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181. Headache

occur with frequent use of any symptomatic treatment of headaches, most commonly with acute treatment of episodic migraines or tension headaches. Typically occurs after using the following drugs for 3 months or more: Triptans, opioids, ergots alone or in combination for >10 days per month for >3 months Acetaminophen, aspirin, or NSAIDs, alone or in combination for >15 days per month for >3 months Suspect MOH if chronic headaches occur on more than 15 days per month and are worsened or not improved (...) appear equally effective in treating episodic tension headaches. Make choice based on side-effect profile and patient’s previous tolerability to a medication. Ibuprofen 200-400mg every 4-6 hours, max of 1.2g per day Aspirin 1300mg once (loading dose) or 650mg every 4-6 hours Acetaminophen 1300mg once (loading dose) or 650mg every 4-6 hours Naproxen 220mg every 12 hours Products with caffeine added may be more effective (weak, limited evidence) Codeine is NOT recommended for acute treatment of tension

2018 medSask

182. Management of Chronic Kidney Disease

when urinary protein excretion =0.5 g/day • The target HbA1c should be =7% in DKD but this should be individualised according to co-morbidities and age. • Statin should be offered to patients with CKD for primary and secondary prevention of cardiovascular events. • Aspirin should be used in patients with CKD for secondary prevention of cardiovascular disease (CVD). • Aspirin should not be used as primary prevention of CVD in CKD. • Combination of clopidogrel with aspirin should be avoided (...) -steroidal anti-inflammatory drugs (NSAIDs), aspirin and paracetamol usage and the development of CKD. 9 However, among the most common risk factors for acute decline in GFR for patients with established CKD is NSAIDs, including cyclooxygenase-2 inhibitors. 12 Use of proton pump inhibitors (PPI) has been shown to significantly increase the risk of developing CKD (RR/OR range of 1.10 to 1.50) 13 - 15, level II-2 and progression of CKD (HR between 1.26 to 1.32). 15 - 16, level II-2 The risk correlates

2018 Ministry of Health, Malaysia

184. Stable Coronary Artery Disease (2nd Edition)

. To ensure successful implementation of this CPG we suggest:  Continuous medical education and training of healthcare providers on diagnosis and management of Stable CAD. This can be done by road shows, electronic media, and in-house training sessions.  Performance measures that include: ? Percentage of patients with Stable CAD on optimal medical therapy with aspirin (or clopidogrel or ticlid if aspirin intolerance) and statin therapy? Applicability of the Guidelines and Resource Implications (...) that include: ? Percentage of patients with Stable CAD on optimal medical therapy with aspirin (or clopidogrel or ticlid if aspirin intolerance) and statin therapy? Applicability of the Guidelines and Resource Implications: This guideline was developed taking into consideration our local health resources. Almost all the investigations and most of the medications recommended are available in public hospitals or at the cardiac centres in Malaysia. This guideline aims to educate health care professionals

2018 Ministry of Health, Malaysia

185. Gastroesophageal Reflux Disease (GERD)

inhibitors should be given to control GERD symptoms. Single dose and more intensive treatment to eliminate esophageal acid exposure have not been proven to reduce cancer risk. Low-dose aspirin reduces cancer risk, but should be reserved for Barrett’s esophagus patients who have cardiovascular risk factors for which aspirin is indicated. Endoscopic and surgical therapies for Barrett’s esophagus are evolving. The use of radiofrequency ablation (RFA) or endoscopic mucosal resection (EMR) should be reserved

2018 University of Michigan Health System

186. Mechanical and Bioprosthetic Heart Valves: Anticoagulant Therapy

heparin (LMWH) until a therapeutic INR has been attained. Maintenance of a therapeutic INR is important to reduce the risk of thrombosis. [See Warfarin Guide and Warfarin: Management of Out-of-Range INR Guide]. Aspirin It is recommended that patients with a mechanical aortic or mitral valve who are at low risk of bleeding should receive ASA (81 mg daily) in addition to the warfarin therapy. Caution should be used in patients with an increased bleeding risk, especially with a history

2017 Thrombosis Interest Group of Canada

187. Atrial Fibrillation Full Text available with Trip Pro

or recurrent cardiac ischaemia or infarction, and stent thrombosis) should be undertaken for patients with AF who have a long-term requirement for anticoagulation for stroke prevention and require dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS) or stent implantation (or both). Low Strong Duration of triple therapy (aspirin, P2Y 12 inhibitor and OAC) should be as short as possible to minimise bleeding, while ensuring coverage of the initial period of high risk of stent thrombosis (...) and/or recurrent coronary ischaemia. Moderate Strong Where DAPT is required in combination with OAC, low-dose aspirin (100 mg) and clopidogrel (75 mg) are recommended. Ticagrelor and prasugrel are not recommended in this situation. Low Strong Where OAC is used for AF, discontinuation of antiplatelet therapy should be considered 12 months after stent implantation, ACS, or both, with continuation of OAC alone. Low Weak Anticoagulation in special situations—chronic kidney disease (CKD) The decision to use

2018 Cardiac Society of Australia and New Zealand

189. SMFM Statement Pharmacological treatment of gestational diabetes Full Text available with Trip Pro

diabetes. Cochrane Database Syst Rev . 2017 ; 11 : CD012037 | Metformin is an oral biguanide that primarily acts to decrease hepatic glucose production by inhibiting gluconeogenesis. It also increases glucose uptake in peripheral tissues and decreases glucose absorption in the gastrointestinal tract. x 14 Romero, R., Erez, O., Hüttemann, M. et al. Metformin, the aspirin of the 21st century: its role in gestational diabetes mellitus, prevention of preeclampsia and cancer, and the promotion of longevity (...) . et al. Metformin, the aspirin of the 21st century: its role in gestational diabetes mellitus, prevention of preeclampsia and cancer, and the promotion of longevity. Am J Obstet Gynecol . 2017 ; 217 : 282–302 | | | | | | 15 Gui, J., Liu, Q., and Feng, L. Metformin vs insulin in the management of gestational diabetes: a meta-analysis. PloS One . 2013 ; 8 : e64585 | | | | 16 Charles, B., Norris, R., Xiao, X., and Hague, W. Population pharmacokinetics of metformin in late pregnancy. Ther Drug Monit

2018 Society for Maternal-Fetal Medicine

193. Treatment of Chronic Radiation Proctitis

of 10% buffered formalin. A total of 100 patients underwent the treatment. Cessation of bleeding was noted in 93% of the patients following a mean of 3.5 applications at 2- to 4-week intervals. Patients with severe proctitis and those on aspirin therapy required on average 1.5 additional treatments. Re- current bleeding was noted in 8 patients, and all responded to additional formalin applications. 20 Luna-Pérez et al 21 re- ported their experience in 20 women with radiation proc- titis refractory

2018 American Society of Colon and Rectal Surgeons

194. Management of Hemorrhoids

of grade I hemorrhoids, with a recent trial evaluating the efficacy of polidocanol, a nonester local anesthetic approved for use by the US Food and Drug Administration, with 88% of patients treated successfully (12-week follow-up). 27 Al- though there are no randomized data to support the use of sclerotherapy in anticoagulated patients, a case-matched series of 37 patients receiving antiplatelet therapy, includ- ing aspirin, ticlopidine, clopidogrel, and cilostazol; antico- agulant therapy, including

2018 American Society of Colon and Rectal Surgeons

195. Management of menopausal symptoms in women with a history of breast cancer

specific PI with underlying conditions that might be compromised by increases in blood pressure. Caution is advised for patients with cardiovascular, cerebrovascular, or lipid metabolism disorders due to increases in blood pressure and heart rate. Risk of bleeding events associated with concomitantly using drugs that affect coagulation or bleeding (e.g. NSAIDs, aspirin) Care should be taken with elderly patients or patients taking diuretics who are a group at risk of hyponatraemia. Escitalopra m Major (...) mellitus. Not recommended for use during the first four months of pregnancy. Paroxetine Major depression Obsessive compulsive disorder Panic Monoamine oxidase inhibitors Should not be used in combination with Pimozide or Thioridazine The most commonly observed adverse events associated with use and not seen at an equivalent incidence among placebo treated patients: Nausea Medicines that interfere with haemostasis (NSAIDs, aspirin, warfarin etc.) Drugs affecting hepatic metabolism Clinical worsening

2017 Cancer Australia

196. Type 2 diabetes in adults: management

off patent on health-economic issues. In addition, new evidence and safety issues relating to the off-label use of antiplatelet therapy (aspirin and clopidogrel) in the primary prevention of cardiovascular disease motivated an update of this review. Medicines The guideline will assume that prescribers will use a medicine's summary of product characteristics to inform decisions made with individual patients. This guideline recommends some medicines for indications for which they do not have a UK (...) blood pressure target every 4–6 months. Check for possible adverse effects of antihypertensive drug treatment – including the risks from unnecessarily low blood pressure. [2009] [2009] 1.5 Antiplatelet therapy 1.5.1 Do not offer antiplatelet therapy (aspirin or clopidogrel) for adults with type 2 diabetes without cardiovascular disease. [new 2015] [new 2015] 1.5.2 For guidance on the primary and secondary prevention of cardiovascular disease in adults with type 2 diabetes, see the NICE guidelines

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

198. Melanoma: assessment and management

of vitamin D supplementation listed as active currently, 1 in Italy and 1 in Australia. However, there are many uncertainties about the design of vitamin D trials, which might become clearer in the next few years. These include the dose of vitamin D, use of concurrent aspirin therapy and the baseline level at which vitamin D supplementation would be started. 2.5 The effect of drug therapy for concurrent conditions on melanoma survival In people diagnosed with melanoma what is the effect of drug therapy

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

199. Hereditary Gastrointestinal Cancers: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

in the incidence of CRC- and other LS-associated tumours among those individuals treated with 600 mg daily aspirin taken for at least 2 years versus placebo [31]. Aspirin may be considered as a cancer prevention measure in individuals with LS, although the optimal dose has still not been determined and is the objective of the ongoing CAPP3 study that compares daily aspirin at 600 mg, 300 mg and 100 mg [I, C]. Environmental and lifestyle factors Smoking and obesity increase the risk of adenomas and CRC in LS (...) for familial pancreatic cancer. Gut 2013; 62: 339-347. 29. Schmeler KM, Lynch HT, Chen LM et al. Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome. N Engl J Med 2006; 354: 261-269. 30. Myrhoj T, Andersen MB, Bernstein I. Screening for urinary tract cancer with urine cytology in Lynch syndrome and familial colorectal cancer. Fam Cancer 2008; 7: 303- 307. 31. Burn J, Gerdes AM, Macrae F et al. Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal

2019 European Society for Medical Oncology

200. Policy on Acute Pediatric Dental Pain Management

be administered on a regular schedule during the first 36 to 48 hours to create stable plasma levels of analgesics and decrease the chance of breakthrough pain. 11,12 Treatment of postoperative pain may include opioid anal- gesics and non-opioid analgesics. Since most cases of postoper- ative pain include an inflammatory component, nonsteroidal anti-inflammatory agents ( NSAIDs) are considered first line agents in the treatment of acute mild to moderate postoper- ative pain. 11 Aspirin-containing analgesics

2017 American Academy of Pediatric Dentistry


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