Management of Poisoning

Intended Learning Outcomes
Certificate Details:
  • Description:
  • This course deals with the basic principles required for managing cases of intoxications and poisoning with special focus on both general supportive measures and specific treatment with antidotes. The objective of this course is to familiarize students with the most important toxic substances, their toxic effects, and treatment. Several examples of toxicants are presented and discussed in detail.

  • Aim:
  • This course aims to equip students with the cognitive and professional skills needed for the management of poisoned patients and identify appropriate therapeutic strategies using scientific and evidence-based knowledge

Learning Outcomes:
  • Knowledge and Understanding: By the end of the course the student will be able to:
    1. Summarize the basic principles involved in the management of the poisoned patient including an overview of the supportive measures.
    2. List the decontamination strategies used to reduce absorption in poisoned patients such as activated charcoal, gastric lavage and whole bowel irrigation.
    3. List the measures used to enhance elimination in poisoned patients including multiple dose activated charcoal, urinary alkalinisation and haemodialysis.
    4. Explain the pharmacological basis for the use of general and specific antidotes in poisoned patients.
  • Intellectual Skills: By the end of the course the student will be able to:
    1. Interpret the clinical symptoms, signs and laboratory findings in common cases of poisoning following the intake of pesticides and drugs.
    2. Appraise the evidence for the use of gastrointestinal decontamination measures and commonly used antidotes in the management of poisoned patients.
  • Professional and practical skills: By the end of the course the student will be able to:
    1. Interpret the results of investigations carried out in order to ensure the optimal management of patients suspected to be poisoned with commonly used drugs and chemicals.
    2. Manage the different cases of toxidromes in poisoned patients.
    3. Assess poisoned patients for the provision of proper symptomatic treatment and supportive care.
  • General and Transferrable Skills: By the end of the course the student will be able to:
    1. Communicate effectively with health care teams, poisoned patients and their families and relatives.

Lecture Scheme
Part One:
Week No Date Time Lecture Title Lecturer
1. 6

Principles of managing poisoned patient

  • Initial evaluation of the patient: vital signs
  • Decontamination
  • Principles and techniques applied to enhance elimination of toxicants
  • Toxidromes
2 Tutorials and E-labs
1. 6

Pharmacokinetics and Toxicokinetics principles

  • Administration, liberation, and absorption of toxicants
  • Prevention of absorption from the gastrointestinal tract
  • Distribution and metabolism of toxicants in the body
2 Tutorials and E-labs
2. 8

Workshop:

  • Lecture on basic life support
  • Airway management
  • Peripheral lines +Inter-Osseous
  • Nasogastric tube
Part Two:
Week No Date Time Lecture Title Lecturer
3. 6

Laboratory principles

Critical care aspect of analytical toxicology

Fluid, electrolyte, and acid-base principles

2 Tutorials and E-labs
3. 6

Acute overdose of common medications

  • Cardiovascular principles (Calcium channel blockers- Beta blockers – Digitalis)
  • Theophylline
  • Neurologic and psychiatric principles
  • Antipsychotics and lithium
2 Tutorials and E-labs
4. 8

Workshop:

  • Advanced cardiac life support
  • ECG interpretation
  • Tachycardia & Bradycardia algorism
  • Defibrillation
  • Related medication
Part Three:
Week No Date Time Lecture Title Lecturer
5. 6

Substances of abuse and Drugs of addiction:

  • Neurotransmitters and neuromodulators versus withdrawal principles)
  • Opiates and opioids
  • Benzodiazepines and barbiturates
  • Amphetamines
2 Tutorials and E-labs
5. 6

Analgesics and anti-inflammatory medications

  • Non-steroidal anti-inflammatory drugs
  • Acetaminophen and salicylates

Ethanol and Methanol

Hydrocarbons

2 Tutorials and E-labs
4. 8

Workshop:

  • Advanced cardiac life support
  • ECG interpretation
  • Tachycardia & Bradycardia algorism
  • Defibrillation
  • Related medication
Part Four:
Week No Date Time Lecture Title Lecturer
7. 6

Pesticides & insecticides:

  • Organophosphates and carbamates
  • Organochlorines and pyrethroids

Rodenticides:

  • Warfarin and zinc phosphide

Other Agriculture chemicals (Aluminum phosphide)

2 Tutorials and E-labs
7. 6

Food poisoning

Botulism and botulism antitoxin

Household products:

  • caustics(corrosives)
  • antiseptics and disinfectants
2 Tutorials and E-labs
8. 8

Workshop:

  • Renal replacement therapy
  • Lecture on nutrition of critically ill patient
Part Five:
Week No Date Time Lecture Title Lecturer
9. 6

Natural toxins and envenomation

Heavy metals (Lead, mercury and arsenic)

Chelating therapy

2 Tutorials and E-labs
9. 6

Noxious gases and Carbon monoxide

Cyanide and hydrogen sulfide

Overview on special antidotes

2 Tutorials and E-labs
10. 8

Workshop:

  • Decontamination and war gases
  • Case scenario
10. 8

Assignment 2


Required Bibliography:
  • Curtis KlaassenCasarett&Doull's Toxicology: The Basic Science of Poisons, Eighth Edition Hardcover – 1 Jul 2013 Mc Graw-Hill Education / Medical; 8 edition (1 July 2013) ISBN-10: 0071769234ISBN-13: 978-0071769235
  • Lewis S Nelson, Robert S HoffmanGoldfrank's Toxicologic Emergencies by , 2015 10th Revised edition ISBN: 0071801847 / ISBN-13: 9780071801843
  • Kent R Olson (Editor) Poisoning and Drug Overdose 6th Edition. Mc Graw Hill (US), ISBN9780071668330

Optional Bibliography:
  • Lindsay Murray Mark Little Ovidiu Pascu, Kerry Anne Hoggett (Toxicology Handbook, 3e Paperback – 3 Jun 2015 Publisher: Churchill Livingstone; ISBN-10: 0729542246 ISBN-13: 978-0729542241
  • National Research Council Scientific Frontiers in Developmental Toxicology and Risk Assessment. (US) Committee on Developmental Toxicology. Washington (DC): National Academies Press (US); 2000.
  • F X Reichl, L Ritter Illustrated Handbook of Toxicology (2011), Thieme (Germany) ISBN 9783131269218
  • Dries DJ, EndorfFW.Inhalation injury: epidemiology, pathology, treatment strategies.Scand J Trauma ResuscEmerg Med. 2013 Apr 19;21:31. doi: 10.1186/1757-7241-21-31. Review.
  • Gibb H, Devleesschauwer B, Bolger PM, Wu F, Ezendam J, Cliff J, Zeilmaker M, Verger P, Pitt J, Baines J, Adegoke G, Afshari R, Liu Y, Bokkers B, van Loveren H, Mengelers M, Brandon E, Havelaar AH, Bellinger D. World Health Organization estimates of the global and regional disease burden of four foodborne chemical toxins, 2010: a data synthesis. F1000Res. 2015 Dec 3;4:1393. doi: 10.12688/f1000research.7340.1. eCollection 2015
  • Hodgson E.Toxins and venoms. Prog MolBiolTransl Sci. 2012;112:373-415. doi: 10.1016/B978-0-12- 415813-9.00014-3. Review.
  • Narayan et al. (2013) Household organophosphorus pesticide use and Parkinson's disease. Int J. Epidemiol 42(5) 1476-85. FREE ACCESS.
  • PitschmannV.Overall view of chemical and biochemical weapons. Toxins (Basel). 2014 Jun 4;6(6):1761-84. doi: 10.3390/toxins6061761. Review. Free PMC Article

Medication Error and Patient Safety

Intended Learning Outcomes
Certificate Details:
  • Description:
  • This course will increase awareness about medication errors throughout the healthcare system and the use of appropriate methods of prevention and the training of health care professionals in medication error reporting.

  • Aim:
  • The aim of this course is to improve the knowledge of the health care professionals (Nurses, pharmacist or medical doctor) about medication error, pharmacovigilance and comprehend different strategies for error reduction which will enable them to make an effective contribution to a health care team and thus improve patient safety.

Learning Outcomes:
  • Knowledge and Understanding: By the end of the course the student will be able to:
    1. Identify different epidemiologies, causes and types of medication error in national and international health care systems.
    2. Explain differences between adverse drug reactions, adverse events and medication errors.
    3. Describe ways to prevent medication error and improve patient safety.
    4. Outline how patient safety and pharmacovigilance responsibilities are organized within the health care team.
  • Skills (including transferable/generic skills): By the end of the course the student will be able to:
    1. Intellectual skills
      • Understand and interpret different case reports through the interpretation of relevant patient histories, physical examinations and laboratory data.
      • Specify requirements in the reporting of adverse reactions or medication errors to health authorities.
      • Analyze ways in which patient safety and pharmacovigilance is regulated nationally and internationally and identify relevant international policy-making bodies.
    2. Professional and Practical Skills
      • Compile a drug safety database, assess a product’s safety profile, and hand include safety information in documentation for regulatory authorities, healthcare professionals, and consumers.
      • Analyze epidemiologic data in the development of protocols and medication error prevention strategies.
    3. General and Transferable Skills
      • Analyze different resources such as books, scientific journals and professional sites in order to be able to extract the relevant required information.

Lecture Scheme
Week No Date Time Lecture Title Lecturer
1. 3

Introduction of the course pointing out its importance

Introduction about medication errors *(definition, adverse events, sentinel events and near misses)

3 Epidemiology of medication error and factors affecting rates of occurrence of medication errors
2. 3

Types of medication errors

2

Pharmacovigilance (Definition, regulation, practices)

1

Assignment 1

3. 3

Adverse events reporting and post-marketing activities

3

Population of special vulnerability

4. 3

Regulatory issues across global governmental agencies like the European medicine that improve patient safety and reduce medication errors

2

Strategies used to prevent medication error

1

Assignment 2

5. 3

Documentation and recording of medication error (electronic health records) (Theoretical)

5

Field visit 1: Documentation and liability (pharmacovigilance center)

6. 6

Field visit 2 (pharmacovigilance center)

7. 6

Field visit 3 (Alexandria University poison center)

8. 3

Discussion of case Reports (delivered from field visits)

– Case Presentation

3

Discussion of case Reports (delivered from field visits)

– Case Presentation

9. 6

Preparation of end of the course assignment about how to improve pharmacovigilance and reduce medication errors

– Final presentation


Required Bibliography:
  • National Coordinating Council for Medication Error Reporting and Prevention. What is a medication error? New York, NY: National Coordinating Council for Medication Error Reporting and Prevention; 2015. (http://www.nccmerp.org/ about-medication-errors, accessed 19 September 2016).
  • Ferner RE, Aronson JK. Clarification of terminology in medication errors: definitions and classification. Drug Saf. 2006;29:1011-22
  • Lu CY, Roughead E. Determinants of patient-reported medication errors: a comparison among seven countries. Int J Clin Pract. 2011;65:733-40.
  • Drug Safety: Volume 40, Issue 12, pp 1241–1248 Medication Errors: A Characterisation of Spontaneously Reported Cases in EudraVigilance https://link.springer.com/article/10.1007/s40264-017-0569-3
  • Union European. Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to medicinal products for human use. OJ. 2001;44(L311):67–128.
  • Pharmacovigilance Risk Assessment Committee. Good practice guide on recording, coding, reporting and assessment of medication errors (EMA/762563/2014).
  • http://www.ema.europa.eu/docs/en_GB/document_library/Regulatory_and_procedural_guideline/2015/11/WC500196979.pdf (2015). Accessed 15 Jun 2017.

Occupational Toxicology

Intended Learning Outcomes
Certificate Details:
  • Description:
  • This course will increase knowledge about the toxicity of different body systems and organs caused by chemicals related to with different occupations and work places. It will help in the prevention of occupational health and safety incidents at the work places and strengthen the understanding of safety protocols and reports related to these specific occupations.

  • Aim:
  • The aim of this course is to update the knowledge of the health care professional (Nurses, pharmacist or medical doctor) about occupational toxicology that enable them to recognize the risk factors, improve health and safety regulations in the work place and the early detection of toxicity among those at a given work place.

Learning Outcomes:
  • Knowledge and Understanding: By the end of the course the student will be able to:
    1. Identify different toxicological health and safety risks at different workplaces.
    2. List the possible potentially toxic biological and chemical agents at different workplaces and the symptoms whilst understanding their mechanism of action.‎
    3. Identify suitable occupational hygiene and safety tools which will address the needs in different work places and their role in the prevention of occupational toxicity or in reducing the exposure to toxic agents.
    4. Recognize the different routes of exposure to toxic agents at different work places and the occupational exposure limit for these toxic agents.
  • Skills (including transferable/generic skills): By the end of the course the student will be able to:
    1. Intellectual skills
      • Differentiate between occupational toxicological accidents and diseases which may arise due to occupational hazards at different work places
      • Discuss the general principles of bio-monitoring of potentially toxic agents at different work place.
    2. Professional and Practical Skills
      • Identify common chemical carcinogens, corrosives, heavy metals, toxic gases, irradiations and biological hazards at different work places.
      • Assess the potential health hazards of different toxic agents on the workers in a given workplace, using different methodologies.
    3. General and Transferable Skills
      • Apply health and safety protocols and guidelines together with the first aid skills in the work place.

Lecture Scheme
Week No Date Time Lecture Title Lecturer
1. 3

Introduction to environmental toxicology, occupational toxicity and contamination.

3 Pharmacodynamics of Occupational and industrial toxins.
2. 3

Occupational respiratory diseases

3

Occupational skin diseases

1

Assignment 1

3. 3

Occupational liver diseases

3

Occupational kidney diseases

4. 3

Occupational nervous system diseases.

3

Occupational reproductive toxicity

1

Assignment 2

5. 3

Occupational hygiene and epidemiology

3

Occupational carcinogenic and teratogenic effects

6. 6

Environmental toxins (pesticides – solvents – heavy metals – gases)

7. 3

Occupational and Industrial safety

3

Risk assessments of occupational toxins

8. 3

Field visit 1 for factories to assess the toxic chemicals exposure

- Case presentation

9. 6

Field visit 2 to Assiut university hospital to assess cases of occupational hazards

– Final presentation

10. 6

Final presentation and assessment


Required Bibliography:
  • Winder c and Stacey (2005): Occupational Toxicology. 2nd edition. CRC press
  • Curtis Klaassen. Casarett&Doull's Toxicology: The Basic Science of Poisons, Eighth Edition Hardcover – 1 Jul 2013 McGraw-Hill Education / Medical; 8 edition (1 July 2013) ISBN-10: 0071769234ISBN-13: 978-0071769235
  • Lewis S Nelson, Robert S Hoffman. Goldfrank'sToxicologic Emergencies, 2015 10th Revised edition ISBN: 0071801847 / ISBN-13: 9780071801843

Optional Bibliography:
  • F X Reichl, L Ritter. Illustrated Handbook of Toxicology (2011), Thieme (Germany) ISBN 9783131269218
  • Lindsay Murray, Mark Little,OvidiuPascu, Kerry Anne Hoggett (Toxicology Handbook, 3e Paperback – 3 Jun 2015 Publisher: Churchill Livingstone; ISBN-10: 0729542246 ISBN-13: 978-0729542241