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Pruritus in Pregnancy

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261. Evaluation of Abnormal Liver Chemistries

for chronic hepatitis B is conducted with HBsAg testing. Testing for acute hepatitis B is with HBsAg and IgM anti-HBc. The following groups are at highest risk: persons born in endemic or hyperendemic areas (HBsAg prevalence >2%), men who have sex with men, persons who have ever used injection drugs, dialysis patients, HIV-infected individuals, pregnant women, and family members, household members, and sexual contacts of HBV-infected persons. (Strong recommendation, very low level of evidence). 4. Testing (...) , primary sclerosing cholangitis; ULN, upper limit of normal. Kwo et al. The American Journal of GASTROENTEROLOGY VOLUME 112 | JANUARY 2017 www.nature.com/ajg 20 meal due to increased levels of intestinal alkaline phosphatase ( 8 ). Alkaline phosphatase may be elevated during pregnancy due to placental synthesis of alkaline phosphatase. Typically, alkaline phosphatase elevates with obstruction of the bile ducts, which is due to increased canalicular synthesis of alkaline phosphatase with subsequent

2017 American College of Gastroenterology

262. Low Back Pain

POPULATION Adult patients 18 years or older in primary care settings EXCLUSIONS Pregnant women; patients under the age of 18 years; diagnosis or treatment of specific causes of low back pain such as: surgical conditions including instability; referred pain (from abdomen, kidney, ovary, pelvis, bladder); inflammatory conditions (rheumatoid arthritis, ankylosing spondylitis); infections (discitis, osteomyelitis, epidural abscess); degenerative and structural changes (spondylosis, spondylolisthesis, gross (...) , urtcaria, minute hemorrhagic spots, vesiculation or dermatitis, sensation of warmth locally, and pruritus. Patients should be advised to read the product ingredients to ensure they are getting the correct amount and correct product mentioned in the recommendation. It is important to be aware that a product could list on the label different extracts of the same active ingredient (e.g., devil’s Claw and wood spider). Devil’s Claw, Salix, and Capsicum frutescens are currently regulated by Health Canada

2017 Accelerating Change Transformation Team

263. Rifaximin for preventing episodes of overt hepatic encephalopathy

in the abdominal cavity), rashes, pruritus (itching), muscle spasms, arthralgia (joint pain), and peripheral oedema (swelling). For full details of adverse reactions and contraindications, see the summary of product characteristics. 2.3 Rifaximin is available as 550 mg film-coated tablets at a net price of £259.23 per 56-tablet pack (excluding VAT; British national formulary online [accessed December 2014]). It is administered orally at a recommended dose of 550 mg twice daily. The company estimated an average (...) and 84.9% in the placebo group). People could stop treatment if they had an adverse event with an unacceptable risk to them, developed any condition meeting the exclusion criteria, had a breakthrough episode of overt hepatic encephalopathy, became pregnant or asked to be withdrawn. 3.3 The primary outcome in RFHE3001 was time to first breakthrough episode of overt hepatic encephalopathy. An episode of overt hepatic encephalopathy was defined as an increase in the Conn score from 0 or 1 to 2 or more

2015 National Institute for Health and Clinical Excellence - Technology Appraisals

264. Heart failure - chronic: Managing angiotensin-converting enzyme inhibitors

blood pressure due to increased hypotensive effect. [ ; ; ; ; ; ; ; ] ACE-inhibitors in pregnancy and breastfeeding Pregnancy [ ; ; ; ; ] Angiotensin-converting enzyme (ACE) inhibitors are not recommended during the first trimester of pregnancy. Evidence on the risk of teratogenicity in the first trimester of pregnancy is conflicting, and an increase in the risk of congenital malformation (particularly of the cardiovascular and central nervous system) cannot be excluded. ACE-inhibitors (...) sleeping) and other causes have been ruled out, consider switching to an . Angio-oedema — higher incidence reported in Afro-Caribbean people. Angio-oedema may be of delayed onset. Rash (may be associated with pruritus and urticaria). Gastrointestinal symptoms including taste disturbances, nausea, vomiting, dyspepsia, diarrhoea, constipation, and abdominal pain. Pancreatitis , altered liver function tests, cholestatic jaundice, hepatitis, fulminant hepatic necrosis, hepatic failure — discontinue

2020 NICE Clinical Knowledge Summaries

265. Hirsutism: Topical eflornithine

(such as shaving or waxing) may be used in conjunction with topical eflornithine. In such cases, the cream should be applied no sooner than five minutes after the use of the hair removal method because increased stinging or burning may otherwise occur. [ ; ] What are the contraindications and cautions for eflornithine? The manufacturer advises that topical eflornithine should not be used in: Pregnant women — the potential risk of topical eflornithine to human pregnancy is unknown. Breastfeeding women (...) barbae; alopecia; stinging, burning, tingling, or dry skin; pruritus; erythema; skin irritation; rash; and folliculitis. If skin irritation or intolerance develops, the frequency of application should be reduced temporarily to once a day. Stop treatment if irritation continues. [ ] What drug interactions occur with eflornithine? There are no known drug interactions with topical eflornithine — no interaction studies have been carried out. [ ] © .

2020 NICE Clinical Knowledge Summaries

266. Acne vulgaris: Azelaic acid

, then apply twice daily. If skin irritation occurs reduce the amount used or frequency of application to once a day until the irritation ceases — temporarily interrupt treatment for a few days if required. Contraindications and cautions Hypersensitivity to the active substance or to any of the excipients. Avoid contact with eyes; avoid contact with mouth; avoid contact with mucous membranes. Caution is advised if considering prescribing to pregnant of breastfeeding women. Adverse effects Skin irritation (...) including dryness, discomfort, erythema, peeling, contact dermatitis, pruritus, and skin discoloration. Worsening of asthma (rare). [ ; ; ; ] © .

2020 NICE Clinical Knowledge Summaries

267. Immunizations - travel: Scenario: Meningococcal meningitis

reaction to any component of the vaccine. Postpone quadrivalent meningococcal vaccination if the person has a current severe febrile illness. Minor illness without fever or systemic upset is not a valid reason to postpone immunisation. Meningococcal vaccines may be given to pregnant women when clinically indicated. There is no evidence of risk from vaccinating pregnant women or those who are breast-feeding with inactivated virus, bacterial vaccines or toxoids. Basis for recommendation The information (...) on contraindications to quadrivalent meningococcal vaccination is based on expert opinion in the Department of Health publication Immunisation against infectious disease (The Green Book) [ ]. Adverse effects Menveo ® Commonly reported reactions include injection site reactions (such as pain, erythema, induration, and pruritus), headache, nausea, rash, and malaise. Nimenrix ® Commonly reported reactions include injection site reactions (such as pain, erythema, and swelling), headache, nausea, irritability

2020 NICE Clinical Knowledge Summaries

268. Chronic obstructive pulmonary disease: Antibiotics

and subcutaneous tissue — rash, pruritus (common); Stevens-Johnson syndrome (uncommon); drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalised exanthematous pustulosis (AGEP) (rare); toxic epidermal necrolysis, erythema multiforme (frequency unknown). Other common adverse effects include: Anorexia. Arthralgia. Deafness. Fatigue. Visual impairment. Other adverse effects include: Acute kidney injury. QT interval prolongation. Drug interactions Antacids — plasma concentrations (...) pseudomembranous colitis and haemorrhagic colitis). For more information, see the CKS topic on . Skin — skin rash (common), urticaria and pruritus (uncommon). Very rarely: erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, bullous and exfoliative dermatitis and acute generalised exanthematous pustulosis. Other rare or very rare adverse effects include: Hepatitis, cholestatic jaundice. Hyperkinesia, dizziness, convulsions. Interstitial nephritis. Leucopenia, thrombocytopenia, haemolytic

2020 NICE Clinical Knowledge Summaries

269. Hypothyroidism: Levothyroxine

changes due to hypothyroidism. With longstanding hypothyroidism — levothyroxine should be introduced very gradually to avoid any sudden increase in metabolic demands. With diabetes mellitus — treatment with levothyroxine may increase blood glucose levels. The dose of anti-diabetic drugs may need to be increased. Who are breastfeeding or pregnant — levothyroxine therapy should be supervised by an endocrinology specialist. Who are elderly — levothyroxine therapy should be introduced gradually to avoid (...) . Cardiovascular — such as angina, arrhythmias, palpitations, and tachycardia. Immunological — such as hypersensitivity reactions (including rash, pruritus, urticaria, and oedema). Metabolic — such as weight loss. Musculoskeletal — such as arthralgia and muscle weakness. Neurological — such as anxiety, tremor, restlessness, excitability, insomnia. Psychiatric — may induce mania. Reproductive — menstrual irregularities. General — such as headache, flushing, sweating, fever, heat intolerance. [ ; ] Drug

2020 NICE Clinical Knowledge Summaries

270. Seborrhoeic dermatitis: Scenario: Seborrhoeic dermatitis - scalp and beard

Eczema Association — . Treat seborrhoeic dermatitis of the scalp and beard in adolescents and adults with: Ketoconazole 2% shampoo (twice a week for 4 weeks, then once every 1-2 weeks for maintenance) or selenium sulphide shampoo (twice a week for 2 weeks [contraindicated in pregnancy]). Scales can be removed before shampooing by applying warm mineral or olive oil (for mild crusting) or a keratolytic preparation (for example salicylic acid and coconut oil for thicker scale) for several hours before (...) (four weeks or less) (relative risk (RR) 3.76, 95% confidence interval (CI) 1.22 to 11.56, three RCTs, 313 participants) and in one long-term trial (lasting 12 weeks). Steroids were also more effective in reducing erythema, scaling, and pruritus. Adverse effects were similar in both groups. Prevention of recurrence The recommendation to use an antifungal shampoo once a week or once every two weeks to prevent recurrence is based on expert opinion [ ; ; ; ; ; ; ; ]. Continuous long-term use of topical

2020 NICE Clinical Knowledge Summaries

271. Hospital-acquired pneumonia caused by methicillin-resistant Staphylococcus aureus: telavancin

(between 1 in 10 and 1 in 100). T elavancin is contraindicated in pregnancy (potential risk of teratogenicity). The SPC states that there is a risk of QT c prolongation with telavancin. Hospital-acquired pneumonia caused by methicillin-resistant Staphylococcus aureus: telavancin (ESNM44) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 21P Patient factors atient factors T elavancin should be given as an intravenous (...) hours. All patients receiving telavancin should have their renal function monitored daily for at least the first 3 to 5 days of treatment and every 48 to 72 hours thereafter. Hospital-acquired pneumonia caused by methicillin-resistant Staphylococcus aureus: telavancin (ESNM44) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5 of 21T elavancin is contraindicated in pregnancy (potential risk of teratogenicity

2014 National Institute for Health and Clinical Excellence - Advice

272. Screening for asymptomatic bacteriuria within the framework of the German maternity guidelines, under special consideration of test methods

for asymptomatic bacteriuria in pregnant women 19 February 2015 Institute for Quality and Efficiency in Health Care (IQWiG) - 3 - assessment this leads to the conclusion that there is no hint, indication, or proof of a reduction in the occurrence of lower UTIs. Information on the outcome “neonatal morbidity” (for the outcome “kernicterus”) was available in one study. Information on the outcome “adverse events” was available for several events (vomiting, skin rash/pruritus, photosensitivity, and discontinuation (...) original text is absolutely authoritative and legally binding. Executive Summary IQWiG Reports – Commission No. S13-02 Screening for asymptomatic bacteriuria within the framework of the German maternity guidelines, under special consideration of test methods 1 Executive summary of final report S13-02 Version 1.0 Screening for asymptomatic bacteriuria in pregnant women 19 February 2015 Institute for Quality and Efficiency in Health Care (IQWiG) - i - Publishing details Publisher: Institute for Quality

2015 Institute for Quality and Efficiency in Healthcare (IQWiG)

274. Tagrisso - osimertinib

was considered acceptable by the CHMP (see discussion on non-clinical aspects). Reproduction Toxicity Osimertinib has been evaluated in a modified rat embryo-foetal development study that included an assessment of pre-implantation pregnancy and a littering phase. Studies on male and female fertility, embryo-foetal development in rabbits and a pre-and postnatal development study in rats were not submitted. Fertility and early embryonic development In repeat dose toxicity studies, an increased incidence

2016 European Medicines Agency - EPARs

276. Episalvan - birch bark extract

and infestations 32 (11.4) 21 (10.0) 11 (15.9) Wound infection 11 (3.9) 7 (3.3) 4 (5.8) Skin infection 13 (4.6) 7 (3.3) 6 (8.7) Skin and subcutaneous tissue disorders 29 (10.4) 26 (12.3) 3 (4.3) Pain of skin 15 (5.4) 12 (5.7) 3 (4.3) Pruritus 13 (4.6) 13 (6.2) 0 Safety Analysis Set: all patients who received at least a single application of Oleogel-S10. Use in Pregnancy and Lactation There is no clinical experience of Episalvan gel in pregnant or lactating women. No effects during pregnancy are anticipated (...) and other concentrations and formulations of Episalvan gel. In the pooled analysis of safety, one or more AEs were reported for a total of 35% of patients. The SOCs with highest incidence were infections and infestations (11%), injury, poisoning and procedural complications (8%) and skin and subcutaneous tissue disorders (10%). Most frequent AEs (by preferred term) comprised pyrexia and wound infection, skin infection, pain of skin and pruritus, each reported at a rate of 4 6%. Regarding AEs classified

2016 European Medicines Agency - EPARs

277. Neofordex - dexamethasone. To treat adults with multiple myeloma

fertility are contradictory (SmPC, section 5.3). Women should avoid pregnancy during Neofordex treatment. Dexamethasone may cause congenital malformations. Dexamethasone may be used with known teratogens (e.g. thalidomide, lenalidomide, pomalidomide, plerixafor), or with cytotoxic substances which are not recommended in pregnancy. Patients receiving Neofordex in combination with products containing thalidomide, lenalidomide or pomalidomide should adhere to the pregnancy prevention programmes of those

2016 European Medicines Agency - EPARs

279. Acute pain management: scientific evidence, fourth edition, 2015

). Furthermore, specific clinical situations, such as post-operative pain and acute medical and cancer pain, are addressed, as well as acute pain in specific settings (eg, burns units, intensive care units, emergency departments). Pain in children is dealt with for the first time in a detailed section presenting evidence-based management for this complex and challenging group. Other groups covered in detail are pregnant women, older patients, and patients with opioid tolerance or with an addiction (...) -operative setting, which, compared with single-injection peripheral nerve blocks, result in improved pain control, decreased need for opioid analgesics, reduced nausea and improved patient satisfaction. Compared with opioid analgesia, continuous peripheral nerve blocks (regardless of catheter location) provide better post-operative analgesia and reductions in opioid use as well as decreased nausea, vomiting, pruritus and sedation. The use of ultrasound guidance to perform blocks increases block success

2016 MJA Clinical Guidelines

280. Australian recommendations for the management of hepatitis C virus infection: a consensus statement

during DAA therapy. Pregnancy, breastfeeding and children As there are no safety data for the use of any DAA regimen during pregnancy, treatment of pregnant women is not recommended. Ribavirin (classed as Category X) and pegIFN are contraindicated during pregnancy. Both women and men should be counselled about the risk of teratogenicity and the importance of avoiding pregnancy during and for 6 months after ribavirin treatment. As noted above, women treated with PrOD should avoid ethinyl estradiol (...) . The most commonly reported adverse effects are nausea, pruritus and insomnia; these are uncommon and mild in most people. Rises in serum alanine aminotransferase (ALT) levels have been rarely observed, particularly among women taking ethinyl estradiol-containing contraceptives, which should be stopped before treatment. Alternative contraceptive agents (eg, progestin-only contraception) or methods are recommended. Transient isolated hyperbilirubinaemia may be seen early (Weeks 1–2) but typically

2016 MJA Clinical Guidelines

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