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142. Palliative Care for the Patient with Incurable Cancer or Advanced Disease: Part 1: Approach to Care

Health Care Office or Palliative Care Team for information. Medications that may be given by the subcutaneous (SC) route in the primary setting 2 (maximum volume per SC injection site = 2 ml) • Atropine (0.6 mg/mL) • Calcitonin • Chlorpromazine (25 mg/mL) • Clodronate (30, 60 mg/mL) • Dexamethasone (4 mg/mL) • Dimenhydrinate (Gravol® 50 mg/mL)* • Diphenhydramine (Benadryl® 50 mg/mL) • Epinephrine • Fentanyl (50 mcg/mL) • Furosemide (10 mg/mL – note max. 20 mg.SC/site) • Glycopyrrolate (0.2 mg/mL

2017 Clinical Practice Guidelines and Protocols in British Columbia

144. Minimal change disease and focal segmental glomerulosclerosis in adults: rituximab

have been reported in more than 50% of participants in clinical trials across rituximab's licensed indications, with 12% of participants experiencing severe reactions (SPC for rituximab). Severe infusion-related reactions with a fatal outcome have been reported in post-marketing use. Premedication with an anti-pyretic and an antihistamine (for example, paracetamol and diphenhydramine) should always be given before administration of intravenous rituximab. In addition, premedication

2016 National Institute for Health and Clinical Excellence - Advice

145. Autoimmune haemolytic anaemia: rituximab

, reported in 12% to more than 50% of participants in clinical trials across rituximab's licensed indications. Severe infusion-related reactions with a fatal outcome have been reported in post-marketing use. Premedication with an anti-pyretic and an antihistamine (for example, paracetamol and diphenhydramine) should always be given before administration of intravenous rituximab. In addition, premedication with a glucocorticoid should be given (except in people with non-Hodgkin's lymphoma or chronic

2015 National Institute for Health and Clinical Excellence - Advice

146. Topical itch therapy and allergy skin testing

was noted on the nonexposed arm, indicating that systemic absorption is likely responsible for the effect. These data are based upon testing of 5 normal individuals. I could not find any reports of the duration of diphenhydramine topical applications, but it would be much shorter in light of the relatively short half-life of diphenhydramine. A topical anesthetic, EMLA™, can be used for itch and should not affect the histamine cutaneous response. Finally, prolonged topical application of corticosteroid (...) creams or ointments may affect allergy testing due to depletion of cutaneous mast cells (4,5,6). In summary, discontinuation of short-lived antihistamine creams such as diphenhydramine should be stopped 24 hours before testing, long acting H1 inhibitor creams such as doxepin should be discontinued for 11-14 days, topical anesthetics for itch could probably be used up to 8-12 hours before testing and prolonged topical corticosteroid may have a prolonged effect based upon duration and potency

2020 Publication 4891070

147. Opioid reaction

by a significant wheal but no flare. Naloxone attentuated cutaneous wheal and flare responses to fentanyl and the flare response to morphine. Intradermal antihistamines (diphenhydramine and cimetidine) produced significant wheal and flare responses. Electron micrographs of biopsies from fentanyl-induced wheals demonstrated normalmast cell architecture with no evidence of mast cell degranulation. Opioid effects on wheal and flare responses and mast cell degranulation appear independent of opioid analgesic

2020 Publication 4891070

148. Fluorescence dye allergy

to reduce the likelihood of an irritation response. I would also consider 1:100 and 1:10 v/v dilutions and perform intradermal testing. If all of the testing is negative, then I would suggest pretreating the patient similar to individuals with a history of radiocontrast sensitivity, i.e. oral prednisone 50 mg 13, 7 and 1 hour before the procedure and H1 inhibitor diphenhydramine 50 mg 1 hour before the procedure. The accuracy of skin testing or value of pretreatment for fluorescence dye reaction

2020 Publication 4891070

149. Antihistamines and skin testing

recommendation for a patient (number of days) to avoid antihistamines before their skin testing and challenges? A: Generally, one week for 2nd and 3rd generation antihistamine (cetirizine, loratadine, fexofenadine and levocetirizine and desloratadine). 48 hours is usually adequate for 1st generation (diphenhydramine and chlorpheniramine). One recent study demonstrated that the wheal and flare responses returned to greater than 90% baseline within 4 days of not taking cetirizine. (1) 1) Shtessel M, Tversky J

2020 Publication 4891070

150. Guidelines on the Prevention of Postoperative Vomiting in Children

anti-emetic effect with cyclizine and furthermore there was significant pain on injection 85 . 1+ UC There is currently no evidence to support the use of cyclizine for POV in children either for prophylaxis or for treatment. Cyclizine is not recommended for reducing POV in children. Dimenhydrinate Dimenhydrinate is the theoclate salt of diphenhydramine. Dimenhydrinate is available in Canada, the US and Australia both over-the counter and by prescription. It is not available in the UK. It can (...) be given orally, intravenously and as a suppository. It was synthesized with the intention of antagonizing the moderately sedative effects of diphenhydramine with the mildly stimulant effects of theophylline. However sedation and dry mouth and other anti-muscarinic side effects do occur. Serious adverse reactions appear to be rare although it is a weakness of both published RCTs and meta-analyses that there is little documentation of side effects. Two systematic reviews report on dimenhydrinate 43, 90

2017 Association of Paediatric Anaesthetists of Great Britain and Ireland

151. Oral Aphthous Ulcer - Guidelines for Prescribing Triamcinolone Dental Paste

and should be used only up to 4 times a day. Combination products which contain local anaesthetics in a vehicle that forms a protective coating over sore. Examples: Orabase with benzocaine®, Kanka®, Zilactin-B ® – also caution about sensitivity reactions and maximum frequency of application four times a day. Supplementing with vitamin B12, ( level 2 [mid-level] evidence ), vitamin B6, folic acid and/or zinc might be associated with symptom improvement. Milk of magnesia and diphenhydramine allergy liquid

2017 medSask

153. Management of Insomnia Disorder in Adults: Current State of the Evidence

improve sleep onset latency (???) Antidepressants Doxepin (???) May improve some outcomes (???) May improve (???) Improves total sleep time (???) May improve other outcomes (???) Others c (???) (???) (???) (???) Benzodiazepines T emazepam (???) (???) (???) (???) Others d (???) (???) (???) (???) Over-the-Counter Sleep Medications and Supplements Diphenhydramine, doxylamine, melatonin (???) (???) (???) (???) ER = extended release a Sleep outcomes include sleep onset latency, total sleep time, time awake

2017 Effective Health Care Program (AHRQ)

154. CrackCAST E129 – Bacteria

cause delirium with alterations in mental status. Organophosphate insecticides cause hyperthermia and altered mental status. Dystonic reactions are self-limited and respond to diphenhydramine or benztropine. Neuromuscular blockade from the administration of aminoglycosides is distinguished by medication history. Heavy metal poisoning produces changes in mental status. Magnesium toxicity may mimic botulism, but the history and serum magnesium levels distinguish these entities. In paralytic shellfish

2017 CandiEM

155. CRACKCast E120 – Dermatologic presentations

or vesicles should be treated with cool wet compresses of Domeboro or Burow’s solutions (aluminum acetate). Topical baths, available over the counter, may also be comforting. Systemic antihistamines, such as hydroxyzine and diphenhydramine, may help control pruritus; nonsedating antihistamines are preferred for use during the day. If present, secondary bacterial infection must also be treated. Know your ddx: Cutaneous candidiasis Contact dermatitis Atopic dermatitis Tinea cruris Intertrigo HSV

2017 CandiEM

156. One Emergency Medicine Resident. One Month of Palliative Care. Ten lessons.

treatment options in home or long-term care environments where indwelling intravenous catheters are both annoying and dangerous. The solution? Subcutaneous injection. 3 Many medications can be given this route: haloperidol, metoclopramide, ondansetron, diphenhydramine, morphine, lorazepam and dexamethasone to name but a few. Remember this route as a useful option to facilitate PO intake (and potentially later intravenous placement), patient safety, and symptom relief. 7) Be smart with pain and opioid

2017 CandiEM

157. CRACKCast E119 – Allergy, Hypersensitivity, Angioedema, and Anaphylaxis

, but it is believed to be non-immunologic (non-IgE). Clinically, the risk for severe adverse reaction with ionic and nonionic contrast materials is less than 1%. Standard Treatment Protocol for Patients with Hx of RCI Anaphylaxis Prednisone 50 mg by mouth given 13 hours, 7 hours, and 1 hour before the procedure Consider an H2 antagonist, such as ranitidine 150 mg by mouth given 3 hours before the procedure Diphenhydramine 50 mg PO given 1 hour before the procedure Consider ephedrine 25 mg by mouth given 1 hour (...) Second-line Agents Antihistamines Diphenhydramine: Adults: 50 mg IV or 50 mg oral Pediatric: 1 mg/kg IV or oral Ranitidine: Adult: 50 mg IV (150 mg oral) Pediatric: 1 mg/kg IV or oral Aerosolized Beta-agonists (if bronchospastic) Combivent (albuterol and ipratropium) Glucocorticoids (No Benefit in the Acute Management) Methylprednisolone: Adult: 125 to 250 mg IV Pediatric: 1 to 2 mg/kg IV Prednisone/prednisolone: Adult: 40 to 60 mg oral Pediatrics: 1 to 2 mg/kg oral Observation and Disposition

2017 CandiEM

159. Delirium in Adult Cancer Patients: ESMO Clinical Practice Guidelines

anticholinergic activity, e.g. tricyclic antidepressants, diphenhydramine, promethazine, trihexyphenidyl, hyoscine butylbromide Other psychoactive: antipsychotics, antidepressants, levodopa, lithium Anti-infectives: cipro?oxacin, acyclovir, ganciclovir Histamine H2 blockers Omeprazole Immunomodulators: interferon, interleukins, ciclosporin Medication polypharmacy Otherstatusorpredisposingcomorbidities[5,39] Age> 70 years Pre-existing cognitive impairment, e.g. dementia History of delirium Hearing impairment

2018 European Society for Medical Oncology

160. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline

insomnia (versus no treatment) in adults. (WEAK) We suggest that clinicians not use trazodone as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults. (WEAK) We suggest that clinicians not use tiagabine as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults. (WEAK) We suggest that clinicians not use diphenhydramine as a treatment for sleep onset and sleep maintenance insomnia (versus no treatment) in adults. (WEAK) We suggest

2017 American Academy of Sleep Medicine

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