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Hepatotoxic Medication

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141. Pruritus

, Ekin Savk 11 , Markus Streit 12 , Erwin Tschachler 13 , Joanna Wallengren 14 , Sonja Ständer 15 1 Department of Clinical Social Medicine, Environmental and Occupational Dermatology, Ruprecht-Karls-University Heidelberg, Germany 2 Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland 3 Department of Dermatology and Venerology, Skane University Hospital, Lund University, Malmö, Sweden and National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brummundal (...) Free Hospital, London, UK 9 Department of Nephrology, DKD Helios Wiesbaden, Germany 10 Department of Dermatology, University Hospital Brest, France 11 Department of Dermatology, Adnan Menderes University, Aydin, Turkey 12 Department of Dermatology, Kantonsspital Aarau, Switzerland 13 Department of Dermatology, Medical University Vienna, Austria 14 Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Dermatology and Venereology, Lund, Sweden 15 Department of Dermatology

2019 European Dermatology Forum

143. 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

144. 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

145. 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

147. Chiefs? inquiry corner

lifestyle changes in order to lose weight, these measures often fail to achieve sustained, clinically meaningful weight loss. Endocrine Society guidelines recommend adding pharmacotherapy to lifestyle changes in patients with a BMI ≥27 with one or more obesity-related comorbidities or a BMI >30 with or without such comorbidities, and a history of failure to achieve clinically meaningful and sustained weight loss (which is defined as >5% of total bodyweight). Five medications have been approved in the US (...) for chronic weight management: Phentermine, Orlistat, Lorcaserin, Naltrexone/Buproprion, and Liraglutide. These drugs have all been shown to achieve at least 5% mean weight loss in placebo-controlled clinical trials. Choosing between these medications should take into account a patient’s comorbidities, and the expected side effect profile. If 3-5% weight loss is not achieved in 3-4 months, a new weight loss plan should be considered. It is also important to avoid medications for other chronic conditions

2019 Clinical Correlations

148. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of PCOS in Adolescence Full Text available with Trip Pro

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

2019 Pediatric Endocrine Society

149. Nutrition Support of Children With Chronic Liver Disease: A Joint Position Paper of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition

, recommenda- tions are provided. Lastly, suggestions for future research studies are described. Key Words: cirrhosis, frailty, malnutrition, metabolic bone disease, nutrient de?ciencies (JPGN 2019;69: 498–511) C hildhood is a vulnerable period of development during which significant variations in nutritional needs can be complicated by underlying medical conditions. Malnutrition is a common complication of cholestatic and end-stage liver diseases, which together may increase the morbidity and mortality (...) in the child with chronic liver disease is important. What Is New There are significant gaps in the literature that addresses the optimal nutrition support of patients with chronic liver diseases. Thisreportproposestheuseofaclinicalalgorithmto standardize the nutritional management of children with end-stage liver disease. Received October 8, 2018; accepted June 19, 2019. From the Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati OH, the y Department

2019 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

150. Comparative Effectiveness of Analgesics To Reduce Acute Pain in the Prehospital Setting

others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report is made available (...) Administration (NHTSA) requested this report from the EPC Program at AHRQ and provided funding for the report. AHRQ assigned this report to the following EPC: University of Connecticut Evidence- based Practice Center (Contract Number 290-20-1500012-I). The reports and assessments provide organizations with comprehensive, evidence-based information on common medical conditions and new healthcare technologies and strategies. They also identify research gaps in the selected scientific area, identify

2019 Effective Health Care Program (AHRQ)

151. 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

152. 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

153. 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

154. 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

155. 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

156. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

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

2019 American Gastroenterological Association Institute

157. 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

158. Update of the guideline synopsis for the DMP "rheumatoid arthritis" - rapid report

, external experts who are involved in the Institute’s research commissions must disclose “all connections to interest groups and contract organizations, particularly in the pharmaceutical and medical devices industries, including details on the type and amount of any remuneration received”. The Institute received the completed Form for disclosure of potential conflicts of interest from each external expert. The information provided was reviewed by a Committee of the Institute specifically established (...) guideline(s) High GoR (n/N) Suitability for a DMP methodological assessment IQWiG designation a / notes T8: Tocilizumab (continued) V1.4.3.1.3/T8 – K4 (hepatotoxicity) Liver function tests should initially be performed in all patients receiving TCZ at 4-week intervals. Other hepatotoxic drugs should only be used cautiously in patients on TCZ, as is the case with MTX treatment. BSR 2013 TCZ 0/2 Less suitable See also treatment monitoring sheet [25] V1.4.3.1.3/T8 – K5 (lipid levels) All patients on TCZ

2017 Institute for Quality and Efficiency in Healthcare (IQWiG)

159. Hepatic steatosis

discomfort pruritus jaundice spider angioma palmar erythema nail changes Dupuytren's contracture bruising petechiae excoriations gynaecomastia parotid gland enlargement testicular atrophy alopecia caput medusae Cruveilhier-Baumgarten murmur peripheral oedema ascites low blood pressure hepatic encephalopathy fetor hepaticus haematemesis melaena obesity insulin resistance or diabetes dyslipidaemia hypertension metabolic syndrome rapid weight loss hepatotoxic medications total parenteral nutrition (TPN (...) abdominal MRI oesophogastroduodenoscopy (OGD) EEG portal venous pressure measurements liver biopsy elastography cytokeratin-18 fragments Treatment algorithm ONGOING Contributors Authors Assistant Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition Associate Program Director Transplant Hepatology Fellowship Program Department of Medicine University of Pittsburgh Medical Center Pittsburgh PA Disclosures SMM declares that he has no competing interests. Professor of Medicine Medical

2017 BMJ Best Practice

160. Targeted Immunomodulators for the Treatment of Moderate-to-Severe Plaque Psoriasis: Effectiveness and Value

Immunomodulators for Plaque Psoriasis | Condition Update About ICER The Institute for Clinical and Economic Review (ICER) is an independent non-profit research organization that evaluates medical evidence and convenes public deliberative bodies to help stakeholders interpret and apply evidence to improve patient outcomes and control costs. The funding for this report comes from government grants and non-profit foundations, with the largest single funder being the Laura and John Arnold Foundation. No funding (...) . New England CEPAC seeks to help patients, clinicians, insurers, and policymakers interpret and use evidence to improve the quality and value of health care. The New England CEPAC is an independent committee of medical evidence experts from across New England, with a mix of practicing clinicians, methodologists, and leaders in patient engagement and advocacy. All Council members meet strict conflict of interest guidelines and are convened to discuss the evidence summarized in ICER reports and vote

2018 California Technology Assessment Forum

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