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Alcohol Tremor

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161. Trimbow (beclometasone / formoterol / glycopyrronium bromide) - chronic obstructive pulmonary disease (COPD)

with simultaneous cyclopentyl ring elimination. BDP is rapidly hydrolysed to its main active metabolite B17MP and to B21MP that are subsequently transformed into the pharmacologically inactive alcohol derivatives (BOH). Assessment report Trimbow Page 38/90 FF metabolism involves O-glucuronidation, with the phenolic glucuronide as primary metabolite in rats, dogs and humans. In vitro studies suggest that GB has low potential for drug-drug interactions at clinically relevant concentrations. Toxicology The safety

2017 European Medicines Agency - EPARs

162. Miglustat Gen.Orph - Gaucher Disease

significant (NCS) for all subjects prior to study entry. Check-in tests for urine cotinine, breath alcohol, urine drugs of abuse, and urine hCG (females only) were conducted and all results were negative or within range. Clinical laboratory tests for haematology, biochemistry, and urinalysis were again conducted at the end of the study. All the post-study clinical laboratory tests results, including those of the repeats, were either within normal range or were deemed by a study investigator to be NCS (...) Zavesca 100 mg hard capsules, Actelion. Approval of Miglustat Gen.Orph can be supported from a clinical point of view. 2.5. Risk management plan Safety concerns Important Identified Risks • Diarrhoea and other gastrointestinal ADR’s • Nervous system effects/events such as: Tremor Peripheral neuropathy (numbness, tingling) • Weight loss • Reductions in platelet counts. Important Potential Risks • Adverse effect on spermatogenesis parameters and reducing fertility. • Reproductive toxicity including

2017 European Medicines Agency - EPARs

163. Cannabis

, their use is almost three times higher than that of adults. ? The rate of daily cannabis use among the Canadian general population remains steady. Effects of Cannabis Use Short-term: Cannabis produces euphoria and relaxation, changes in perception, time distortion and deficits in attention span. It also negatively impacts the ability to divide attention and results in deficits in memory, body tremors and impaired motor functioning. Cannabis also impairs coordination and balance. Other physical effects (...) and municipal levels. 10 Driving while impaired by a drug, including cannabis, is an offence under the Criminal Code of Canada. Drivers who are impaired by drugs are subject to the same penalties as those impaired by alcohol. The government tabled Bill C-46 in April 2017 to strengthen the enforcement of impaired driving laws and also plans to enact this legislation in conjunction with the Cannabis Control Act. Currently, Canadians can legally access cannabis for medical purposes. Under the Marihuana

2018 Canadian Centre on Substance Abuse

164. Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee

management, nutrition, pain control, protease inhibitors, surgery (JPGN 2018;66: 159–176) A cute pancreatitis (AP) has been increasingly diagnosed in children in recent decades (1–3). A variety of etiologies can result in AP in children, including structural/anatomic, obstructive/ biliary, trauma, infections, toxins, metabolic, systemic illness, inborn errors of metabolism, and genetic predispositions. These are a more prevalent compared with adult AP, when biliary and alcoholic causes are well (...) , and tremors (105). A review of narcotics and sphincter of Oddi function by Thompson (106), documents that no studies to date directly compare the effects of meperidine and morphine on sphincter of Oddi manometry and no comparative studies exist in patients with AP. Furthermore, no studies or evidence exist to indicate morphine is contraindicated for use in AP. A Cochrane review from 2013 includes 5 studies with a total of 227 subjects to assess the efficacy and safety of several opioids. Medications

2018 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

165. Appropriate Use Criteria: Imaging of the Head & Neck

movement disorders, to exclude an underlying structural lesion ? Hemifacial spasm ? Huntington’s disease ? Multiple system atrophy (MSA) ? Parkinson’s disease with atypical features ? Progressive supranuclear palsy ? Secondary dystonia ? Other focal or lateralizing movement disorder, such as hemiballismus, athetosis or chorea Note: Imaging is generally not indicated for evaluation of typical Parkinson’s disease, essential tremor or primary dystonia. Multiple sclerosis and other white-matter diseases (...) | Copyright © 2018. AIM Specialty Health. All Rights Reserved. 15 headache. Cephalalgia. 2007;27(8):904-911. 65. Secretariat. MA. Neuroimaging for the Evaluation of Chronic Headaches: An Evidence-Based Analysis. Ont Health Technol Assess Ser. 2010; 10(26): 1–57. 66. Sharifi S, Nederveen AJ, Booij J et al. Neuroimaging essentials in essential tremor: a systematic review. Neuroimage Clin. 2014 May 9;5:217-31. 67. Silvestri GA, Gould MK, Margolis ML, et al. Noninvasive staging of non-small cell lung cancer

2018 AIM Specialty Health

166. Hoarseness (Dysphonia) Full Text available with Trip Pro

. In this group, failure to evaluate the larynx can delay cancer diagnosis, resulting in higher staging, need for more aggressive treatment, and reduced survival rates. Other conditions that cause dysphonia are neurologic (eg, vocal fold paralysis, spasmodic dysphonia [SD], essential tremor, Parkinson’s disease, amyotrophic lateral sclerosis, multiple sclerosis), gastrointestinal (eg, reflux, eosinophilic esophagitis), rheumatologic/autoimmune (eg, rheumatic arthritis, Sjögren’s syndrome, sarcoidosis (...) , habits (eg, smoking, alcohol use), concurrent medical conditions, and prior surgery ( and ). Careful evaluation allows the clinician to (1) categorize dysphonia severity, (2) develop a treatment plan, and (3) prioritize patients who may need escalated care. , Physical examination should include a full head and neck examination with particular attention to listening to the voice (perceptual evaluation), inspection and palpation of the neck for masses or lesions, and, if feasible, indirect mirror

2018 American Academy of Otolaryngology - Head and Neck Surgery

167. CRACKCast E147 – General Approach to the Poisoned Patient

of the parasympathetic system. Muscarinic effects: Diarrhea, diaphoresis Urination Miosis Bradycardia Bronchorrhea Emesis Lacrimation Lethargic Salivation Nicotinic effects: Mydriasis Tachycardia Weakness Tremors Fasciculations Seizures Somnolent Organophosphate and carbamate insecticides, nerve agents, nicotine, pilocarpine, physostigmine, edrophonium, bethanechol, urecholine, Liquids from e-cigarettes (muscarinic effects are less prominent) Antidotes: Atropine 2-pam aka Pralidoxime (2-pyridine aldoxime methyl (...) chloride) Benzos Supportive Sedative/hypnotic Sedation Vs. Hallucinogenic Depression of brain activity and muscular metabolism Altered mental status Pupils not changed clinically Benzodiazepines, barbiturates, carisoprodol, meprobamate, glutethimide, alcohols, zolpidem ( USA) Supportive Rule out traumatic injuries Opiate Sedation, diminished respiratory drive – responsive to naloxone Miosis, hypothermia, respiratory depression, apnea, Bradycardia, hyporeflexia, pulmonary edema Opioids (eg, heroin

2018 CandiEM

168. CRACKCast E151 – Antidepressants

criteria for Serotonin Syndrome? Hunter criteria Exposure to a known serotonergic agent; AND Any of the following: Spontaneous clonus Inducible clonus and agitation or Diaphoresis Ocular clonus and agitation or Diaphoresis Tremor and hyperreflexia Hypertonic w/ Temp > 38 o C and ocular clonus or inducible clonus “The descending ladder of hyper-reflexia” As the hyper-reflexia gets less and less impressive, the additional criteria become more pronounced [5] How can you discern between NMS and Serotonin (...) Syndrome? Both look the same = FARM Fever Autonomic instability Rigidity / rhabdo Mental status changes However, the major differentiating features: NMS = parkinsonian type lead pipe rigidity; slower onset; similar presentation to the unwell septic patient SS = spastic rigidity – agitation / tremor / CLONUS / increased motor activity; rapid onset Onset: SS relatively rapid within hours NMS over days potentially Course: NMS may wax and wane. SS peaks then declines Obviously hyper-reflexia is the most

2018 CandiEM

169. CRACKCast E165 – Sedative Hypnotics

blocker. Endotracheal intubation to protect against emesis, aspiration pneumonitis, and hypoxia is often necessary for patients with significant CNS or respiratory depression from GHB overdose. Withdrawal from GHB or its precursors begins with anxiety, tremor, and insomnia, but it can progress to a severe syndrome characterized by delirium and autonomic instability. Management of this syndrome often requires high-dose benzodiazepine or barbiturate therapy (because they are GABA depleted). Rosens (...) for noncardiogenic pulmonary edema & aspiration pneumonitis ***Note: Barbiturate withdrawal syndrome includes: Tremors Hallucinations Seizures delirium (similar to the delirium tremens of ethanol withdrawal) [5] How are barbiturate overdoses managed? Investigations / Supportive care / Invasive ventilation as needed Labs: The therapeutic level of phenobarbital is 15 to 40 μg/mL (65 to 172 μmol/L) A serum level greater than 50 μg/mL can be associated with coma, especially in a patient who is not a chronic user

2018 CandiEM

171. Improving Quality of Life: Substance Use and Aging

. Eglit and Dilip V. Jeste Epidemiology of Psychoactive Substance Use Among Older Adults Scott B. Patten The Aging Brain and Substance Use Tarek Rajji and Simon Davies Consequences of Alcohol and Drug Use in Older Adults Jonathan Bertram and David K. Conn Considerations for Co-occurring Health Conditions Karolina Kozak and Tony George Detection, Screening and Assessment David K. Conn Substance Use Treatment for Older Adults Frederic C. Blow A Call to Action Franco J. Vaccarino, Elysia Vaccarino (...) use, as we do in this report, is key to developing new and more tailored strategies for reducing the harms of alcohol and drugs on older adults. Since 2005, the series now known as Substance Use in Canada has highlighted alcohol- and drug-related issues that are in need of greater attention. For this seventh edition, we began with two questions: How can we help people age in a healthy way? and How can we ensure they have the supports they need to sustain a good quality of life in their later years

2018 Canadian Centre on Substance Abuse

172. Baricitinib (Olumiant) - rheumatoid arthritis

core are: microcrystalline cellulose, croscarmellose sodium, magnesium stearate and mannitol. Ingredients of the film-coating are: iron oxide red (E172), lecithin (soya) (E322), macrogol, polyvinyl alcohol, talc and titanium dioxide (E171). The product is available in polyvinylchloride/polyethylene/polychlorotrifluoroethylene - aluminium blisters and polyvinylchloride/aluminium/oriented polyamide - aluminium perforated unit dose blisters as described in section 6.5 of the SmPC. 2.2.2. Active

2017 European Medicines Agency - EPARs

174. Nausea/vomiting in pregnancy: Prochlorperazine

symptoms These depend on the dose and the susceptibility of the individual person: Parkinsonian symptoms (including tremor) may occur more commonly in adults or the elderly and may appear gradually. Dystonia (abnormal face and body movements) and dyskinesia are more common in young people and can occur after only a few doses. Akathisia (restlessness) characteristically occurs after large initial doses. Tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw) usually develops (...) . Neonates, if exposed to prochlorperazine in the third trimester of pregnancy, may experience extrapyramidal and/or withdrawal symptoms. Reported effects include agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding difficulties. [ ; ] What are the contraindications and cautions when prescribing prochlorperazine? Do not prescribe prochlorperazine to: People with: Phaeochromocytoma. Liver or renal dysfunction. History of jaundice. Parkinson's disease. Hypothyroidism

2018 NICE Clinical Knowledge Summaries

175. Nausea/vomiting in pregnancy: Cyclizine

with high doses or in the elderly. Other adverse effects include: Blood and lymphatic system disorders — agranulocytosis, leucopenia, haemolytic anaemia, and thrombocytopenia. Immune system disorders — hypersensitivity reactions, including anaphylaxis. Psychiatric disorders — disorientation, restlessness, nervousness, euphoria, insomnia, and auditory and visual hallucinations. Nervous system disorders — somnolence, headache, dystonia, dyskinesia, extrapyramidal motor disturbances, tremor, convulsions (...) . Prescribe cyclizine with caution to people with: Prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Hepatic disease. Epilepsy. Severe heart failure or acute myocardial infarction — cyclizine may cause a fall in cardiac output associated with increases in heart rate, mean arterial pressure, and pulmonary wedge pressure. Porphyria. [ ; ] What drug interactions occur with cyclizine? Alcohol — the anti-emetic effect of cyclizine may increase

2018 NICE Clinical Knowledge Summaries

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

. Caution should be taken for patients with conditions such as congenital Management of menopausal symptoms in women with a history of breast cancer page 79 of 181Generic name (brand names) Indications Contraindications Common side effects (occurring in =1% of patients) Drug interactions Precautions / Comments Headache Insomnia Somnolence Tremor *for side effects occurring in between 1% and 10% of patients please see specific PI efficacy long QT syndrome; acquired long QT syndrome; a family history (...) symptoms in women with a history of breast cancer page 80 of 181Generic name (brand names) Indications Contraindications Common side effects (occurring in =1% of patients) Drug interactions Precautions / Comments Gabapentin Epilepsy Neuropathic pain Hypersensitivity to gabapentin Side effects occurring in >5% of participants* Fatigue Nausea Vomiting Somnolence Dizziness Ataxia Nystagmus Headache Tremor Diplopia Asthenia Cimetidine Antacids may reduce gabapentin bioavailability Antiepileptic drugs

2017 Cancer Australia

177. Hypersexuality: fluoxetine

[n=25], fluoxetine [n=17] or fluvoxamine [n=16]) at a sexual behaviours clinic in Canada between 1991 and 1995. Seventy-nine percent of the participants were also receiving some receiving some form of psychosocial intervention. It was reported that 31% of participants had a personality disorder, 28% had depression, 17% had alcohol dependence and 16% had adjustment disorders. Outcomes measured included severity of illness and global improvement (using a 7-point Clinical Global Impression Scale (...) in 10 or more) adverse reactions: fatigue, nausea, diarrhoea, headache and insomnia. Common (between 1 in 10 and 1 in 100) adverse reactions are reported to include: decreased appetite and weight loss, anxiety, nervousness, restlessness, sleep disorders and abnormal dreams, disturbances in attention, dizziness, lethargy, tremor, blurred vision, palpitations, vomiting, dry mouth, dyspepsia, flushing, rash and urticaria, arthralgia, frequent urination and chills. Fluoxetine is contra-indicated

2015 National Institute for Health and Clinical Excellence - Advice

178. Clearing the Smoke on Cannabis: Cannabis Use and Driving ? An Update

Clearing the Smoke on Cannabis: Cannabis Use and Driving ? An Update Key Points • Among young drivers, driving after using cannabis is more prevalent than driving after drinking. • Cannabis impairs the cognitive and motor abilities necessary to operate a motor vehicle and doubles the risk of crash involvement. • After alcohol, cannabis is the most commonly detected substance among drivers who die in traffic crashes. • The police have the tools and authority required to detect and arrest drivers (...) who are impaired by cannabis. Background After alcohol, cannabis, also referred to as marijuana, is the most widely used psychoactive substance in Canada. According to the 2015 Canadian Tobacco, Alcohol and Drugs Survey (CTADS), 12.3% of Canadians aged 15 years and older reported using cannabis at least once in the past year (Statistics Canada, 2016), significantly higher than the 10.6 in 2013. The use of cannabis is generally more prevalent among youth, with 20.6% of youth aged 15 to 19 and 29.7

2017 Canadian Centre on Substance Abuse

179. Complex regional pain syndrome in adults. UK guidelines for diagnosis, referral and management in primary and secondary care 2018 (2nd edition)

as a symptom ? 2 ‘Vasomotor’ Temperature asymmetry and/or skin colour changes and/or skin colour asymmetry If you notice temperature asymmetry: must be >1°C ? ? 3 ‘Sudomotor/oedema’ Oedema and/or sweating changes and/or sweating asymmetry ? ? 4 ‘Motor/trophic’ Decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair/nail/skin) ? ? † A third diagnostic subtype called CRPS-NOS (not otherwise specified) can be considered for patients who have abnormalities (...) tissue, joint or skin) ? orthopaedic mal-fixation ? joint instability ? arthritis or arthrosis ? bone or soft tissue injury (including stress fracture, instability or ligament damage) ? compartment syndrome ? neural injury (peripheral nerve damage, including compression or entrapment, or central nervous system or spinal lesions), or neuropathy (such as from diabetes, alcohol misuse) ? thoracic outlet syndrome (due to nerve or vascular compression) ? arterial insufficiency (usually after preceding

2018 British Society of Rehabilitation Medicine

180. Parkinson's disease in adults.

inform the Driver and Vehicle Licensing Agency (DVLA) and their car insurer of their condition when PD is diagnosed. [2006] Diagnosing Parkinson's Disease Definition and Differential Diagnosis Suspect Parkinson's disease people presenting with tremor, stiffness, slowness, balance problems and/or gait disorders. [2006] If Parkinson's disease is suspected, refer people quickly and untreated to a specialist with expertise in the differential diagnosis of this condition. [2006, amended 2017] Clinical (...) with Parkinson's disease should be seen at regular intervals of 6 to 12 months to review their diagnosis.) [2006] Single Photon Emission Computed Tomography (SPECT) Consider 123 I-FP-CIT [(N-omega-fluoropropyl-2beta-carboxymethoxy-3beta-(4-iodophenyl)tropane)] SPECT for people with tremor if essential tremor cannot be clinically differentiated from parkinsonism. [2006, amended 2017] 123 I-FP-CIT SPECT should be available to specialists with expertise in its use and interpretation. [2006] Positron Emission

2017 National Guideline Clearinghouse (partial archive)

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