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Dyspepsia in Pregnancy

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102. Anticoagulation - oral

warfarin [ ]. Adverse effects What are the adverse effects of dabigatran? The most common adverse effects reported for dabigatran include diarrhoea, dyspepsia, nausea, anaemia, abdominal pain, gastrointestinal haemorrhage, genitourinary haemorrhage, and nose bleeds. Bleeding is a common adverse effect of all anticoagulants, and a number of serious and fatal haemorrhages have been reported in elderly people taking dabigatran who also had a degree of renal impairment. Idarucizumab (Praxbind®) is specific

2019 NICE Clinical Knowledge Summaries

103. Diabetes - type 2

, planning a pregnancy, or breastfeeding. It also does not cover the diagnosis and management of impaired glucose regulation, or make detailed recommendations on the diagnosis and management of other types of diabetes. There are separate CKS topics on and . The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary healthcare. How up-to-date is this topic? How up-to-date is this topic? Changes Changes September 2019 — minor (...) and stop medications to lower blood glucose, blood pressure and blood lipids in accordance with NICE guidance. Trained healthcare professionals initiate and manage therapy with insulin within a structured programme that includes dose titration by the person with diabetes. Women of childbearing age with diabetes are regularly informed of the benefits of preconception glycaemic control and of any risks, including medication that may harm an unborn child. Women with diabetes planning a pregnancy

2019 NICE Clinical Knowledge Summaries

104. MI - secondary prevention

should not be used at any stage of pregnancy, and have also issued updated advice on interactions with statins. Issued in January 2008. September to December 2007 — converted from CKS guidance to CKS topic structure. The evidence-base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence. Updated to reflect the NICE guideline on secondary prevention for people who have had a myocardial infarction. The main change (...) . It may be appropriate to offer an ACE inhibitor to anyone who has had an MI more than 12 months ago and who is not currently taking one. For further detailed information on prescribing an ACE inhibitor, see the CKS topic on . Patient information leaflets on use of ACE inhibitors in pregnancy are freely available from the UK Teratology Information Service at . [ ] Contraindications and cautions Contraindications and cautions Use of angiotensin-converting enzyme (ACE) inhibitors is contraindicated

2019 NICE Clinical Knowledge Summaries

105. Neuropathic pain - drug treatment

on an update to the manufacturer's Summary of Product Characteristics, hyponatraemia has been included as a possible adverse effect of gabapentin [ ]. April 2015 — minor updates: Correction to the prescribing information for tramadol with regards to the legal requirements for hand writing prescriptions. The text regarding the use of tramadol in pregnancy and breastfeeding has been removed and a link to the CKS topic on Analgesia has been provided. June 2014 — minor update. Update to the text to reflect (...) dose, before deciding it is not effective [ ; ; ]. If amitriptyline is not effective or not tolerated, discontinue treatment gradually over a minimum of 4 weeks to prevent discontinuation symptoms (such as dizziness, nausea, paraesthesiae, anxiety, diarrhoea, flu-like symptoms, and headaches) [ ; ]. Pregnancy and breastfeeding Can tricyclic antidepressants be used during pregnancy and breastfeeding? Amitriptyline may be used during pregnancy and breastfeeding for the management of neuropathic pain

2019 NICE Clinical Knowledge Summaries

106. Leg ulcer - venous

, resulting in enlarged veins, oedema, and venous skin changes (hyperpigmentation, , , and ). As the condition of the skin and subcutaneous tissue worsens, it becomes increasingly vulnerable to ulceration. Risk factors for developing venous leg ulcers include [ ; ; ; ; ; ; ] : Increasing age. Obesity. Immobility. Limited range of ankle function. Previous ulcer. Personal or family history of varicose veins. Personal history of deep vein thrombosis. Female sex. Multiple pregnancies. Arteriovenous fistula

2019 NICE Clinical Knowledge Summaries

108. Heart failure - chronic

vaccinations should be offered. Self-care advice should be given. Nutritional status should be assessed. Follow-up and advanced care planning should be offered, if appropriate. Women of child-bearing age should be given advice about contraception and pregnancy. Have I got the right topic? Have I got the right topic? From age 16 years onwards. This CKS topic is based on guidelines developed by the Scottish Intercollegiate Guidelines Network (SIGN) [ ], the National Institute for Health and Clinical (...) categories. Causes include: Myocardial disease Coronary artery disease (most common). Hypertension. Cardiomyopathies: Familial. Infective. Immune-mediated (for example autoimmune). Toxins (for example alcohol or cocaine). Pregnancy. Infiltrative (for example sarcoidosis, amyloidosis, haemochromatosis, connective tissue disease). Valvular heart disease (for example aortic stenosis). Pericardial disease Constrictive pericarditis. Pericardial effusion. Congenital heart disease Arrhythmias (for example

2019 NICE Clinical Knowledge Summaries

109. Atrial fibrillation

Excellence (NICE) guideline: Atrial fibrillation: the management of atrial fibrillation [ ]. This CKS topic covers the management of people with atrial fibrillation (AF), including people with paroxysmal AF, and covers management issues such as rate control, anticoagulation treatment, and when to admit or refer to a cardiologist. This CKS topic does not cover the management of AF in children, AF during pregnancy, AF causing haemodynamic instability, postoperative AF, or atrial flutter. This guideline

2019 NICE Clinical Knowledge Summaries

110. Lyme disease

, neutropenia, eosinophilia (frequency unknown). Gastrointestinal — nausea, vomiting (common), dyspepsia (uncommon), abdominal discomfort, diarrhoea, tooth discolouration and enamel hypoplasia in children (frequency unknown). Rarely: dysphagia, oesophagitis, oesophageal irritation, pseudomembranous colitis. For more information, see the CKS topic on . Hepatic disorders – hepatotoxicity, hepatitis, jaundice, hepatic failure (frequency unknown). Renal disorders — blood urea increased. Skin — photosensitivity (...) and within 3 days of starting the tetracycline. Adjust the warfarin dose accordingly. [ ; ; ; ] Pregnancy and breastfeeding Pregnancy and breastfeeding Pregnancy Doxycycline is contraindicated in women who are pregnant. Tetracyclines may be considered in the first trimester if required urgently and no suitable alternatives with a better safety profile are available. Breastfeeding Doxycycline is contraindicated in women who are breastfeeding. However, concerns about bone deposition of tetracyclines

2019 NICE Clinical Knowledge Summaries

111. Lipid modification - CVD prevention

disease [ ], the British National Formulary (BNF) [ ], the manufacturer's Summary of Product Characteristics for atrovastatin [ ], and what CKS considers good clinical practice. First-line therapy Which first-line lipid modification therapy should I offer for primary prevention of CVD? Offer high intensity statin treatment unless this is (for example in pregnancy). Discuss the risks and benefits of statin treatment so that the person can make an informed choice about their treatment. Advise that: High (...) Characteristics for atorvastatin [ ], and what CKS considers good clinical practice. First-line therapy Which first-line lipid modification therapy is recommended for secondary prevention of CVD? Offer high intensity statin treatment unless this is (for example in pregnancy). If the person is already taking a different statin for secondary prevention of cardiovascular disease (CVD), see the section on . Discuss the risks and benefits of statin treatment so that the person can make an informed choice about

2019 NICE Clinical Knowledge Summaries

112. Cellulitis - acute

, maceration or fungal infection between the toes, or a concomitant skin disorder (such as atopic eczema). Other risk factors for cellulitis include [ ; ; ; ; ; ]: Lymphoedema. Leg oedema. Venous insufficiency and history of venous surgery. Obesity. Pregnancy [ ]. R isk factors for either rapid progression of cellulitis or delayed response to treatment include [ ; ; ; ; ] : Conditions that predispose to infection, including diabetes mellitus, chronic liver or renal disease, immunocompromise (...) for 5–7 days. Doxycycline 200 mg on the first day then 100 mg once daily, for a total of 5–7 days. Erythromycin (in pregnancy) 500 mg four times daily for 5–7 days. For adults with infection near the eyes or nose who do not require : Prescribe co-amoxiclav 500/125 mg three times a day for 7 days. If this is unsuitable, or the person has a penicillin allergy, prescribe: Clarithromycin 500 mg twice daily for 5–7 days with metronidazole 400 mg three times daily for 7 days. For adults with known

2019 NICE Clinical Knowledge Summaries

113. NaviCam for diagnosing gastrointestinal tract conditions

for about 8 hours. The capsule is then passed in the person's stool and discarded. The NaviCam is contraindicated in pregnancy and for people with pacemakers, implantable electronic devices or implanted metal parts (similar exemption criteria to MRI scans). Innovations The NaviCam is less invasive than conventional gastroscopy, needing no intubation or sedation. Unlike other magnetic or passive wireless capsule endoscopy systems, the NaviCam capsule can be controlled remotely and guided through (...) fully with all legal obligations to: promote race and disability equality and equality of opportunity between men and women, eliminate unlawful discrimination on grounds of race, disability, age, sex, gender reassignment, marriage and civil partnership, pregnancy and maternity (including women post-delivery), sexual orientation, and religion or belief (these are protected characteristics under the Equality Act 2010). The NaviCam is contraindicated in pregnancy and for people with pacemakers

2017 National Institute for Health and Clinical Excellence - Advice

115. Autosomal Dominant Polycystic Kidney Disease - Management of Polycystic Liver Disease

kidney disease using abdomi- nal ultrasound (1C). b. We recommend that all female patients with autosomal dominant polycystic kidney disease and livercystsundergocounselingregardingtherisksof pregnancy and exogenous estrogen exposure in worsening liver cyst growth (1C). c. We recommend that females at risk of symptoms fromhepaticcystsavoidestrogensupplements(1D). d. We recommend that a multidisciplinary team (hep- atologist, hepatobiliary surgeon, interventional ra- diologist, and nephrologist) care (...) ,some,mainlythose with severe cystic liver disease, have abdominal pain or swelling, and, less commonly, dyspepsia, early satiety, dyspnea, and back pain. The severity of cystic liver disease can be assessed by magnetic resonance imaging (MRI), based on total cyst number or total liver volume. 5 Complications such as hepatic cyst infection and bleeding cause pain acutely, and are not uncommon, occurring in at least 5% of patients. 7 The treatment is the same as for infected or bleeding kidney cysts

2015 KHA-CARI Guidelines

116. Atrial Fibrillation ? Diagnosis and Management

-threatening pulmonary fibrosis, hepatic dysfunction, and aggravation of arrhythmias Monitor transaminases and thyroid function every 6 months. Reduce dose of concurrently used beta-blockers, procainamide, quinidine, and warfarin by 50%. dronedarone Multaq® (IR tablet: 400 mg) 400 mg PO BID. $139 Limited Coverage Special Authority Diarrhea, dyspepsia, nausea, and hepatic dysfunction (rare) Slight increase in plasma creatinine related to inhibition of secretion Contraindicated in patients with severe heart (...) and strength) Adult dose Cost per 30 days a PharmaCare coverage b Common and/or serious side effects Therapeutic considerations Oral anticoagulants Vitamin K Antagonists warfarin Coumadin®, G (IR tablet: 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 mg Initial: 2.5-10 mg PO daily, then individualize to maintain an INR of 2-3. $2-10 Regular Coverage Bleeding and skin necrosis Contraindicated in pregnancy. Many potential interactions. Direct Factor Xa Inhibitors dabigatran Pradaxa® (IR capsule: 110, 150 mg) 150 mg PO BID

2015 Clinical Practice Guidelines and Protocols in British Columbia

117. Breast Cancer Treatment (PDQ®): Health Professional Version

, or melanomas. Refer to the following PDQ summaries for more information on these cancer types: Breast cancer also affects men and children and may occur during pregnancy, although it is rare in these populations. Refer to the following PDQ summaries for more information: Incidence and Mortality Estimated new cases and deaths from breast cancer (women only) in the United States in 2019:[ ] New cases: 268,600. Deaths: 41,760. Breast cancer is the most common noncutaneous cancer in U.S. women (...) family members can be referred for genetic counseling and testing.[ - ] (Refer to the PDQ summaries on ; ; and for more information.) (Refer to the PDQ summary on for more information about factors that increase the risk of breast cancer.) Protective Factors Protective factors and interventions to reduce the risk of female breast cancer include the following: Estrogen use (after hysterectomy).[ - ] Exercise.[ - ] Early pregnancy.[ - ] Breast feeding.[ ] Selective estrogen receptor modulators (SERMs

2018 PDQ - NCI's Comprehensive Cancer Database

118. Dabigatran (Pradaxa)

with dyspepsia in up to 10% of users; the frequency of this complication can be reduced by having patients take the drug with meals. Dyspepsia usually resolves with time and may improve with the use of an anti-ulcer medication such as a proton pump inhibitor, but caution is advised as the absorption of dabigatran is decreased when co-administered with aluminum, magnesium or calcium containing antacids. PERI-PROCEDURAL MANAGEMENT: See Clinical Guide: New/Novel Oral Anticoagulants (NOAC): Peri-Operative (...) is contraindicated in patients with CrCl <30 mL/min. Dose modification is not needed in patients with hepatic impairment but dabigatran should be used with caution in those with cirrhosis or baseline coagulopathy who are at high risk of bleeding. Mechanical heart valves: Dabigatran is contraindicated in patients with mechanical heart valves. Pregnancy and breast feeding: Dabigatran crosses the placenta and should not be used in pregnancy. It is unknown whether dabigatran passes into the breast milk; therefore

2015 Thrombosis Interest Group of Canada

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