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Life-Threatening Drug-Induced Rashes

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121. Evidence-based Guidelines for Treating Bipolar Disorder

a lifetime perspective. Anxiety symptoms are often persistent between episodes and may contribute to mood insta- bility (I). Anxiety disorders are associated with increased illness burden and poor outcome (I): they require assessment and treatment (S). Stimulant drugs may mimic manic symptoms (II). A drug- induced state, including psychosis, should wane with the clear- ance of the offending drug (II): use 5 half-lives as the relevant interval (and the longest half-life stated in a range). Levodopa

2016 British Association for Psychopharmacology

123. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline

Practice Center for the preparation of the evidence report commissioned by the Agency for Healthcare Research and Quality (AHRQ). Copyright © 2014 American Urological Association Education and Research, Inc.® 2 AUA/SUFU Guideline Overactive Bladder 4. OAB is not a disease; it is a symptom complex that generally is not a life-threatening condition. After assessment has been performed to exclude conditions requiring treatment and counseling, no treatment is an acceptable choice made by some patients (...) options and whose symptoms are intolerable. Guideline Statement 4. OAB is not a disease; it is a symptom complex that generally is not a life threatening condition. After assessment has been performed to exclude conditions requiring treatment and counseling, no treatment is an acceptable choice made by some patients and caregivers. Expert Opinion Discussion. Initiating treatment for OAB generally presumes that the patient can perceive an improvement in his or her quality of life. In patients who

2014 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction

124. Diagnosis and Treatment of Non-Neurogenic Overactive Bladder (OAB) in Adults: AUA/SUFU Guideline

complex that generally is not a life-threatening condition. After assessment has been performed to exclude conditions requiring treatment and counseling, no treatment is an acceptable choice made by some patients and caregivers. Expert Opinion 5. Clinicians should provide education to patients regarding normal lower urinary tract function, what is known about OAB, the benefits vs. risks/burdens of the available treatment alternatives and the fact that acceptable symptom control may require trials (...) OAB is not a disease; it is a symptom complex that generally is not a life threatening condition. After assessment has been performed to exclude conditions requiring treatment and counseling, no treatment is an acceptable choice made by some patients and caregivers. Expert Opinion × Discussion Initiating treatment for OAB generally presumes that the patient can perceive an improvement in his or her quality of life. In patients who cannot perceive symptom improvements, treatment may

2014 American Urological Association

125. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for CYP2C9 and HLA-B Genotype and Phenytoin Dosing

then be made—generally 30– 40? mg at a time in 2-week intervals in adults—to stabilize the level within the typical therapeutic range (10–20 µg/dl). In urgent situations such as status epilepticus, i.v. loading doses of 15–20? mg/kg are given, followed by maintenance doses, i.v. or oral, as above. Acute dose-related side effects include sedation, ataxia, dizziness, nystagmus, nausea, and cognitive impairment. The drug is highly allergenic, and rashes rang- ing from mild eruptions to life-threatening (...) | VOLUME 96 NUMBER 5 | NOVEMBER 2014 547CPIC GuIdelInes 8. Purkins, L., Wood, N., Ghahramani, P ., Love, E.R., Eve, M.D. & Fielding, A. Coadministration of voriconazole and phenytoin: pharmacokinetic interaction, safety, and toleration. Br. J. Clin. Pharmacol. 56 (suppl. 1), 37–44 (2003). 9. Hung , S.I. et al. Common risk allele in aromatic antiepileptic-drug induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Han Chinese. Pharmacogenomics 11, 349–356 (2010). 10. Cheung, Y .K., Cheng

2014 Clinical Pharmacogenetics Implementation Consortium

126. Lipanthyl (fenofibrate) - hypertriglyceridaemia or hyperlipidaemia

the ACCORD study in women treated by lipid-lowering combinations. As HAS - Medical, Economic and Public Health Assessment Division 9/11 regards the Abbot products, the analysis was extended to include other risks (hypercholesterolaemia, cholelithiasis, pancreatitis, myopathy/rhabdomyolysis, drug-induced hepatitis, increase in CPK, photosensitivity, venous thromboembolic disease, risk of developing diabetes and hyperglycaemia with statins in addition to the potential risk of major cardiovascular events (...) combination should be avoided given the risk of muscle disorder which may be increased and in particular in the event of a pre-existing muscle disease. 06 TRANSPARENCY COMMITTEE CONCLUSIONS In view of all the above information, and following the debate and vote, the Committee believes that the conclusions of its previous opinion of 26 September 2007 do not need to be changed. 06.1 Actual benefit The cardiovascular diseases promoted by dyslipidaemia may be life-threatening due to complications

2014 Haute Autorite de sante

127. Guidelines for the screening, care and treatment of persons with hepatitis C infection

abnormalities from the use of RBV. For this reason, women of childbearing age and their partners are advised to use two forms of contraception (including a barrier method) during and for six months after the end of treatment. • HCV treatments require regular monitoring for toxicity and efficacy. Side- effects range from mild to life threatening, and are detected by laboratory monitoring and on clinical review. 21 Issues related to treatment access The aim of these guidelines is to facilitate

2014 World Health Organisation Guidelines

129. Systemic lupus erythematosus

a flare of systemic disease. Sometimes a more generalised form over the body is present. DLE are characterised by slightly raised, scaly lesions that have a potential to scar. They can be found commonly on the scalp and face, and less commonly over the limbs and trunk. Only 5% of people with DLE have SLE, but conversely among individuals with SLE, 20% will have DLE. 17 Subacute cutaneous lupus erythematosus is another lupus-specific rash. It is a common skin manifestation in drug-induced lupus (...) or constitutional features. 8 In some cases, patients may present with more serious and potentially life-threatening renal, neurological or cardiopulmonary complications. 9 Since the disease most commonly affects women of childbearing age, it is a diagnosis that should be considered when such a patient presents with symptoms relating to multiple systems. Most SLE manifestations are the result of chronic inflammatory response at the affected end organ, which can be demonstrated using laboratory, imaging

2014 Clinical Practice Guidelines Portal

132. Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions Full Text available with Trip Pro

survivors of childhood cancer diagnosed between 1970 and 1986, at least 1 of 6 domains of health status (general health, mental health, functional status, activity limitations, cancer-related pain, and cancer-related anxiety) declined moderately to severely in 44%. The cumulative incidence of a chronic health condition 30 years after cancer diagnosis is now 73%, with a cumulative incidence of 42% for severe, disabling, or life-threatening conditions or death attributable to a chronic condition. Also (...) , vinblastine, and dacarbazine; CNS, central nervous system; ICCC, International Classification of Childhood Cancer; RT, radiation therapy; and SEER, Surveillance, Epidemiology, and End Results. Although some adverse effects of cytotoxic therapy may be unavoidable, the evolution of pediatric cancer treatments has already changed the prevalence and spectrum of adverse treatment effects. Because threshold doses for vital organ toxicity have been recognized, acute life-threatening treatment effects

2013 American Heart Association

133. Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease Full Text available with Trip Pro

Prevention and Treatment of Thrombi 2680 15.Nursing Considerations in the Identification and Treatment of Thrombi in Infants and Children 2682 16.Special Circumstances Related to Thromboprophylaxis2683 16.1.Air Travel, Immobilization 2683 16.2.Oral Contraceptives 2683 16.3.Pregnancy 2683 16.4.Obesity 2683 16.5.Children and Adults With Developmental Delay 2683 1. Introduction Thrombosis has long been recognized as a potentially life-threatening complication in children with congenital heart disease (CHD (...) 2.6.2.2). 3.3. Long-term Management of Children on Anticoagulation Medications 3.3.1. General Principles Many children with CHD require long-term thromboprophylaxis to decrease the morbidity and mortality secondary to thromboembolic phenomenon. The sequelae of venous thromboembolism are life-threatening and can include organ failure, pulmonary embolism (PE), embolic stroke, and sepsis. An aspect of surgical palliation for many children with CHD is the placement of systemic to pulmonary artery shunts

2013 American Heart Association

134. Anaphylaxis identification, management and prevention

-induced, probable medication- induced, insect venom-induced, of undetermined cause and relating to a medical or surgical procedure Adapted from Liew WK, Williamson E, Tang ML. Anaphylaxis fatalities and admissions in Australia. J Allergy Clin Immunol 2009;123:434–42 0 0.05 0.1 0.15 0.2 0.25 Age group Anaphylaxis (food) Anaphylaxis (drugs and probable drugs) Anaphylaxis (insect sting) Rate per 100 000 population Anaphylaxis (unknown and others) 19.6% 37.5% 13.4% 5.4% 6.3% Food Drug Probable drug Insect (...) ), assess reaction severity and treat accordingly • Call for assistance • Give adrenaline IM (lateral thigh) 0.01 mg/kg (maximum adult dose 0.5 mg) • Lay patient flat (elevate legs if tolerated) • Set up IV access • Give high flow oxygen + airway/ventilation support if needed • If hypotensive, also: – set up additional wide bore IV access (14 G or 16 G in adults) for normal saline infusion – give IV normal saline bolus 20 mL/kg stat 2. If there is inadequate response, an immediate life threatening

2013 Clinical Practice Guidelines Portal

135. Tropical Travel Trouble 009 Humongous HIV Extravaganza

. Nevirapine – rash 4% (mild to severe SJS and TEN), drug induced hepatitis in up to 10%. Etravirine – rash 4% (mild to severe SJS and TEN) Protease inbititors (all end in ‘navir) commonly cause diarrhoea in the early generations but is improved in more modern regimens. Frequently will cause drug/drug interactions due to the presence of ritonavir or cobicistat which can boost other agents. Insulin resistance / diabetes Dyslipidaemia Lipodystrophy Jaundice and renal stones with Atazanavir Drug induced (...) and PI’s but okay with integrates and NRTIs. Mycobacterial: MTB complex and non-tuberculous mycobacteria. Fungal: cryptococcus, histoplasmosis, candidiasis, PCP. Parasitic: Liver flukes, cryptosporidium, micosporidium. Malignancy: Lymphoma and Kaposi sarcoma. Drugs: consider drug induced hepatitis if: AST/bili >5x ULN or 3.5x baseline. Coagulopathy, eosinophilia, rash and lactic acidosis. Consider TB IRIS if: Evidence of IRIS in another system. New tender hepatomegaly. Predominantely cholestatic. USS

2018 Life in the Fast Lane Blog

136. Tropical Travel Trouble 008 Total TB Extravaganza

is not suitable for 6 months of treatment? Answer and interpretation Disseminated TB (including miliary): 9-12 months. CNS TB : 12 months. Skeletal TB : at least 9-12 months. Drug resistant TB (20 months). Q7. What are the potential side effects of RHZE treatment? Answer and interpretation Rifampicin (R) – Hepatitis, GI upset, skin rashes, thrombocytopenia, renal failure, haemolytic anaemia, orange discolouration of bodily fluids, frequent drug interactions (see HIV section) and drug induced SLE. Isoniazid (H (...) . IRIS describes a collection of inflammatory disorders associated with paradoxical worsening of pre-existing infectious processes following the initiation of antiretroviral therapy in HIV +ve individuals. The immune system wakes up with ART and goes into overdrive. If your TB is a cold abscess on your back and you get IRIS, it doesn’t really matter if this swells or associated lymph nodes swell, but the same situation intracranially can potentially be life threatening – remember the Munro Kelly

2018 Life in the Fast Lane Blog

138. Urologic Surgery Antimicrobial Prophylaxis

endocarditis. 37 Although infectious endocarditis remains a life-threatening disease, with some cardiac conditions predisposing to infectious endocarditis and bacteremia with organisms causing infectious endocarditis occurring commonly in association with genitourinary procedures, the American Heart Association now recommends that antimicrobial prophylaxis during genitourinary procedures is not an effective strategy for prevention of infectious endocarditis. Infectious endocarditis is more likely to result (...) risks of prophylactic antimicrobial administration include allergic reactions, which vary from minor rashes to anaphylaxis, and suppression of normal bacterial flora, which can lead to Clostridium difficile colitis, colonization and infection with resistant organisms, and other adverse effects. Although the frequency of adverse events for any specific antimicrobial agent is calculable for population exposures, it is difficult to assess the gravity of each adverse event, as well as the need

2012 American Urological Association

139. Position paper on hereditary angioedema

) • Drug induced histamine dependent angioedema (eg NSAID intolerance) Suspect mast cell dependent when • Angioedema coexists with urticaria or other features of anaphylaxis • Obvious trigger (i.e. drug, food) • Response to antihistamines (either for treatment or prevention) Trial of antihistamines and corticosteroids is indicated until diagnosis is confirmed. ASCIA Position Paper on Hereditary Angioedema 8 © ASCIA August 2012 Table 2. Features distinguishing HAE from other forms of Angioedema [10 (...) breast milk before initiation of treatment with danazol. ASCIA Position Paper on Hereditary Angioedema 10 © ASCIA August 2012 3.5.2 Perioperative period Surgical procedures may pose a special risk to patients with HAE and when possible, require planning and consultation between the immunologist, anaesthetist and surgical teams. Some procedures such as those involving laryngopharyngeal manipulation or instrumentation carry a much greater risk of triggering potentially life-threatening episodes

2012 Clinical Practice Guidelines Portal

140. Anaphylaxis recognition and treatment

in these examples is the subtlety or absence of skin features. Some other pointers to consider are: unless a clear alternate diagnosis is present, life-threatening hypotension should be treated as anaphylaxis. Severe asthma that does not respond to standard therapy may also be due to anaphylaxis. Paroxysmal onset should trigger a search for allergic precipitants, as should the presence of skin flushing which may be subtle and noticed only by relatives while rashes and angioedema may be associated (...) and stable overall at ~0.64 deaths per million people per year, however medicine induced anaphylaxis deaths increased in the order of 300%. 1 Case fatality rates were approximately 1:1000 for food anaphylaxis (commonest in children) and 1:100 for medicine and insect venom anaphylaxis (mostly in adults). Age is a major risk factor for death, with most deaths occurring in adults aged over 35 years. In children and adolescents, fatal and near-fatal anaphylaxis appears to be strongly associated

2012 Clinical Practice Guidelines Portal

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