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142. 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

143. 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

145. 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

146. 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

147. 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)

148. Pharmacology and Substance Use

, morphine, etc.), sedatives and medications for anxiety and sleep (e.g., lorazepam, diazepam, diphenhydramine, etc.). Depressants have this slowing effect because they affect certain neurotransmitters that act as the brakes in the brain. ? Stimulants increase brain activity, especially in areas that are part of the reward system (see Figure 1). Because of this activity, stimulants lead to pleasurable and rewarding effects. They include drugs such as cocaine, methamphetamine, methylphenidate

2017 Canadian Centre on Substance Abuse

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. CRACKCast E070 – Oral Medicine

causes of oral ulcerations: Hand-foot-mouth / Herpetic stomatitis/ HIV / Syphilis / TB / Wegner’s / Scleroderma / Lupus / to name a few Symptomatic care Saline and Hydrogen peroxide rinses Mix of Benzocaine and diphenhydramine gel Rx for steroid – antibiotic ointments (Kenalog or orabase) F/U with GP to ensure resolution WiseCracks Case 1: Spot Diagnosis! 32yo male with obvious right sided deep space neck infection and chest pain, SOB and severe septic shock. Remember: Deep fascial layers of neck

2017 CandiEM

152. CRACKCast E029 – Nausea and Vomiting

hyperaldosteronism 2) List commonly used antiemetics including their dose and their receptor site of action. Treatment pathophysiology: Because the CTZ is stimulated by dopamine & other neurotransmitters, most of the drugs to relieve N/V are: Dopamine D2 antagonists (metoclopramide / Maxeran) Serotonin receptor antagonists ( ondansetron / Zofran) Cholinergic & histamine receptors antagonists are in the lateral vestibular nucleus (diphenhydramine, scopolamine, dimenhydrinate) Cannabinoid receptors also inhibit (...) Prochlorperazine, haloperidol, promethazine s/e: dystonic reactions (4%), sedation, restlessness (16%) Treated: with diphenhydramine or benztropine Metoclopramide (prokinetic agent – increased gastric emptying) Has mild anticholinergic and antiserotonin effects Useful in GERD, gastroparesis s/e: tardive dyskinesia, drowsiness, diarrhea, Serotonin antagonists Ondansetron – s/e headaches and constipation/diarrhea Benzodiazepines: No literature to support their routine use for non-specific N/V in the ED Non-pharm

2017 CandiEM

153. Oral versus Intravenous Administration of Pre-Chemotherapy Symptom Control Medications: Safety and Guidelines

administration of one medication for chemotherapy symptom control; one evidence-based guideline was identified regarding administration of pre-chemotherapy symptom control medications. Tags antineoplastic agents, chemotherapy, dexamethasone, dexasone, diphenhydramine, diphenylhydramine, metoclopramide, ondansetron, ranitidine, reglan, zantac, zofran, chemo-therapy, pre-chemo, pre-chemotherapy, prechemo, prechemotherapy Files Rapid Response Summary of Abstracts Published : March 11, 2016 Follow us: © 2019

2016 Canadian Agency for Drugs and Technologies in Health - Rapid Review

155. 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

157. Constipation in older adults: Stepwise approach to keep things moving

) Anticholinergic drugs: antipsychotic drugs, benztropine, oxybutynin Anti-Parkinson drugs: amantadine, bromocriptine, pramipexole Anticonvulsant drugs: gabapentin, phenytoin, pregabalin Antidepressant drugs: tricyclic antidepressants, paroxetine Antidiarrheal drugs: diphenoxylate, loperamide Antiemetic drugs: dimenhydrinate, ondansetron, prochlorperazine, promethazine, scopolamine Antihistamine drugs: diphenhydramine, hydroxyzine Antihypertensive drugs: α-adrenergic agonists (eg, clonidine), β-blockers

2016 RxFiles

159. Antiemetics (Full text)

of diphenhydramine as an adjunctive drug. There was no new evidence regarding lorazepam or diphenhydramine as adjuncts to antiemetics. Clinical interpretation. Diphenhydramine was incorporated into antiemetic regimens primarily to prevent the adverse effects from dopaminergic blockade—for example, akasthisia—that were anticipated with the use of high-dose metoclopramide before the introduction of selective 5-HT 3 receptor antagonists. With high doses of metoclopramide rarely used for the prevention (...) of antineoplastic agent-induced nausea and vomiting, the rationale for the inclusion of diphenhydramine no longer exists. CLINICAL QUESTION 7. What is the role of cannabinoids in the prevention or treatment of nausea and vomiting induced by antineoplastic agents or radiation? Recommendation 7. Evidence remains insufficient for a recommendation regarding medical marijuana for the prevention of nausea and vomiting in patients with cancer who receive chemotherapy or radiation therapy. Evidence is also insufficient

2017 American Society of Clinical Oncology Guidelines PubMed

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