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Chapter 3 Clinical and Environmental Toxicity is a compilation of Chapter 4, Drug Toxicity and Poisoning and Chapter 67 Environmental Toxicology: Carcinogens and Heavy Metals from Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12th Edition. The specific pharmacology (including the mechanisms of action) of drugs mentioned in Chapter 3 is discussed in previous or subsequent chapters. The Mechanisms of Action and the Clinical Summary Tables are limited to the commonly used antidotes, toxic metals, and the metal chelators that are used therapeutically to treat heavy metal poisoning. In addition to the material presented here, the 12th Edition includes:

  • A detailed description of drug toxicity testing in animals

  • A detailed description of drug safety testing and clinical trials in humans

  • A list of important resources for information related to drug toxicity and poisoning

  • A description of various methods of decontaminating a poisoned patient

  • A discussion of environmental risk assessment and risk management

  • A detailed discussion of carcinogenesis and chemoprevention

  • A discussion of the principles of the treatment of metal exposure


  • Understand the dose-response relationship of drugs and how it is used to quantify efficacy and toxicity.

  • Understand how drugs are tested for safety and efficacy in humans.

  • Know the different types of therapeutic drug toxicity.

  • Describe the different types of drug-drug interactions and know how they apply to drug therapy.

  • Know the principles of managing a drug poisoning including the safe use of specific antidotes.

  • Know the toxicity of acute and chronic heavy metal exposure.

  • Understand the mechanisms of action and therapeutic uses of metal chelators for the treatment of acute metal exposure.


  • Acetylcysteine (MUCOMYST)

  • Aflatoxin B1

  • Arsenic

  • Atropine

  • Benzo[a]pyrene

  • Cadmium

  • Chromium

  • Deferasirox (EXJADE)

  • Deferoxamine (DESFERAL)

  • Dimercaprol

  • Dimercaptosuccinic acid (DMSA), succimer (CHEMET)

  • Diphenhydramine (BENEDRYL)

  • EDTA CaNa2

  • Ethanol

  • Flumazenil

  • Fomepizole

  • Lead

  • Mercury

  • Naloxone (NARCAN)

  • Penicillamine

  • Physostigmine

  • Pralidoxime chloride (2-PAM)

  • Sodium 2,3-dimercaptopropane sulfonate (DMPS)—not approved by FDA, but approved for use in Germany

aA complete list of antidotes is shown in Table 3-1; bexamples of important carcinogens are shown in Table 3-2; ca list of toxic metals with frequent environmental or occupational exposure is shown in Table 3-3.

Table 3-1Some Common Antidotes and Their Indications

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