Veterinary Clinical Toxicology

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Course

ANPH 520

Semester

Spring

Year

2022

Catalog

School of Veterinary Medicine

Faculty and Staff Information

The course director is Prof. Dr. Arno H. Werners DVM, MEd, PhD, DECVPT (awerners@sgu.edu). Office hours will be by appointment.

Lecturers in the course are Associate Professor Dr. Kamashi Kumar BVSc & AH, MVSc, PhD (kamashikumar@sgu.edu), Associate Professor Dr. Talia Guttin VMD, MEd, DACVIM (tguttin@sgu.edu) and Prof. Dr. Arno H. Werners.

Course Location

All lectures will be delivered in Ray and Jan Sis Hall. The lectures will be recorded (Panopto) as well as available “live” via Zoom. We will use the “Lessons” tab on Sakai to make sure that you keep up with the course material. Links will be available on this page to the learning materials for that week and the lecture slides, short video’s of more complicated aspects of veterinary toxicology, assignments, and additional reading.

Required Resources

Lecturers will use notes and/or slides. Notes and/or slides will be available on Sakai only and will not be available as a print-out. The slides will be accessible for digital note taking. For certain subjects, lecturers may decide to include scientific articles or chapters from reference books in the study material. These will also be made available electronically on Sakai and are subject to questions on assessments. All lectures will be available via Panopto recordings: the link is published on the Sakai site and on the “Lesson” tab on Sakai. There are no other required resources for this course, however, the following book can be used as reference: “Veterinary Toxicology. Basic and Clinical Principles, 2nd edition; Ramesh C. Gupta editor; Academic Press”.

Recommended Resources

There are no recommended resources, other than the book mentioned above (“Veterinary Toxicology. Basic and Clinical Principles, 2nd edition; Ramesh C. Gupta editor; Academic Press”).

Accommodation

Students who need accommodations should contact Student Accessibility and Accommodations Services (SAAS), located in the Welcome Center, inside the International Students Office.
Information can be found at mycampus.sgu.edu/group/saas

Other Requirements

None.

Course Rationale

A vast number of substances potentially toxic to animals exist, including pesticides, household cleaning products, agricultural chemicals, automotive products, human prescription and non-prescription drugs, herbal remedies, mycotoxins, and poisonous plants and animals. With such huge numbers of potential toxins, it is impossible for veterinarians to be knowledgeable about all of them. But because some poisonings can cause illness or even death within only minutes to hours after exposure, immediate access to reliable information on diagnosis and treatment is essential. Often intoxications involve new drugs or chemical products for which very little or no published veterinary toxicity data is available. Standard veterinary medical textbooks usually include information on only the more common toxins. Even texts devoted specifically to toxicology cannot provide information on all toxins in all species. Information gained from product manufacturers or human poison control centres often pertains to human exposures only. Because of wide metabolic and physiological differences between species, it is rarely appropriate to extrapolate toxicity data from humans to other species. Veterinary toxicologists at veterinary colleges can provide valuable information on many toxicants, but as with many manufacturers, are often available only during routine office hours. An other important source are the different animal poison control centres. Therefore, it is important that veterinarians are aware of the variety of additional toxicological information sources available.

Course Learning Outcomes

In this course students will develop a proficient working knowledge of toxicological principles, including toxicological testing and the effects of toxins on organ systems, several common toxins in different animal species and practical approaches to the animal that presents with an intoxication.

Upon successful completion of this course, the student will be able to:

Compare and contrast veterinary regulatory toxicology and veterinary clinical toxicology.
Analyse and explain in a general sense how and where toxins act at the molecular/cellular/physiologic level (toxicodynamics).
Articulate and apply knowledge of toxin absorption, bioavailability, distribution, metabolism and excretion (including bio-activation and bio-inactivation), and judge the effects of exposure on the clinical signs observed (toxicokinetics).
Integrate toxicokinetic and toxicodynamic information to formulate:
A differential diagnosis
The importance of sample collection Additional diagnostic tests
A prognosis
Predict and recognise major intoxications in the different veterinary species, including toxic plants and mycotoxins.
Design the most appropriate therapeutic protocol for common and important intoxications using knowledge of species, breed, age, sex, disease states, genetics and other factors, and integrate pharmacological therapy in a multimodal treatment plan (i.e., surgery, nutrition, management, etc).
Outline the desired response to pharmacological therapies as well as reflect on the most appropriate methods to monitor for treatment success.
Effectively communicate information about intoxications and therapeutic plans to clients (translate information to lay person, educate stakeholders) , technical staff, and colleagues and ensure consistency with and cognizense of demographical, socio-economical and cultural considerations.

Lesson Learning Outcomes

Topic	Lesson Learning Outcomes	Course learning outcomes
General toxic principles (INT)	Compare and contrast toxins and toxicants Compare and contrast the spectra of undesired effects Compare and contrast the different Adverse Drug Reactions (ADRs) Describe the importance of species differences Differentiate between acute subacute and chronic toxicities	7, 8, 9
Toxicokinetics (TK)	Describe common toxicokinetic principles Interpret toxicokinetic data and draw conclusions regarding the potential clinical effects Compare and contrast the different effects of routes of exposure and its clinical repercussions Interpret dose-response relationships and put them into a clinical perspective	2, 3
Terminology and Toxicological testing (TEST)	Compare and contrast the use of different in vitro and in vivo toxicological tests Describe the differences between experimental and clinical toxicology when evaluating different toxicological tests Describe the purpose of the different toxicological tests and evaluate their outcomes Evaluate the differences between acceptable daily intake and maximum residue level, incorporating all relevant parameters Describe the rationale and principles of additional toxicological tests Evaluate the importance of transgenerational toxicity Articulate the role biotransformation plays in the toxicity of chemicals	6, 8
Carcinogenicity and Mutagenicity (MUT)	Compare and contrast the different in vitro tests used to evaluate carcinogenicity, mutagenicity or gentoxicity Describe the place these tests have in the approval of (veterinary) medicinal products Evaluate the effects of ochratoxin A as a mutagenic agent	1, 2, 3, 6
Hepatotoxicity and Intervention (HEP)	Reiterate the importance of biotransformation, including species differences in drug metabolising enzymes Compare and contrast the effects of toxins on different parts of the liver Describe the different toxic responses of the liver (biotransformation dependent and independent toxicity) Compare and contrast the effects of different toxins on the liver, including zonal effects Describe the different intervention strategies and compare and contrast their mechanisms of action, advantages and disadvantages	1, 2, 3, 4, 5, 9
Cardiotoxicity (CARDIO)	Compare and contrast the different cardiotoxic chemicals, their mechanisms of action, clinical signs and therapeutics	1, 2, 3, 4, 5, 9
Nephrotoxicity (KID)	Reiterate the importance of the kidney in biotransformation and elimination of chemicals Compare and contrast the different chemicals that have an effect on the kidney, including their mechanism of action, clinical signs and therapeutic interventions	1, 2, 3, 4, 5, 9
Mycotoxins (MYCO)	Compare and contrast pre-harvest and post-harvest fungal infections and the implications for prevention Describe the general characteristics of fungal toxins Describe the factors that determine fungal growth Compare and contrast mycoses, mycotoxicoses and toxicoinfections Compare and contrast the different mycotoxins that play a role in animal health, including mechanisms of action, clinical signs and therapeutic interventions	1, 2, 3, 4, 5, 9
Immuno (IMM)and Neurotoxicity (NEURO)	Compare and contrast different neuropathies (including excitotoxicity) Identify neurotoxins based on clinical signs/pathology results and clarify their mechanism of action Clarify how chemicals elicit their effects on the immune system List relevant immunotoxicities and immunological reactions in veterinary medicine and describe the underlying mechanisms	1, 2, 3, 4, 5, 9
Plant Toxicology (PLANT)	Compare and contrast mechanism of action, the clinical signs and the treatment modalities Compare and contrast plant tox- ins and their effects on different organ systems.	1, 2, 3, 4, 5, 9
Clinical Toxicology of Food Producing Animals (CT FA)	Recognise intoxications in food producing animals based on presented history and clinical signs Clarify mechanisms underlying the clinical signs observed Determine what samples should be taken for diagnostic purposes and how these samples should be stored and transported List the most relevant intoxications and adverse effects of Veterinary Medicinal Products (VMPs) Create a therapeutic protocol to treat common intoxications Provide information on the legal restrictions when treating intoxications in food producing animals	7, 9
Clinical Toxicology of Companion Animals (CT CA)	Recognise intoxications in companion animals and clarify the underlying mechanisms responsible for the clinical signs observed Integrate previous knowledge of companion animal pathophysiology and toxicology to diagnose intoxications Create a therapeutic protocol to treat common intoxications Assemble patient information to construct a differential diagnosis (this includes determining which samples to take, how to store and transport them)	7, 9
Clinical Toxicology of the Equine Patient (CTE)	Compare and contrast treatment modalities for equine intoxications Design specific treatment for individual cases Integrate previous knowledge of equine pathophysiology and toxicology to diagnose intoxications Assemble patient information to construct a differential diagnosis (this includes determining which samples to take, how to store and transport them)	7, 9

Alignment of Course Learning Outcomes with Program Learning Outcomes


1	Compare and contrast veterinary regulatory toxicology and veterinary clinical toxicology.
2	Analyse and explain in a general sense how and where toxins act at the molecular/cellular/physiologic level (toxicodynamics).	A3: Recall, understand, and adequately utilise knowledge of aetiology, pathogenesis and pathology of common infectious, non-infectious, and zoonotic diseases, including biosafety and biosecurity considerations
3	Articulate and apply knowledge of toxin absorption, bioavailability, distribution, metabolism and excretion (including bio-activation and bio-inactivation), and judge the effects of exposure on the clinical signs observed (toxicokinetics).	A2: Analyse homeostasis and disturbances of basic structures and functions of healthy animals A3: Recall, understand, and adequately utilise knowledge of aetiology, pathogenesis and pathology of common infectious, non-infectious, and zoonotic diseases, including biosafety and biosecurity considerations A6: Apply multi-disciplinary scientific knowledge to clinical situations and understand evidence-based veterinary medicine
4	Integrate toxicokinetic and toxicodynamic information to formulate: A differential diagnosis The importance of sample selection and collection Additional diagnostic tests A prognosis	A6: Apply multi-disciplinary scientific knowledge to clinical situations and understand evidence-based veterinary medicine C1: Execute a comprehensive patient diagnostic plan and demonstrate problem solving skills to arrive at a diagnosis
5	Predict and recognise major intoxications in the different veterinary species, including toxic plants and mycotoxins.	A3: Recall, understand, and adequately utilise knowledge of aetiology, pathogenesis and pathology of common infectious, non-infectious, and zoonotic diseases, including biosafety and biosecurity considerations
6	Design the most appropriate therapeutic protocol for common and important intoxications using knowledge of species, breed, age, sex, disease states, genetic and other factors, and integrate pharmacological therapy in a multimodal treatment plan (i.e., surgery, nutrition, management etc.). Outline the desired response to pharmacological therapies as well as reflect on the most appropriate methods to monitor for treatment success	C2: Create comprehensive treatment plans
7	Effectively communicate information about intoxications and therapeutic plans to clients (translate information to lay person, educate stakeholders) , technical staff, and colleagues and ensure consistency with and cognizense of demographical, socio-economical and cultural considerations.	C8: Demonstrate and model effective client communication and ethical conduct

Course Schedule

Week	Topics and Materials Covered	Scheduled Activities	Time Commitment
Week 0	Lecture: Introduction to the course Lecture: General toxic principles	Monday January 10th 10.30am AST Lecture 1: introduction to the course Friday January 14th 09.30am AST Lecture 2: General toxic principles	Lecture 2 hours Clinical toxicology assignment 1 hour
Week 1	Lecture: Regulatory versus clinical toxicology Working on clinical toxicoogy assignment	Wednesday January 19th 10.30am AST Lecture 3: Regulatory versus clinical toxicology	Lecture 1 hour Clinical toxicology assignment 1 hour
Week 2	Lecture: Toxicokinetics 1st assessment	Thursday January 27th 09.30am AST Lecture 4: Toxicokinetics Saturday January 29th 17.00pm AST Examsoft Qs (2 Qs General toxic principles 2 Qs Regulatory versus clinical toxicology)	Lecture 1 hour SAQs 20 minutes
Week 3	Lecture: Intro to clinical toxicology Lecture: Genotoxicity, carcinogenicity and mutagenicity Working on clinical toxicology assignment	Wednesday February 2nd 09.30am AST Lecture 5: Intro to clinical toxicology Friday February 4th 09.30am AST Lecture 6: Genotoxicity, carcinogenicity and mutagenicity	Lecture 2 hours Clinical toxicology assignment 1 hour
Week 4	Lecture: Introduction to cardiovascular toxicology Lecture: Introduction to plant toxicology 2nd assessment	Thursday February 10th 10.30am AST Lecture 7: Introduction to cardiovascular toxicology Friday February 11th 10.30am AST Lecture 8: Introduction to plant toxicology Saturday January 12th 17.00pm AST Examsoft Qs (2 Qs Toxicokinetics and 2Qs Intro to clinical toxicology)	Lecture 2 hours SAQs 20 minutes
Week 5	Lecture: Introduction to gastrointestinal toxicology Working on clinical toxicology assignment	Thursday February 17th 10.30am AST Lecture 9: Introduction to gastrointestinal toxicology	Lecture 1 hour Clinical toxicology assignment 2 hours
Week 6	Working on clinical toxicology assignment 3rd assessment	Saturday February 26th 17.00pm AST Examsoft Qs (2 Qs Introduction to plant toxicology, 2 Qs Genotoxicity, carcinogenicity and mu- tagenicity)	SAQs 20 minutes Clinical toxicology assignment 2 hours
Week 7	Submission of Clinical toxicology assignment	Saturday March 5th 17.00pm AST deadline for submission of clinical toxicology assignment
Week 8	Lecture: Introduction to renal toxicity 4th assessment	Tuesday March 8th 10.30am AST Lecture 11: Introduction to renal toxicity Saturday March 12th Examsoft Qs (2 Qs Intro to CVS toxicology and 2 Qs Intro to GI toxicology)	Lecture 1 hour SAQs 20 minutes
Week 9	Lecture: Introduction to neurotoxicity Working on plant toxicology assignment	Tuesday March 15th 11.30am AST Lecture 12: Introduction to neurotoxicity	Lecture 1 hour Plant toxicology assignment 1 hour
Week 10	Lecture: Introduction to liver toxicity 5th assessment	Friday March 25th 10.30am AST Lecture 13: Introduction to liver toxicity Saturday March 26th 17.00pm AST Examsoft Qs (2 Qs Intro to renal toxicology and 2 Qs Intro to CNS toxico- logy)	Lecture 1 hour SAQs 20 minutes
Week 11	Lecture: Introduction to mycotoxins Working on plant toxicolgy assignment	Wednesday March 30th 09.30am AST Lecture 14: Introduction to mycotoxins	Lecture 1 hour Plant toxicology assignment 1 hour
Week 12	Lecture: Top 10 plant toxins 6th assessment	Thursday April 7th 10.30am AST Lecture 15: Top 10 plant toxins Saturday April 9th 17.00pm AST Examsoft Qs (2 Qs Intro to liver toxicology and 2 Qs Intro to mycotoxins	Lecture 1 hour SAQs 20 minutes
Week 13	Lecture: Top 10 plant toxins	Monday April 11th 11.30am AST Lecture 16: Top 10 plants toxins Saturday April 16th 17.00pm AST Submission of plant toxicology assignment	Lecture 1 hour
Week 14	Final examination	Monday April 25th 12pm AST Final examination

Grading and Assessment Policy

Grading scale

Percentage Score	Letter Grade
> 89.5%	A
84.5 - 89.5	B+
79.5 - 84.4	B
74.5 - 79.4	C+
69.5 - 74.4	C
64.5 - 69.4	D+
59.5 - 64.4	D
< 59.4	F

Assessment policy

Knowledge of the subject will be tested formatively throughout the term and summatively in a final examination. All the material presented (notes, articles, book chapters, lecture slides) is subject in all the assessments, unless the lecturer specifically indicates differently. The final exam (60 questions; see breakdown in table below) will cover all material presented during the term. The final grade will consist off the mark for the clinical toxicology assignment (10%), the SAQs (via Examsoft) (15%), the plant toxicity assignment (15%), the peer evaluation (5%) and the mark for the final examination (55%).

Assignments are completed by group. Group allocation will be announced through Sakai at a later date. The topic for each group for both assignments can be found in table 4 in the appendix.

Three (3) points per assignment will be taken from the total for the assignments and the peer assessment when they are not submitted on time.

The format of the questions on the examinations will be Multiple Choice Questions (MCQs), Short Answer Questions (SAQs), Fill in the Blank (FITB) and Matching questions.

The lecturers will very carefully design the exams. The most current SGU examination policy and assessment guidelines are adhered to and the examination policy is leading in all issues that might arise. Students are required to follow the instructions of the course director and the proctors in all matters. Discussions and reviews of/on exams and examination material can only take place within the first seven (7) days after completion of the examination. Comments and challenges regarding the final examination should be communicated through the designated SGA student representative within 24 hours after the end of the examination.

Assessment	% of total grade	Total # of points	Subjects
Clinical toxicology assignment	10%	30	See group assignments (appendix table 4) Rubric in appendix table 5
Plant toxicology assignment	15%	33	See group assignments (appendix table 4) Rubric in appendix table 6
SAQs	15%	24 (1 points per question)	See detailed course schedule (appendix table 3)
Peer evaluation	5%		1 evaluation per group (appendix table 7)
Final examination	55%	60	2 questions per lecture hour (Introduction lecture to the course not included) = total of 28 questions 1 question per clinical toxin. Docu- ment will become available after week 8

A grade reduction of 5% will be applied to that exam if students do not observe the following parameters listed in the assessment policy for students during exams monitored online:

Avoid talking out loud.
Avoid looking away from the monitor.
Avoid having distractions (animals, people in or walking through the room or making noise during the exam).
Check that your webcam is recording your full face at all times with adequate lighting.

Group	Clinical toxicology assignment	Plant toxicology assignment	Students
1	Anticoagulant rodenticides	A lactating cow with fever and bleeding from different orifices	Johnston, Mackenzie Fedele, Kaila Gridley, Katherine George, Tony
2	Ionophores in cattle	A horse with depression, anorexia and discoloured urine	Hubick, Shelby Rudolf, Erica Mordukhaev, Michelle
3	Bromethalin in dogs	A dairy cow with respiratory problems	Healey, Brianna Jafferally, Sahara Laird, Rachael
4	Crotalid envenomation in a horse	A cow at pasture with colic, hemorrhagic diarrhoea and anorexia	James, Emily Liu, Jenny Phillips, Ashley
5	Blister beetles in horses	A cow at pasture with respiratory and cardiovascular abnormalities	Comeau, Karine Simmons, Jasmine Maldonado-Ross, Johana
6	Oak intoxication in heifer calves	A boxer dog presented with general weakness, anorexia and clinical signs of CV collapse	Lochner, Celine McCarthy, Jonathan Pinney, Kyle
7	Phenylbutazone intoxication in horses	A lactating cow presents with arrhythmias and peripheral oedema	Abrahamson, Meghan Allender, Aaron McCartin, Jenna
8	Carprofen intoxication in dogs	Piglets presenting with muscular weakness, respiratory disstress and cardiac failure	Redmond, Erica Silberman, Claire Rogers, Alexandra
9	Raisin intoxication in a dog	A horse presents with laminitis	Whitney, Madison Guzman Sanchez, Marielis Murray, Brittany
10	Ethylene glycol intoxication in a llama	Cattle presenting with watery to mucoid diarrhoea and decreased rumen motility	Brandt, Lindsey Manning, Margaret Cruz, Peter
11	Arsenic intoxication in a cow	A pig presenting with anorexia, diarrhoea, colic and depression	Barry, Alexis Donegan, Patrick Riddick, Brittany
12	Isoxazoline intoxication in a dog	A horse preseting with severe colic signs	Hothi, Parveen Wilson, Mariah Heidel, Ilana
13	Allium spp. intoxication in a dog	A Labrador pup presents with swelling of lips, tongue and muzzle	Morales, Shelby Jno Baptiste, Jolyn Bryan, Rachel
14	Organophosphate intoxication in cattle	A bull presents with frothy salivation and an inflammed muzzle	Uvaydov, Rachel Shen-Kinny, Lance Allegretti, Delaina
15	Marijuna intoxication in a dog	A stabled horse presents with frothy salivation and depressed	Garcia Rodriguez, Miguel Angel Peak, Mallory Chang, Alex
16	Avermectins in MDR1 deficient dogs	On a sheep farm animals present depressed with excessive salivation and other GI-tract clinical signs	Scheppke, Brianna Patrick, Randa Aziz, Tania
17	Lilly intoxication in a cat	Free ranging sheep with colic	Momi, Azadveer Moise, Jacob Rhoden, Raheed
18	Box elder tree intoxication in a draft horse	Dog with periodic episodes of persistent vomiting	Vaught, Sydney Saravia, Diana Madara, Devon
19	Metronidazole intoxication in a cat	Sheep presenting with anorexia, lethargy and depression	Alexander, Taylor Yates-Lavery, Ida Julia Landron, Camila Gallagher, Dane
20	Duloxetine (CymbaltaⓇ) intoxication in a cat	Phytotoxicity	Brewster, Ashlyn Nunnelley, Jacqueline Gussman, Emily Epes, Elizabeth
21	Amlodipine intoxication in a cat	A horse presenting with a saw-horse stance, staggering and trembling	Christen, Madeleine Via, Amanda Barrick, Aubree-Anna Desai, Sonali
22	Permethrin intoxication in a cat	An ataxic horse with difficulty chewing	White, Yvonne Krolczyk, Victoria Cunningham, Lauren Barsoum, Ireny
23	Xylitol intoxication in a dog	Cattle with neurological signs such as head pressing	Leinberger, Priscilla Knapp, Kayli Maglaris, Zoe
24	Ethanol toxicity in a dog	Phytotoxin causing clinical signs of the nervous system	Pierce,Lauren Maur, Glenna Macchiarelli, Sisina
25	Amphetamine intoxication in a dog	Gradual but progressive onset of muscle weakness in a cow	Abraham, Celin Duncan, Kayla Mabine, Joanna Collins, Karli
26	Copper intoxication in Boer goats	A horse with a fixed facial expression	Nicholes, Sheriden Ramsey, Thomas Bray, Brooke Ferguson, Alanna
27	Lead intoxication in sheep	Seizures and other neurological signs in a cow	Alexander, Peterlyn MacDonald, Jennifer Freibergs, Margaret Mezei, Reece
28	Pyridostigmine bromide intoxication in cats	Crooked calf disease	Wood, Jaymi Eaton, Chloe Gray, Rachel Manly, Courtney
29	Buffo toad intoxication in a dog	Gradual weight loss, weakness and anorexia in a cow	Brown, Natasha Daroch, Ivan Villafranca, Kassandra Collette, Zachary
30	Chocolate intoxication in a dog	Acute pneumonia in a group of cattle	Bowling, Jessica Mikos, Amy Cerrato, Vanessa
31	Amanita phalloides intoxication in a dog	Abrupt onset of weakness and flaccid paralysis in a cow	Kvernmo, Melissa Gemmell, George Mari, Francesca Smith, Zachary
32	Pyridostigmine intoxication in a cat	Erythema, blisters, pruritus and swelling in a group of cows	Jones, Ana-Simone Sullivan, Aubrey Jacobs, Brianna Kennedy, Courtney

Table 5: Rubric for clinical toxicology assignment

In this assignment you need to picture yourself as an ER doctor that is presented with a patient with a toxicity. You forgot what you learned about this and have just a few minutes to look up how to treat this case.

We want you to answer the following questions in the assignment:

What does the toxin do to the body. Provide a general answer (kidney failure; cardiac arrhythmias), include all systems involved ordered in relevance and refrain from providing a lengthy discussion on the pathophysiology of this particular toxin.
Present the common clinical signs in order of importance/clinical relevance (report frequently observed signs first).
Shortly describe the typical lab findings in order of importance/relevance (report frequently observed lab findings first).
Is there a specific test for it? Differentiate between a stable-side test you can perform in practice and tests that require sample submission to a specialised laboratory.
Describe the treatment protocol and differentiate between general treatment (decontamination, cathartics etc.) and specific treatment.
What is the prognosis after exposure to this toxin? Differentiate between high doses and low doses when applicable/relevant.
Describe monitoring for that toxin (when the animal presents without clinical signs and for monitoring of treatment success).
Write a short layman’s summary for the owner, describing what is found, how the intoxication is treated and what the prognosis is. Tip: let your parents or your neighbour read the text; if they understand what you have written than you are okay!
Give a maximum of 3 references for the information you have presented. References can only include peer reviewed articles, should be relevant and the latest information on the subject. References only have to be mentioned at the end of the document and not throughout the text; the reference list should be in APA-7 Style (https://apastyle.apa.org/stylegrammar-guidelines/references/examples)
Provide a word count at the end of the document.
The total word count should be between 400 and 750 words. The title, authors and references are included in the total word count.
Required format: A4 page, style Arial 12pt with 1.2 lin

Recommended Study Strategies

This course will be assessed in a midterm examination, a comprehensive final examination, clinical intoxication presentations, peer evaluations and the assignment. It is essential to stay on top of the study material throughout the course. To be able to do so, it is advised to follow the following steps:

The basic toxicological principles are very similar to the pharmacological principles and hence a good understanding of basic pharmacology will be very helpful when studying this information.

Find common themes amongst the different toxins; a good first step is to look at the organs affected by different toxins. Compare and contrast the toxins and make your own charts with the different aspects of certain toxins.

Instructor's Expectations of the Student

Students are expected to familiarise themselves with the material before coming to class and actively participate in the discussions in class.

Professionalism Statement

Students attending St. George’s University are expected to conduct themselves with integrity, dignity, and courtesy, according to a code of conduct that de nes the interests, reputation, and stature of the University community. Learning experiences at St. George’s University are not only meant to develop strong aca- demic skills, but also to cultivate students with positive professional attributes, who are well adjusted to the norms of social graces and good social behaviour. The Code of Conduct includes student comportment and the honour code, as well as those actions that warrant disciplinary action. The University reserves the right to take any action that it sees t to protect the rights of the student body, as well as the reputation of the University.

Abuses of this Code, outlined in the student manual, will result in disciplinary action, which may include suspension or dismissal. It is the responsibility of all students to know the University Code of Conduct. It is required that all stu-dents abide by the terms of the University Code of Conduct.

Attendance/Participation Policy

Students are expected to be available during the standard 8-5am AST school day, to virtually attend, engage with online content, and participate in all classes and clinical rotations for which they have registered. Employment is not an excusable absence. Although attendance, engagement, and participation may not be re- corded at every academic activity, attendance, engagement, and participation is graded for mandatory sessions. Students’ lack of attendance, engagement, and participation may adversely affect their academic status as specified in the grading policy.

If failure to attend, engage, or participate in individual classes, examinations, and online activities, or from the University itself is anticipated, or occurs spontaneously due to illness or other extenuating circumstances, proper notification procedures must be followed.

Policy Regarding Missing Examinations and/or Failure of Submission of Assignments

Students who fail to attend an examination (Examsoft: SAQs and final examin- ation; Sakai: assignments) or submit an assignment by the deadline without a valid reason (see student manual: SGUSVM POLICY ON AN EXCUSED ABSENCE (EA) FOR STUDENTS) will receive a score of “0” points for the examination.

Students who have technical issues during the examination MUST inform the Course Director (awerners@sgu.edu) and IT (tellexaminationservic es@sgu.edu OR support@sgu.edu OR call 1-631-665-8500 ext. 4444 (US, NU, International) OR 1-473-439-2000 ext. 4444 (Grenada), AND Dean of Students (DOS@sgu.edu) during the open period for the examination. Failure to do so immediately will result in the student receiving the highest score recorded at the time, but NOT being eligible to take a completion examination.

Scheduling of examinations (regular, re-sit, completion, comprehensive, or ex- emption) is at the discretion of the University. Completion exams will be scheduled within 7 days of the original exam date. Re-sit examination will be scheduled in the first week of the following term.

ExamSoft Policy

All students are responsible for knowing and complying with the University’s Code of Conduct and the guidelines. Students must read and then sign the

Honour Code statement at the start of examinations to indicate that they will comply with the University Code of Conduct.

Prior to Exam Day

Each student is required to have a laptop for the purpose of taking computer-based examinations (e-Exams) at SGU. Students must ensure that their laptops meet the current minimum system requirements prior to exam day:
Examinees must use their MY SGU Member Center username and password to access the Custom Home Page (www.examsoft.com/sgu) created by ExamSoft for the University.
Examinees are responsible for downloading and registering the latest version of Examplify on their laptop prior to exam day. Once Examplify has been successfully downloaded, examinees are strongly encouraged to familiarise themselves with the software by downloading and taking practice exams.
Examinees are responsible for setting their laptop up for ExamMonitor prior to the exam (see links below).
Examinees will be notified via MyCourses, of all exam related information. Email notifications will also be sent from ExamSoft Support to examinees, notifying them of examinations available for downloading.
Examinees experiencing difficulties with their laptop are encouraged to visit the IT department for assistance prior to exam day. Examinees needing a laptop must visit the Office of Institutional Advancement (OIA) to request an exam loaner.
Examinees should visit the following information to familiarise themselves with the online proctored exam format and set up their baseline photo.
1. A Examsoft/ExamID quick guide for students (Please note that the current Examplify version is 2.3.8)
2. The examsoft student perspective video 30mins
3. The Examsoft/ExamID FAQ
4. Examsoft information page
5. The general Reminders/Guidelines

The materials (such as slides, handouts and audio/video recordings) provided to students who are taking courses at St. George’s University (SGU) are the intellectual property of the Faculty and/or Administration of SGU. Students are free to use these materials solely for the purpose of group or individual study. Reproduction in whole or in part is prohibited.