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Life-Threatening Drug-Induced Rashes

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82. Urticaria

can lead to scarring. Poor sleep — due to itching. Social isolation and embarrassment. Reduced performance at work or school. Anxiety and depression. Reduced quality of life. In addition, angio-oedema can co-exist with chronic urticaria and may lead to airway obstruction, and anaphylaxis (a life-threatening, generalized or systemic hypersensitivity reaction) may rarely occur in people with urticaria. For more information, see the CKS topic on . [ ; ; ; ; ] Prognosis What is the prognosis (...) ESR with normal CRP may indicate paraproteinaemia. Full blood count (FBC) — eosinophil count may be elevated in parasitic infections and in some drug-induced reactions. An elevated neutrophil count may be associated with . Helicobacter pylori testing (if gastrointestinal symptoms are present) — there is some evidence that H. pylori infection is significantly, though weakly, associated with an increased risk of chronic urticaria. Allergy testing — this may include patch testing or skin prick

2018 NICE Clinical Knowledge Summaries

83. Angio-oedema and anaphylaxis

and/or mucosal changes. These should be assessed as part of the E xposure when using the ABCDE approach. They are often the first features, present in over 80% of anaphylactic reactions, and can be subtle or dramatic. There may be erythema (a patchy or generalized red rash), urticaria, or angio-oedema. The diagnosis of anaphylaxis is supported by the person's exposure to a known . Be aware that: Skin changes without life-threatening airway, breathing, or circulation problems do not signify an anaphylactic (...) -oedema (an inherited genetic abnormality), acquired angio-oedema (usually secondary to lymphoma or a connective tissue disorder), and idiopathic angio-oedema. Anaphylaxis is a severe, life-threatening, generalized or systemic hypersensitivity reaction characterized by rapidly developing airway and/or breathing and/or circulation problems usually associated with skin and mucosal changes. The mechanism for angio-oedema and anaphylaxis is the same, as both histamine and/or bradykinin are involved

2018 NICE Clinical Knowledge Summaries

84. Antiplatelet treatment

, salicylates or another nonsteroidal anti-inflammatory drug (NSAID). Symptoms of hypersensitivity to aspirin or salicylates include bronchospasm, urticaria, angioedema, and rhinitis. These can occur in isolation or in combination and can lead to severe or life-threatening reactions. Active pathological bleeding, such as peptic ulcer or intracranial haemorrhage. Severe cardiac failure. Severe hepatic impairment. Severe renal impairment. Haemophilia or another haemorrhagic disorder (including

2018 NICE Clinical Knowledge Summaries

85. Palliative care - oral

* Drug-induced dry mouth is often caused by the anticholinergic properties of drugs. This is not a comprehensive list of drugs that are associated with dry mouth, as many other drugs can cause these symptoms. Data from manufacturers' summary of products monograph data ( ). Painful mouth Painful mouth The causes of a painful mouth include: Ulceration: Viral (zoster, herpes simplex) ulcers. Aphthous ulcers. Neutropenic ulcers. Inflammation due to: Oral candidiasis. Dental abscess. Dental pain (dentine (...) cause oral discomfort and pain and poor nutrition, and can lead to hospitalization and interruption of treatment. Some people may have life-threatening infection (septicaemia) [ ]. A systematic review aimed to determine the incidence and associated outcomes of mucositis [ ]: Three studies (n = 700) reported hospitalization rates of 15% overall and 32% in people who received altered fractionated radiotherapy. Five studies (n = 1267) reported that 11% of radiotherapy regimens were interrupted

2018 NICE Clinical Knowledge Summaries

86. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

of anxiety and related disor- ders should consider whether the anxiety is due to another medical or psychiatric condition, is comorbid with another medical or psychiatric condition, or is medication-induced or drug-related [32]. When a patient presents with excessive or uncontrolla- ble anxiety it is important to identify other potential causes of the symptoms, including direct effects of a sub- stance (e.g., drug abuse or medication) or medical condi- tion (e.g., hyperthyroidism, cardiopulmonary (...) , locks, appliances) ? Ordering/arranging ? Repeating (e.g., counting, touching, praying) ? Hoarding/collecting/saving ? If you answered “YES” to any of the above… Do you have trouble resisting the urge to do these things? PTSD – MACSCREEN [29,30] ? Have you experienced or seen a life-threatening or traumatic event such as a rape, accident, someone badly hurt or killed, assault, natural or man-made disaster, war, or torture? If you answered “YES” then continue ? Do you re-experience the event

2014 CPG Infobase

87. Treatment of Drug-Susceptible Tuberculosis: Official ATS/CDC/IDSA Clinical Practice Guidelines

acuity (Snellen test) and color discrimination tests, followed by monthly inquiry about visual disturbance and monthly color dis- crimination tests. 7 Liver function tests only at baseline unless there were abnormal- ities at baseline, symptoms consistent with hepatotoxicity develop, or for patients who chronically consume alcohol, take other potentially hepatotoxic medications, or have viral hepatitis or history of liver disease, human immunodeficiency virus (HIV) infection, or prior drug-induced (...) concentration of ?rst-line drugs than administration with food [54]. Any combination of otherwise unexplained nausea, vomiting, and abdominal painisevaluatedwithaphysicalexaminationandliverfunction tests, including alanine aminotransferase (ALT), aspartate ami- notransferase (AST), bilirubin, and alkaline phosphatase to as- sess for possible hepatotoxicity [55].Drug-induced hepatitis is the most frequent serious adverse reaction to the ?rst-line drugs. INH, RIF, and PZA can cause drug-induced liver injury

2016 American Thoracic Society

88. Wearable cardioverter-defibrillator (WCD) therapy in primary and secondary prevention of sudden cardiac arrest in patients at risk

digitised ECG data available to be viewed on LifeVest ® Network [5] (B0001). The WCD monitors the patient’s heart continuously and in case it detects a life-threatening heart rhythm that it can restore, such as VT or VF, it delivers an automatic treatment shock [5]. In case of an alarm triggered by a life-threatening heart rhythm, the conscious patient can prevent the shock by pressing two response buttons found on the monitor unit anytime during the treatment sequence. The WCD can be programmed (...) protection from SCA in high risk periods during diagnosis, or an experi- ence of VT/VF, and the appropriate treatment (or optimisation of it) (A0020, B0002). Health problem The LifeVest ® claims to reduce the risk of SCA by restoring the life-threatening VT/VF that are re- sponsible for the majority of SCAs. Both of these rapid heart rhythms arise in the heart’s lower (pumping) chambers, the ventricles. While VT is a fast, but regular heart rhythm, VF is irregular and unsynchronised. When fibrillating

2016 EUnetHTA

89. Investigation and management of eosinophilia

). The clinical manifestations associated with drug-induced eosinophilia range from asymptomatic to life-threatening (Klion 2009). Rarely a drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) occurs 3?6 weeks after the introduction of a new drug. This syndrome is characterised by a triad of a skin eruption, fever and internal organ involvement (lung, liver, kidneys, lymph nodes or heart) (Dong et al, 2014; Sultan et al, 2015). Drug-induced vasculitis and eosinophilia is also reported (...) be recognised as a possible manifestation of eosinophil-associated tissue damage (Grade 2C). ? In patients with end-organ damage, the frequency of further serial evaluations of organ function should be determined by the severity and extent of organ compromise and/or by worsening of the eosinophilia (Grade 2C). Emergency treatment ? Patients requiring emergency treatment for severe or life-threatening eosinophilia should receive high-dose corticosteroids (Grade 1B). ? Patients receiving corticosteroids

2016 British Committee for Standards in Haematology

93. Ketoconazole HRA

of complications such as hypertension, diabetes mellitus, cardiac abnormalities and alteration in hemostatic parameters, cortisol excess leads to an increased cardiovascular risk (Whitworth, 2005; Arnaldi, 2012) with increased frequency of arterial atherosclerosis (Neary, 2013). Inadequately treated CS is a life-threatening condition. In a Danish study (Lindholm, 2001), the mortality rate of non-malignant CS was 3.7 fold higher than in the normal population and was even worse in CD patients not cured (...) limitation of a rare and life threatening condition, ketoconazole has been a well-established medicinal use within the EU for more than 10 years. Ketoconazole HRA Assessment report EMA/CHMP/534845/2014 Page 10/115 The conclusion on systematic use takes into consideration the relevant proportion of patients covered by the presented data compared to the overall population affected by this condition, the consistency amongst the publications, the representativeness of the patients, as well as the duration

2014 European Medicines Agency - EPARs

94. Ledipasvir/Sofosbuvir

%) 17 (18.1%) Headache 9 (19.6%) 20 (21.3%) Nausea 8 (17.4%) 13 (13.8%) Diarrhea 5 (10.9%) 14 (14.9%) Pruritus 5 (10.9%) 11 (11.7%) Rash 6 (13.0%) 10 (10.6%) Anemia 6 (13.0%) 6 (6.4%) Source: NDA 205834 Applicant Clinical Summary of Safety, Table 35. Three subjects (2.1%) had a Grade 4 laboratory abnormality (increased creatine kinase, increased urate, and increased lipase); all Grade 4 laboratory abnormalities were reported to be transient and returned towards baseline levels before or by the Week

2014 FDA - Drug Approval Package

95. Secukinumab (Cosentyx)

designs were similar, the safety analysis was conducted by pooling the safety data at 12 weeks and 52 weeks. Follow-up safety data provided in the Safety Update Report was also reviewed. Primary safety analyses evaluated treatment-emergent adverse events (AEs), serious AEs (SAEs), severe and life- threatening AEs, AEs leading to discontinuation, deaths and laboratory abnormalities in the Phase 3 trials. Additional analyses of AEs of special interest were conducted. These were chosen based on AEs seen (...) . Erythrodermic psoriasis is considered a Reference ID: 3669014Clinical Review Amy S. Woitach, DO BLA 125-504 Cosentyx (secukinumab) 57 severe disease, and can even be life-threatening. The majority of the reported AEs of erythrodermic psoriasis were unlikely to be true erythrodermic psoriasis because they were considered nonserious, did not lead to study treatment discontinuation, were of mild or moderate severity, and had low PASI scores, many of which were lower at the time of the event compared

2014 FDA - Drug Approval Package

96. Treatment of Acute Hyperkalaemia in Adults

+ ] concentration is above the normal value. It is a potentially life-threatening emergency that can be corrected with treatment. It has relevance to all clinicians and is encountered in a variety of clinical settings. Despite this, there is limited evidence to guide treatment. This may account for the observed variability in the treatment of patients with hyperkalaemia, even within the same hospital. 1 Uniform guidance on the treatment of hyperkalaemia based on the best available evidence is therefore needed (...) is regarded as a medical emergency given its potential for life-threatening consequences. (1A) 2. Hyperkalaemia (Guidelines Hyperkalaemia 2.1-2.2) Guideline 2.1 – Hyperkalaemia: Clinical Assessment; ABCDE and Early Warning Scoring (EWS) Systems. We recommend that all patients with known or suspected hyperkalaemia undergo urgent assessment by nursing and medical staff to assess clinical status using the ABCDE approach, an early warning scoring system, and an appropriate escalation plan bearing in mind

2014 Renal Association

98. Diagnosis and Management of Aplastic Anaemia

be considered for patients refractory to platelet transfusion, provided other causes of refractoriness have been excluded. In the absence of HLA antibodies and for patients failing to increment with HLA‐matched platelets, investigation and matching for human platelet antigen antibodies should be considered. Granulocyte transfusions The use of irradiated granulocytes should be considered in patients with lifethreatening infection related to severe neutropenia (Quillen et al , ), and anecdotally may be life (...) remains the most widely quoted parameter for assessment of iron overload. Magnetic resonance imaging (T2* or R2) can quantitate cardiac and liver iron, and is a useful adjunct although its utility in AA has not been published. There are few published data regarding iron chelation therapy in AA. A large study was the 1‐year Evaluation of Patients' Iron Chelation with Exjade study (Lee et al , ). This confirmed that chelation with deferasirox can be administered safely in patients with AA (no drug

2015 British Committee for Standards in Haematology

100. Allopurinol-induced toxic epidermal necrolysis featuring almost 60% skin detachment. Full Text available with Trip Pro

Allopurinol-induced toxic epidermal necrolysis featuring almost 60% skin detachment. Toxic epidermal necrolysis (TEN) is a life-threatening, immunologically mediated, and usually drug-induced disease. Rarely, clinical pharmacists participating in finding the etiology have been reported.A 33-year-old male presented to the emergency department with a 1-day history of fever and rash. The patient, being newly diagnosed with gout 10 days ago, received allopurinol at a dose of 250 mg by mouth daily (...) . After 10 days' exposure to allopurinol, the patient manifested with an "influenza-like" prodromal phase (fever of 38°C, throat pains), which was treated with amoxicillin and nonsteroidal anti-inflammatory drugs of the oxicam type. The next day, he developed a worsening fever of 39.5°C, accompanied by a pruriginous rash all over his body.On physical examination, we observed coalescing dusky red macules over >60% of his body surface area, with blisters and detachment of large sheets of necrolytic

2019 Medicine

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