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Hepatotoxic Medication

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121. Kaiser Permanente National Cholesterol and Cardiovascular Risk Clinician Guide

intensity of statin therapy: • Reinforce medication adherence; • Reinforce adherence to intensive lifestyle changes; and • Exclude secondary causes of hyperlipidemia. } Consider using the following indicators of anticipated therapeutic response to the recommended intensity of statin therapy. Focus is on the intensity of the statin therapy. As an aid to monitoring: • High-intensity statin therapy generally results in an average LDL–C reduction of = 50% from the untreated baseline. • Moderate-intensity (...) . } For adults taking any dose of statins, consider using caution in those aged >75 years and in those taking concomitant medications that alter drug metabolism, multiple drugs, or drugs for conditions that require complex medication regimens (e.g., those who have undergone solid organ transplantation or are receiving treatment for HIV). A review of the manufacturer’s prescribing information may be useful before initiating any cholesterol-lowering drug. } As on-treatment LDL-C falls to very low levels

2018 Kaiser Permanente National Guideline Program

122. Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV

(Stellenbosch University, South Africa), Tendani Gaolathe (Ministry of Health, Botswana), Eric Goemaere (MSF, South Africa), Andreas Jahn (ITECH, Malawi), Nagalingeswaran Kumarasamy (YRGCARE Medical Centre, India), Thuy Le (Duke University, USA), Valeriane Leroy (Institut National de la Santé et de la Recherché Médicale, ANRS, France), Othoman Mellouk (ITPC, Morrocco), Irene Mukui (Ministry of Health, Kenya), Angela Mushavi (Ministry of Health and Child Care, Zimbabwe), Landon Myer (University of Cape Town (...) , South Africa), Thanyawee Puthanakit (Chulalong University, Bangkok, Thailand), Pablo Rojo (Complutense University of Madrid, Spain), Gayle Sherman (University of the Witwatersrand, South Africa), Wendy Stevens (NHLS and University of the Witwatersrand, South Africa), François Venter (University of the Witwatersrand, South Africa), and Annemarie Wensing (University Medical Centre of Utrecht, Netherlands). Declarations of interest for members of the Guideline Development Group Three members

2019 World Health Organisation HIV Guidelines

123. Levofloxacin

of levofloxacin was unfavourable as first-line treatment for these indications. The risks contributing to this assessment included serious hepatotoxicity, cardiac arrhythmia 2012 12. Choice between Levofloxacin and Moxifloxacin and Multidrug-Resistant Tuberculosis Treatment Outcomes. RATIONALE: We previously showed that the choice of levofloxacin or moxifloxacin for the treatment of patients with fluoroquinolone-sensitive multidrug-resistant tuberculosis (MDR-TB) did not affect sputum culture conversion at 3 (...) or not with a macrolide) or III: levofloxacin . It was accomplished Rx. thorax to 7-10 days, to the month and, other reviews if was necessary. 29 cases were in standard therapy (I or II) and 20 cases 2002 14. An open-label, three-arm pilot study of the safety and efficacy of topical Microcyn Rx wound care versus oral levofloxacin versus combined therapy for mild diabetic foot infections. 22106196 2011 11 22 2012 04 03 2013 11 21 1930-8264 101 6 2011 Nov-Dec Journal of the American Podiatric Medical Association J Am

2018 Trip Latest and Greatest

124. Gemfibrozil

of Gemfibrozil on Hepatotoxicity Induced by Acetaminophen in Mice: the Importance of Oxidative Stress Suppression. 331-339 10.15171/apb.2018.038 Purpose: Gemfibrozil (GEM) apart from agonist activity at peroxisome proliferator-activated receptor-alpha (PPAR (...) . Department of Toxicology, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Dehbashi Fereshteh F Toxicology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. eng Journal Article 2018 (...) a moderate increase in the area under the curve (AUC) of atorvastatin, but the effect of fenofibrate on atorvastatin pharmacokinetics has not been described 2011 13. The effect of gemfibrozil , niacin and cholestyramine combination therapy on metabolic syndrome in the Armed Forces Regression Study. 21358314 2011 04 26 2011 06 23 2015 11 19 1538-2990 341 5 2011 May The American journal of the medical sciences Am. J. Med. Sci. The effect of gemfibrozil , niacin and cholestyramine combination therapy

2018 Trip Latest and Greatest

125. Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1 infection 2015: optimizing health in preparation for adult life

Giaquinto, 12 D Gibb, 13 L Galli, 14 M Hainaut, 15 M Koros, 16 L Marques, 17 E Nastouli, 18 T Niehues, 19 A Noguera-Julian, 20 P Rojo, 21 C Rudin, 22 HJ Scherpbier, 23 G Tudor-Williams 24 and SB Welch 25 (PENTA Steering Committee) 1 Department of Paediatric Infectious Diseases and Immunology, Great Ormond Street Hospital NHS Trust, London, UK, 2 Medical Research Council Clinical Trials Unit, London, UK, 3 Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK, 4 (...) Institute of Child Health, University College London, London, UK, 5 Radboud University Medical Center, Nijmegan, The Netherlands, 6 University Department of Immunology and Infectious Disease, Bambino Gesù Children’s Hospital, Rome, Italy, 7 Our Lady’s Children’s Hospital Crumlin & University College Dublin, Dublin, Ireland, 8 Meyer University Hospital, Florence University, Florence, Italy, 9 HIV i-Base, London, UK, 10 Emilio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil, 11 Paediatric

2018 The Children's HIV Association

126. International evidence-based guideline for the assessment and management of polycystic ovary syndrome (PCOS)

International evidence-based guideline for the assessment and management of polycystic ovary syndrome (PCOS) International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018Publication approval The guideline recommendations on pages 16 to 34 of this document were approved by the Chief Executive Officer of the National Health and Medical Research Council (NHMRC) on 2 July 2018 under section 14A of the National Health and Medical Research Council Act 1992 (...) of all clinicians that are members of the partner and collaborating societies. The information provided in this document does not constitute business, medical or other professional advice, and is subject to change.International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018 1 Acknowledgments We gratefully acknowledge the contribution of our engaged, funding, partner and collaborating organisations: 1 The Australian National Health and Medical Research

2018 European Society of Human Reproduction and Embryology

127. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association

transplants. The risk of statin-induced serious muscle injury, including rhabdomyolysis, is <0.1%, and the risk of serious hepatotoxicity is ≈0.001%. The risk of statin-induced newly diagnosed diabetes mellitus is ≈0.2% per year of treatment, depending on the underlying risk of diabetes mellitus in the population studied. In patients with cerebrovascular disease, statins possibly increase the risk of hemorrhagic stroke; however, they clearly produce a greater reduction in the risk of atherothrombotic (...) with the use of a medication is an adverse event . Thus, an adverse event is not necessarily caused by the medication. When caused by the medication, these undesirable experiences are called adverse effects or adverse drug reactions . Adverse events in a clinical trial are a combination of events that are purely subjective, have subjective and objective components, or are solely objective, such as an increase in blood pressure or an increased risk of newly diagnosed diabetes mellitus

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2019 American Gastroenterological Association Institute

128. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of PCOS in Adolescence

of UPMC, Pittsburgh, PA, USA e University of Michigan, MSRBII, Ann Arbor, MI, USA f Department of Reproductive Medicine, UCSD School of Medicine, La Jolla, CA, USA g Institute of Maternal and Child Research, University of Chile, School of Medicine, Santiago, Chile h Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India i Istanbul Tıp Fakültesi, Çocuk Kliniği, Istanbul, Turkey j Ain Shams University, Cairo, Faculty of Medicine, Cairo, Egypt k Department (...) of Medical and Surgical Sciences, University of Bologna, Bologna, Italy l Division of Women, Youth and Children, Australian National University, Canberra, ACT, Australia m Department of OBGYN, University of Rochester Medical Center, Rochester, NY, USA n Pediatric Endocrinology, Hospital de Girona Dr. Josep Trueta, Girona, Spain o MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom p The University of Adelaide and Robinson

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2019 Pediatric Endocrine Society

129. WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents

interests were managed 104 ANNEX 5: OPIOID ANALGESICS AND INTERNATIONAL CONVENTIONS 105 United Nations drug conventions and their governance system 105 The Single Convention on Narcotic Drugs and opioid analgesics 106 Drug misuse versus patient need 107 Competent national authorities under the international drug control treaties 108 The Convention’s requirements for national estimates of medical need for opioids 108 The importance of reliable estimates 109 Domestic manufacture of strong opioid (...) Prevention; the Department of Essential Medicines and Health Products; the Department of Service Delivery and Safety; the Department of Mental Health and Substance Abuse; and the Eastern Mediterranean Regional Office, Department of Noncommunicable Disease Management. These departments were represented on the WHO Steering Group for the Medical Management of Cancer Pain in Adults and Adolescents Guidelines. Responsible technical officer: Dr Cherian Varghese WHO Steering Group members: Marie-Charlotte

2019 World Health Organisation Guidelines

130. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures

that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils (...) or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication’s pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of appropriately trained staff to both carry out the procedure and monitor

2019 American Academy of Pediatrics

132. Lenvatinib (Lenvima) - for the treatment of adult patients with advanced or unresectable hepatocellular carcinoma

of administration. Treatment should continue as long as clinical benefit is observed or until unacceptable toxicity occurs. Optimal medical management (ie treatment or therapy) for nausea, vomiting, and diarrhoea should be initiated prior to any lenvatinib therapy interruption or dose reduction; gastrointestinal toxicity should be actively treated in order to reduce the risk of development of renal impairment or failure. Treatment should be initiated and supervised by a health care professional experienced (...) more commonly in the lenvatinib group included hypothyroidism (16% versus 1.7%) and vomiting (16% versus 7.6%). 3 Concomitant anti- hypertensive medication was taken by 73% and 68% of patients in the lenvatinib and sorafenib groups respectively. Levothyroxine was given to more patients in the lenvatinib group, 14% compared with 4.6% in the sorafenib group. 2 The European Medicines Agency (EMA) noted that the incidence of hepatic-related serious adverse events and hepatic-related deaths was higher

2019 Scottish Medicines Consortium

134. Recurrent Uncomplicated Urinary Tract Infections in Women

controversial. Nitrofurantoin is listed as a potentially inappropriate medication for older adults by the AGS Beers Criteria, 158 with the strength of recommendation as strong and a listed quality of evidence of low. The 2015 Beers update has been modified to recommend avoidance of nitrofurantoin when creatinine clearance is below 30mL/min. The rationale for avoiding nitrofurantoin included pulmonary toxicity, hepatotoxicity, and peripheral neuropathy, with concern about long-term use if other alternatives (...) care that is widely agreed upon by urolo- gists or other clinicians for which there may or may not be evidence in the medical lit- erature Expert Opinion A statement, achieved by consensus of the Panel, that is based on members clinical training, experience, knowledge, and judgment for which there is no evidence 11 can be applied to most patients in most circumstances and that future research is unlikely to change confidence. Body of evidence strength Grade B in support of a Strong or Moderate

2019 American Urological Association

135. Tocilizumab (RoActemra): rare risk of serious liver injury including cases requiring transplantation

, have been reported in patients treated with tocilizumab; some cases required liver transplantation advise patients to seek medical help immediately if they experience signs and symptoms of liver injury, such as tiredness, abdominal pain, and jaundice monitor alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels at initiation, every 4–8 weeks during the first 6 months of treatment, and every 12 weeks thereafter in patients with rheumatological indications exercise caution when (...) transient or intermittent mild to moderate elevation of hepatic transaminases, with increased frequency when used in combination with potentially hepatotoxic drugs (for example, methotrexate). A recent EU cumulative review found that, in rare cases, treatment was associated with severe liver injury. The review of data from clinical trials, non-interventional studies, spontaneous reports, and the published literature identified 8 cases of tocilizumab-related drug-induced liver injury worldwide, including

2019 MHRA Drug Safety Update

136. Are all criteria for LVH diagnosis on ECG created equal?

) involves wedge resection of emphysematous lung region in order to reduce overinflation and bronchial tension and improve elastic recoil and airflow. It is considered in patients with advanced emphysematous COPD with continued symptoms despite maximal medical therapy and pulmonary rehab. The National Emphysema Treatment Trial (NETT), which included over 1200 patients, is the largest randomized trial to investigate the effectiveness of this procedure. The patients who benefited the most were those (...) with upper lobe predominant emphysema and low exercise capacity – in this group there was a reduction in long-term mortality (risk ratio 0.57, p-value 0.01) as well as improved exercise capacity and quality of life. References: Terbinafine has been associated with hepatotoxicity, making a check of hepatic function before, during or after treatment a common practice. A 2018 retrospective study in JAMA Dermatology looked at 4,300 patients who received terbinafine and found that the rate of elevated

2019 Clinical Correlations

137. British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis

of unplanned pregnancies 85 ; women must be appropriately counselled about this risk • As there is minimal absorption of topically applied imidazoles from the vulvovaginal mucosae there is limited risk of systemic side effects • Topical therapies can cause vulvovaginal irritation and this should be considered if symptoms worsen or persist • A medication history should be taken to advise women that oral fluconazole and other azoles can interact with medications. In general, fluconazole interactions relate (...) does not support the use of low dose protracted regimens such as fluconazole 50mg od for 14- 28 days for recurrent VVC and suggests there is potential for development of antifungal resistance 98 • There is a low risk of idiosyncratic drug-induced hepatitis with oral azoles, although fluconazole is less frequently associated with hepatotoxicity than itraconazole (see later ‘Reactions to treatment’); • Oral ketoconazole is no longer recommended for the treatment of fungal infections due to the risk

2019 British Association for Sexual Health and HIV

138. Management of Atopic Eczema

Management of Atopic Eczema Management of Atopic Eczema Published by: Malaysian Health Technology Assessment Section (MaHTAS) Medical Development Division, Ministry of Health Malaysia Level 4, Block E1, Precinct 1 Federal Government Administrative Centre 62590 Putrajaya, Malaysia Copyright The copyright owner of this publication is MaHTAS. Content may be reproduced in any number of copies and in any format or medium provided that a copyright acknowledgement to MaHTAS is included and the content (...) Atopic Dermatitis (Hanifin and Rajka Criteria) Appendix 4 Investigator’s Global Assessment (IGA) 44 Appendix 5 Dermatology Life Quality Index 45 Appendix 6 Children Dernatology Life Quality Index 46 Appendix 7 Topical Corticosteroids Class & Potency 47 (UK Classification) Management of Atopic Eczema TABLE OF CONTENTS No. Title Page Appendix 8 Fingertip Unit 48 Appendix 9 Six Steps of Wet Wrap Therapy 49 Appendix 10 Written Eczema Action Plan 50 Appendix 11 Recommended Medication Dosing, 51 Side

2019 Ministry of Health, Malaysia

139. Pre-emptive compared with empirical antifungal strategies for invasive Aspergillus infection

current diagnostic methods have poor sensitivity and can be slow, overuse of empirical antifungal therapies in this clinical setting is a significant problem which exposes patients to potential harms of treatment from which they derive no benefit. Resistance to antifungal medications is emerging as a serious threat. Our review assesses whether pre-emptive antifungal strategies incorporating novel biomarker tests could potentially address these issues. What was our approach? We produced an evidence (...) medications. ? There is no strong evidence that these potential benefits can be attained without adverse effects on mortality, meaning that there is substantial uncertainty surrounding the safety of pre-emptive strategies. ? Cost-effectiveness evidence is subject to similar issues of heterogeneity, and the applicability of some economic analyses to the UK context may be limited. ? One Australian economic study reported a non-significant difference in costs between a pre-emptive diagnostic-driven strategy

2019 SHTG Advice Statements

140. BSG consensus guidelines on the management of inflammatory bowel disease in adults

0SF, UK 31. University of Glasgow, Glasgow, G12 8QQ, UK 32. Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK 33. University of Birmingham, Birmingham, B15 2TT, UK 34. University College London, London, WC1E 6BT, UK 35. University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK 36. Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 5BE, UK 37. Brighton and Sussex Medical School, Brighton, BN1 9PX, UK 38. Royal Wolverhampton NHS (...) manuscript 10 Version accepted by Gut 10 th June 2019 4.7 Stricturing disease 90 4.7.1 Medical therapy for strictures 90 4.7.2 Surgical therapy for strictures 90 4.7.3 Strictureplasty 91 4.7.4 Endoscopic therapy for strictures 92 4.8 Non-perianal fistulising Crohn’s disease and abscesses 93 4.8.1 Intra-abdominal abscesses 93 4.8.2 Medical therapy 93 4.8.3 Enterovaginal and enterovesical fistulae 94 4.8.4 Enteroenteric fistulae 94 4.8.5 Enterocutaneous fistulae 95 4.8.6 Anti-TNF therapy for non-perianal

2019 British Society of Gastroenterology

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