It's the problematic question for me of whether Secondary Natural Attacks are 'Off Hand' or 'Iterative'. They seem to blend elements of both. If the former Slam Attacks cannot be used, if the latter they can. If they just follow their own rules, then those should be spelled out. I suspect Wizards are having difficulty themselves, as with the Grappling discussion and how Natural Attacks operate.
I take the point, though. It would be stupid to allow a Lizard Man to make his Weapon Attack, drop his Weapon (Free Action), make two Claw Attacks and a Bite... or even make a Two Handed Weapon Attack followed by a Claw and a Bite, when a Fighter cannot make a Two Handed Weapon Attack followed by a Spiked Gauntlet Attack.
If the Slam Attack is not made with the Fist, though, things start to get blurry for me... especially when I have to draw the distinction between Front Feet and Rear Feet where multiple Feet are involved.
If you have the Trample feat, and you perform a
mounted overrun, your target cannot choose to avoid you,
and if you knock your opponent prone with the overrun,
your mount can make one hoof attack against your
opponent. Suppose you’re mounted on something other
than a horse. Should the mount get one attack with its
primary natural weapon (a hoof attack is the horse’s
primary attack), or does a creature without a hoof attack
get no free attack to attack against the trampled and prone
opponent?
The free attack for the mount in a trample represents the
mount literally knocking down the foe and stepping on him as
he falls underneath the mount’s churning feet. The feat
description specifies a hoof attack, but the kind of natural
weapon is not limited only to hoof attacks. Any attack that is
delivered with a foot, such as a claw or slam attack, also works.
If the quadruped mount has natural weaponry on all four feet,
use the weapon on the front feet. (For example, if your mount
is a big cat, use the claw attack for a trample, not the rake.)
Mounts that don’t attack with their feet don’t get the free
attack. For example, if your mount is a riding dog, it won’t get
a free attack from a trample; it can’t use its bite, and it has no
natural weaponry on its front feet.
I think they probably do follow the 'Off Hand' Rules for the most part, but there are places where they don't, such being unable to switch Attack Routines around (Ghouls, for instance, can't make their Claws their Primary Attack - I'm not even sure if they can attack with them before they Bite).
I think the War Forged could make an Off Hand attack with his Foot, but it looks like Slam Attacks are restricted to any above the first set of Feet...