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Life-Threatening Drug-Induced Rashes

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41. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy Full Text available with Trip Pro

) test, SS-A/Anti-Ro, and SS-B/Anti-La if the rash is predominantly photodistributed or demonstrating photosensitivity. Consider expanding serologic studies or diagnostic work-up if other autoimmune conditions are considered. Skin biopsy, clinical photography may be performed when indicated. Review full list of patient medications to rule out other drug-induced cause for photosensitivity. Recommendation 1.1b – Management. It is recommended that clinicians manage grade 1 toxicities as follows: Should (...) ). Assess for lymphadenopathy, facial or distal extremity swelling (may be signs of drug-induced hypersensitivity syndrome [DIHS]/drug reaction with eosinophilia and systemic symptoms [DRESS]). Assess for pustules or blisters or erosions in addition to areas of “dusky erythema,” which may feel painful to palpation. To assess for a positive Nikolsky sign, place a gloved finger tangentially over erythematous skin and apply friction parallel to the skin surface. Nikolsky sign is positive if this results

2018 American Society of Clinical Oncology Guidelines

43. CRACKCast E171 – Pediatric Cardiac Disorders

obstruction. These anomalies are why there are decreased lung markings on the CXR and cyanosis! Can also be associated with: right-sided aortic arch (25% of patients), ASD (10% of patients), Anomalous origin of the left coronary artery. a) What is the pathophysiology of a Tet spell and how is it managed? Known as a hypercyanotic or hypoxic spell. These episodes occur most commonly in infants, with a peak incidence between 2 and 4 months old. And can be potentially life threatening! (Limpness, seizures (...) Echoviruses, influenza A and B viruses, adenovirus, varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, and hepatitis B virus. Bacterial Corynebacterium diphtheriae, Streptococcus pyogenes, S. aureus, Mycoplasma pneumoniae, Borrelia burgdorferi, and meningococcus. Non-infectious Kawasaki disease, Acute rheumatic fever (ARF), Collagen vascular disorders (eg, systemic lupus erythematosus), Toxins (eg, cocaine and doxorubicin), Endocrine disorders (eg, hyperthyroidism), Drug-induced hypersensitivity

2018 CandiEM

45. Solithromycin Triskel - community-acquired pneumonia, anthrax and tularaemia

: alternative 1 st line treatment if susceptibility is confirmed Amoxicillin: alternative 1 st line treatment if confirmed susceptibility and as oral follow-up (WHO 2008) Penicillin has long been the antibiotic of choice Alternative: ciprofloxacin or doxycycline In severe life-threatening cases IV penicillin or another chosen primary antibiotic, i.e., ciprofloxacin, may be combined with another antibiotic, preferably one which also has good penetration into the central nervous system. Clarithromycin

2017 European Medicines Agency - EPARs

46. Health economics for stratified medicine

to weak evidence of the association between a given pharmacogene and the ADR. However, in others, unfavourable cost-effectiveness resulted from very small QALY gains, which is related directly to the probability of the ADR. This is because prevention of very rare ADRs, even if potentially life-threatening, is unlikely to be cost-effective when the number needed to screen is high. Considering this, he emphasised the importance of taking into account the wider benefits offered by some tests against (...) the relative rarity of serious ADRs and potential for less effective alternative treatments. Key challenges around assessment of pharmacogenetics include difficulty in collecting evidence on rare events, requirements for large RCTs and challenges in defining all possible care pathways and treatment alternatives in a model. Professor Hughes also challenged the normative assumption that a QALY lost because of a condition should be valued equally to a QALY lost through medically-induced side effects

2017 Academy of Medical Sciences

47. CRACKCast E120 – Dermatologic presentations

0.1% lotion – low/mid Hydrocortisone valerate 0.2% ointment – mid Betamethasone dipropionate 0.05% cream – high (more potent than beta.val) Life-threatening conditions at risk for dehydration and infection require inpatient treatment – the rest should be managed as outpatients! Rosen’s In Perspective So, you walk up to that chart and read the CC….”rash”…your heart sinks and all you remember is that maculopapular is the only piece of derm knowledge you have… Let’s build on some derm knowledge (...) the forehead and upper neck and spread to involve the face, trunk, arms, and finally the legs and feet. Koplik spots begin to disappear coincident with the appearance of the rash. Complications may include otitis media, encephalitis, and pneumonitis. Otitis media is the most common complication. Encephalitis occurs in approximately 1 in 1000 cases of measles and carries 15% mortality. Measles pneumonia may also be life-threatening. Treatment: supportive, Vitamin A supplements Fever, skin eruption

2017 CandiEM

48. Guideline for the management of adults with Systemic Lupus Erythematosus Full Text available with Trip Pro

, appropriately treated and regularly monitored [ , , , , ]. An up-to-date comprehensive guideline to optimize these aspects of management that is consistent with current evidence and National Health Service (NHS) practice is warranted to improve the outcome of this variable and potentially life-threatening disease that causes considerable morbidity. There have been no previous UK-based guidelines for lupus. The European (EULAR) recommendations for the management of lupus in general were not very detailed (...) case series [ , ]; 2 SRs [ , ] NSAIDs Symptom control in mild non-renal lupus only 1 3 D 1 SR covers case series/reports [ ] Sunscreen (high-SPF UV-A and UV-B) Prevents UV-induced rashes and other manifestations 7 2 ++ B 1 blind RCT [ ]; 5 cohort studies [ ]; 1 case series [ ] Low-dose oral prednisolone (≤7.5 mg) Mild lupus and to prevent flares 0 4 D Expert opinion Higher doses of oral prednisolone ≤0.5 mg/kg/day Moderate lupus and prevention of flares 0 2 4 2+ D C To prevent flare: 1 blind RCT

2017 British Society for Rheumatology

49. CRACKCast E118 – SLE and Vasculitides

levels · Direct coombs test positive Table 108.1 is very busy – Remember the only mnemonic from med school SOAP BRAIN MD Serositis Oral Ulcers Arthritis Photosensitivity & Pulmonary Fibrosis Blood cells (pancytopenia) Renal, Raynauds ANA Immunologic (anti-Sm, anti-dsDNA) Neuropsych Malar Rash Discoid Rash [3] List drugs that induce lupus See Box 108.2 from Rosens 8 th Edition – SLE and Vasculitides Drugs Definitively Implicated in Causing Drug-Induced Lupus Procainamide Hydralazine Methyldopa (...) th Edition – SLE and Vasculitides Reasons for rheumatological referral for patients with SLE To confirm a diagnosis To assess disease activity and severity To provide general disease management To manage uncontrolled disease To manage organ involvement or life-threatening disease To manage or prevent treatment toxicities Special circumstances (APS, pregnancy, surgery) [4] Spot Diagnosis: A 36 year old female stock trader present with what appears to be necrosis of the nose and ears… [5] Spot

2017 CandiEM

50. British Association of Dermatologists guidelines for the management of pemphigus vulgaris

, are coming into being but at present, in most studies, it is dif?cult to judge the effect of individual drugs and make ?rm treatment recommendations. In these guidelines, we have listed the highest ranking level of evidence and given an overall recommendation for each therapy. A summary of treatment options is given in Table 4. 11.0 General principles of management PV is an uncommon and potentially life-threatening disease requiring immunosuppressive treatment. It should be managed by secondary-care

2017 British Association of Dermatologists

51. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Gui Full Text available with Trip Pro

Annular VA e242 7.2. Papillary Muscle VA e242 7.3. Interfascicular Reentrant VT (Belhassen Tachycardia) e242 7.4. Idiopathic Polymorphic VT/VF e242 8. PVC-Induced Cardiomyopathy e243 9. VA and SCD Related to Specific Populations e243 9.1. Pregnancy e243 9.2. Older Patients With Comorbidities e243 9.3. Medication-Induced Arrhythmias e243 9.4. Adult Congenital Heart Disease e243 10. Defibrillators Other than Transvenous ICDs e246 10.1. Subcutaneous Implantable Cardioverter-Defibrillator e246 10.2 (...) disease are rare and may be due to a cardiac channelopathy, , medication-induced long QT syndrome, or they may be idiopathic. , 2.2. Sudden Cardiac Death 2.2.1. Incidence of SCD SCA and its most common consequence, SCD, constitute major public health problems, accounting for approximately 50% of all cardiovascular deaths, , with at least 25% being first symptomatic cardiac events. , , In addition, analyses of the magnitude of SCD are limited, in part because of the broad range of estimates of the risk

2017 American Heart Association

52. Safe Medication Use in the ICU Full Text available with Trip Pro

are commonly administered in the ICU ( ). Errors with these high-risk medications may increase the risk of nonfatal, yet serious ADEs. Drug-induced complications may include bleeding diathesis, renal or hepatic failure, arrhythmias, and altered mentation ( ). The management of ADEs and associated complications, as well as the potential increase in hospital LOS as a result of preventable ADEs, incurs an enormous economic burden on the healthcare system. The mean attributable costs related to an ADE (...) , establishing causality of death in an ICU patient as a direct result from a specific medication remains a challenge due to the presence of multiple confounding variables such as comorbid disease states, severity of illness, and treatment variability ( ). One report estimated 106,000 hospitalized patients in the United States experienced a fatal adverse drug reaction (ADR) during 1994 ( ). Comparing the fatal ADR rate to the overall recorded death rate (2,286,000) during that same year, these drug-induced

2017 Society of Critical Care Medicine

53. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Hea Full Text available with Trip Pro

(Belhassen Tachycardia) e335 8.4. Idiopathic Polymorphic VT/VF e336 9. PVC-Induced Cardiomyopathy e337 10. VA and SCD Related to Specific Populations e338 10.1. Athletes e338 10.2. Pregnancy e338 10.3. Older Patients With Comorbidities e339 10.4. Chronic Kidney Disease e340 10.5. Valvular Heart Disease e340 10.6. Sex-Related Differences in the Risk of SCD e340 10.7. Medication-Induced Arrhythmias e341 10.8. Adult Congenital Heart Disease e342 11. Defibrillators Other than Transvenous ICDs e347 11.1 (...) a spectrum that ranges from premature ventricular complex (PVC) to ventricular fibrillation (VF), with a clinical presentation that ranges from a total lack of symptoms to cardiac arrest. Most life-threatening VA are associated with ischemic heart disease, particularly in older patients. The risks of VA and SCD vary in specific populations with different underlying cardiac conditions, and with specific family history and genetic variants, and this variation has important implications for studying

2017 American Heart Association

54. ASCIA Position Paper - Hereditary Angioedema (HAE)

Histamine Induced (Mast cell dependent) – majority of cases • Idiopathic histamine induced angioedema • Allergic angioedema (e.g. IgE-mediated food or drug allergy) • Drug induced histamine dependent angioedema (e.g. NSAID intolerance) Suspect mast cell dependent when • Angioedema coexists with urticaria or other features of anaphylaxis • Obvious trigger (e.g. drug, food) • Response to antihistamines (either for treatment or prevention) trial of antihistamines and corticosteroids is indicated until (...) laryngopharyngeal manipulation or instrumentation carry a much greater risk of triggering potentially life-threatening episodes. Postoperative complications such as sepsis increase the risk of attacks during this period. Regimens to protect individuals from acute attacks during interventions are based on uncontrolled studies and are aimed at increasing temporarily the plasma C1-INH levels (see 6.2). 3.5.3 Dental procedures Triggering of attacks following dental work is unpredictable. Extensive dental work may

2017 Australasian Society of Clinical Immunology and Allergy

56. Cabometyx (cabozantinib) - advanced renal cell carcinoma

CAP chest / abdomen / pelvis CHMP Committee for medicinal products for human use CI confidence interval CR complete response CRO contract research organization CT computerized tomography CTC circulating tumour cells CTCAE Common Terminology Criteria for Adverse Events DBP diastolic blood pressure DILI drug-induced liver injury DOR duration of response DRS disease-related symptoms (e)CRF (electronic) case report form CV% percent coefficient of variation EBRT external beam radiation therapy ECG

2016 European Medicines Agency - EPARs

58. Tagrisso - osimertinib

for a Conditional Marketing Authorisation in accordance with Article 14(7) of the above mentioned Regulation based on the following claim(s): Medicinal product which aims at the treatment of a life-threatening disease in accordance with Article 2(1) of Commission Regulation No. 507/2006. Assessment report EMA/CHMP/15445/2016 Page 7/134 New active Substance status The applicant requested the active substance Osimertinib (mesylate) contained in the above medicinal product to be considered as a new active (...) /15445/2016 Page 8/134 2. Scientific discussion 2.1. Introduction Problem statement Lung cancer is an aggressive, heterogeneous, and life-threatening disease. It has been one of the most common cancers in the world for several decades (1.8 million new cases in 2012, 12.9% of all new cancers worldwide (GLOBOCAN 2012). In the EU, lung cancer is ranked as the fourth most frequent cancer; approximately 313,000 new cases were diagnosed in 2012 (Ferlay et al. 2013). Furthermore, lung cancer incidence rates

2016 European Medicines Agency - EPARs

60. Human leukocyte antigens: key regulators of T-cell mediated drug hypersensitivity Full Text available with Trip Pro

by T cells are associated with phenotypically distinct clinical diagnoses and can vary from a mild delayed rash to a life-threatening cutaneous, systemic or organ disease, such as Stephen Johnson syndrome/toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms and drug-induced liver disease. T-cell-mediated ADRs are strongly linked to the carriage of particular HLA risk alleles which are in the case of abacavir hypersensitivity and HLA-B*57:01 has led to translation

2018 HLA

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