxicity/side effects/interactions in day to day practice in the clinical setting. At the beginning of the third week, you will have the opportunity to apply the knowledge and insights acquired during the first 2 weeks in a summative test (50% of grade). In the third and fourth week, the problems associated with various classes of drugs of abuse will be illustrated to you by making use of pharmacological and toxicological data from molecule to patient to population. You will prepare within a group (n=2-3) a pro con debate (15% of grade) whether drugs of abuse should be allowed on the market ("gedogen") or are there good arguments to ban them because their use is associated with major medical and societal problems?
Furthermore, the interplay of multiple 'risk' factors ultimately resulting in an harmful drug effect will be discussed. Much information about drugs comes from clinical trials where monotherapy is given. While the FDA approves that drug, it does not foresee the possibility of patients taking many drugs in real life. Therefore, you will write an informed consent and study synopsis in pairs (35% of grade) of a small-scale human toxicological study in which you would like to investigate a drug-drug interaction, or the safety of a designer drug. Your design will be evaluated by the Ethical Committee of the Radboudumc. In order to provide you with ample time to prepare this subject, this subject will already be introduced in the first week.
Main learning goals
After completion of the course, students are able to
1. Define a general approach of acute or chronic intoxicated patients concerning diagnosis and treatment.
2. Distinguish the most effective and preventive therapeutic measures for intoxicated individuals based on the principles of toxicokinetics and toxicodynamics.
3. Perform interpretation of analytical toxicological results in the framework of the exposed human being.
4. Explain the interindividual variability in susceptibility to harmful drug effects in humans based on endogenous and exogenous factors.
5. Design a small-scale human toxicological study.
6. Define the mechanisms of clinical effects associated with some common drugs of abuse and you are able to evaluate government policy on this subject.