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Valproic Acid Toxicity

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121. Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®): Health Professional Version

to be higher for children with Down syndrome. Rare germline variants with high penetrance. Germline variants that cause pathogenic changes in genes associated with ALL and that are observed in kindreds with familial ALL (i.e., large effect sizes) comprise another category of genetic predisposition to ALL. PAX5 . A germline variant in PAX5 that substitutes serine for glycine at amino acid 183 and that reduces PAX5 activity has been identified in several families that experienced multiple cases of ALL (...) .[ - ] Cytogenetic and genomic findings combined with minimal residual disease (MRD) results can define subsets of ALL with EFS rates exceeding 95% and, conversely, subsets with EFS rates of 50% or lower (refer to the and sections of this summary for more information). Despite the treatment advances in childhood ALL, numerous important biologic and therapeutic questions remain to be answered before the goal of curing every child with ALL with the least associated toxicity can be achieved. The systematic

2018 PDQ - NCI's Comprehensive Cancer Database

122. Malaria prophylaxis

impregnated bed nets. Consider the need for risk assessment. If the person has HIV, discuss options for chemoprophylaxis with their HIV physician who will make the decision on choice of agent. Ensure that parents/carers understand the importance of ensuring that children take chemoprophylaxis properly and complete the full course — maximum recommended doses must not be exceeded as antimalarials can be particularly toxic to children. Consider the need for if the person is visiting a remote area and likely (...) . Choose a recommended regimen based on The Advisory Committee on Malaria Prevention (ACMP) which can be found on the website. To reduce the risk of drug toxicity and resistance, the drug used for emergency standby medication should be different to the chemoprophylactic drug. Explain and provide written information on: When to start the medication — standby emergency medication should be started within 24 hours of onset of any clinical features of malaria (such as fever, chills or myalgia). For further

2018 NICE Clinical Knowledge Summaries

123. Urinary tract infection (lower) - men

to be contaminated. If the catheter has been changed, collect from newly placed catheter using aseptic technique, drain a few millilitres of residual urine from the tubing, then collect a fresh sample from the catheter sampling port. If the catheter has been removed, obtain a midstream specimen of urine. Specimens should be transported and processed with 4 hours unless boric acid preservative is used — if this is not possible it should be refrigerated at 4°C. Urine that has been refrigerated at 4°C for 48 hours (...) remains suitable for culture. If the sample is preserved with boric acid, it can be stored at room temperature prior to transport. Urine preserved with boric acid remains suitable for culture and microscopy for up to 96 hours. Note: boric acid may be inhibitory to some organisms and may inhibit tests for leukocyte esterase. It is essential to follow the manufacturer’s instructions on sample volume in boric acid containers. Interpreting urine culture results Interpreting urine culture results Generally

2018 NICE Clinical Knowledge Summaries

124. Trigeminal neuralgia

include: Lithuim — may result in enhanced neurotoxicity despite lithium plasma concentrations being within the therapeutic range. Paracetamol — long term co-administration may result in hepatotoxicity. Primidone, progabide, quetiapine, valproic acid, valnoctamide and valpromide — may result in raised plasma levels of the active metabolite carbamazepine-10,11-epoxide, increasing the risk of adverse reactions (e.g. dizziness, drowsiness, ataxia, diplopia). The dosage of carbemazepine should be adjusted (...) risk of hyponatraemia. The plasma concentration of carbamazepine may be increased (with an increased risk of toxicity) by the concomitant use of certain drugs, including: Acetazolamide. Antidepressants— fluoxetine, fluvoxamine, paroxetine, trazodone. Azole antifungals. Antivirals — protease inhibitors for HIV treatment (for example ritonavir). Cimetidine. Ciprofloxacin. Danazol. Dextropropoxyphene. Diltiazem. Isoniazid. Olanzapine. Omeprazole Verapamil. Vigabatrin. Carbamazepine accelerates

2018 NICE Clinical Knowledge Summaries

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

in fact be decreased [99,100]. Careful monitoring for evidence of self-harming or suicidal thoughts or behaviors is impor- tant inboth adult and pediatric patients. SSRIs and SNRIs are generally better tolerated and safer than TCAs and MAOIs, having less anticholinergic effects, toxicity, lethality, and psychomotor or cognitive impairment [85,101]. MAOIs are generally reserved for second- or third-line treatment because of side effects, drug interactions, and dietary restrictions [32]. Anxiolytics (...) therapies (see Sec- tions 3–9 for evidence and references). Anticonvulsants: Anticonvulsants are associated with gastrointestinal side effects, somnolence, weight gain, tremor, as well as dermatologic and hematologic side effects [111,118]. In addition, several anticonvulsants have a potential risk of serious rash, erythema multi- forme, Stevens-Johnson syndrome, or toxic epidermal necrolysis [111]. Regular monitoring of serum medica- tion levels and liver function is required for patients on divalproex

2014 CPG Infobase

126. CRACKCast E018 – Seizures

desaturates → intubate avoid long term neuromuscular blockade if possible (rare case where sux. could be used – consider checking K+ on a blood glass) consider EEG for monitoring of epileptiform brain activity Second-line agents: All agents are consensus based: all need to be given over 10 mins or so!!! Phenytoin – 20 mg/kg IV infusion Fosphenytoin (prodrug) – 20 mg/kg IV infusion  Less tendency to cause hypotension and dysrhythmias Phenobarbital – 20-30 mg/kg IV infusion Valproic Acid – 20-40 mg/kg (...) -of-hyponatremia-or-elevated-icp-with-bicarb-ampules/ 3) 3) What are the most common causes of status epilepticus? As per table 18-1: antiepileptic drug associated – withdrawal or under dose ~ 25% ETOH related – 15-25% drug toxicity / post-stroke / CVA / metabolic (lytes) / hypoxia / post-arrest – 35% others: infection, cerebral tumour, trauma, idiopathic – 15% This post was edited and uploaded by Rob Carey (@_Robcarey) (Visited 4,100 times, 1 visits today) Adam Thomas CRACKCast Co-founder and newly minted

2016 CandiEM

127. Drugs That May Cause or Exacerbate Heart Failure Full Text available with Trip Pro

of Care and Outcomes Research Originally published 11 Jul 2016 Circulation. 2016;134:e32–e69 You are viewing the most recent version of this article. Previous versions: Abstract Heart failure is a common, costly, and debilitating syndrome that is associated with a highly complex drug regimen, a large number of comorbidities, and a large and often disparate number of healthcare providers. All of these factors conspire to increase the risk of heart failure exacerbation by direct myocardial toxicity (...) . Hospitalization for HF is the largest segment of those costs. It is likely that the prevention of drug-drug interactions and direct myocardial toxicity would reduce hospital admissions, thus both reducing costs and improving quality of life. Patients with HF often have a high medication burden consisting of multiple medications and complex dosing regimens. On average, HF patients take 6.8 prescription medications per day, resulting in 10.1 doses a day. This estimate does not include over-the-counter (OTC

2016 American Heart Association

128. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection

Preparing people living with HIV for ART 72 CONTENTSvi Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection 4.2 What to expect in the first months of ART 74 4.3 When to start ART 74 4.4 What to start: first-line ART 97 4.5 Monitoring the response to ART and diagnosing treatment failure 127 4.6 Monitoring of and substitutions for ARV drug toxicities 136 4.7 Key ARV drug interactions 147 4.8 What ART regimen to switch to (second- and third-line ART) 150 5 (...) HSR hypersensitivity reaction HSV herpes simplex virus HTS HIV testing services IATT Interagency Task Team IBBS integrated biological and behavioural surveillance INSTI integrase strand transfer inhibitor (also known as integrase inhibitor) IPT isoniazid preventive therapy IRIS immune reconstitution inflammatory syndrome IVD in vitro diagnostics NAT nucleic acid test LA latex agglutination LAM lipoarabinomannan LF urine lateral flow (test for diagnosing TB) LGBTI lesbian, gay, bisexual

2016 World Health Organisation HIV Guidelines

130. Panobinostat (Farydak)

information 5. Patient has grade >2 peripheral neuropathy or grade 1 peripheral neuropathy with pain on clinical examination within 14 days before randomization 6. Patient received prior treatment with deacetylase inhibitors including panobinostat 7. Patient needing valproic acid for any medical condition during the study or within 5 days prior to first administration of panobinostat/study treatment 8. Patient taking any anti-cancer therapy concomitantly (bisphosphonates are permitted only if commenced (...) as deacetylase inhibitors, including valproic acid. Prophylactic anti-emetics such as granisetron could be administered at the discretion of the Investigator. However, anti-emetics

2014 FDA - Drug Approval Package

132. Management of Substance Use Disorder

in 2000 were tobacco (435,000 deaths; 18.1% of total U.S. deaths), poor diet and physical inactivity (365,000 deaths; 15.2%), and alcohol consumption (85,000 deaths; 3.5%). Other causes of death were microbial agents (75,000), toxic agents (55,000), motor vehicle crashes (43,000), incidents involving firearms (29,000), sexual behaviors (20,000), and illicit use of drugs (17,000).[7] From 1990-2010, the highest disability-adjusted life years, which accounted for years of life lost due to premature

2015 VA/DoD Clinical Practice Guidelines

133. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

randomized trial of 1-month prophylactic treatment with valproic acid showed no reduc- tion in incident seizures over 1-year follow-up (19.5% in the treatment group, 22.2% in the placebo group; P=0.8). 168 Prophylactic anticonvulsant medication has thus not been demonstrated to be beneficial. Clinical seizures or electrographic seizures in patients with a change in mental status should be treated with antisei- zure drugs. Continuous EEG monitoring should be considered in ICH patients with depressed

2015 Congress of Neurological Surgeons

134. Guidelines for the management of spontaneous intracerebral hemorrhage Full Text available with Trip Pro

reports. A small randomized trial of 1-month prophylactic treatment with valproic acid showed no reduction in incident seizures over 1-year follow-up (19.5% in the treatment group, 22.2% in the placebo group; P =0.8). Prophylactic anticonvulsant medication has thus not been demonstrated to be beneficial. Clinical seizures or electrographic seizures in patients with a change in mental status should be treated with antiseizure drugs. Continuous EEG monitoring should be considered in ICH patients

2015 American Academy of Neurology

135. Management of an unprovoked first seizure in adults

appear to be mild and reversible when an affected patient is switched to another AED. , AEDs included phenytoin, phenobarbital, carbamazepine, valproic acid, and lamotrigine, , , , , some of which may now be considered older AEDs but were standard, commonly used AEDs at the time of the studies. Although AEDs may cause different AEs, most events are known to be dose-related and reversible through dose reduction or discontinuation of the responsible drug. , Evidence from reports of AED AEs (...) ” seizure). We excluded studies of provoked seizures, which are defined as seizures due to an acute symptomatic condition (e.g., a metabolic or toxic disturbance, cerebral trauma, stroke) and differ in prognosis from unprovoked seizures. , , , This practice guideline considers the evidence for prognosis and treatment of adults with an unprovoked first seizure; a 2003 guideline addresses this for children. We posed 3 questions: (1) What are the risks for seizure recurrence after a first seizure? (2) Does

2015 American Academy of Neurology

136. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage Full Text available with Trip Pro

randomized trial of 1-month prophylactic treatment with valproic acid showed no reduc- tion in incident seizures over 1-year follow-up (19.5% in the treatment group, 22.2% in the placebo group; P=0.8). 168 Prophylactic anticonvulsant medication has thus not been demonstrated to be beneficial. Clinical seizures or electrographic seizures in patients with a change in mental status should be treated with antisei- zure drugs. Continuous EEG monitoring should be considered in ICH patients with depressed

2015 American Heart Association

137. Evidence-based Guideline: Management of First Unprovoked Seizure in Adults

appear to be mild and reversible when an affected patient is switched to another AED. , AEDs included phenytoin, phenobarbital, carbamazepine, valproic acid, and lamotrigine, , , , , some of which may now be considered older AEDs but were standard, commonly used AEDs at the time of the studies. Although AEDs may cause different AEs, most events are known to be dose-related and reversible through dose reduction or discontinuation of the responsible drug. , Evidence from reports of AED AEs (...) ” seizure). We excluded studies of provoked seizures, which are defined as seizures due to an acute symptomatic condition (e.g., a metabolic or toxic disturbance, cerebral trauma, stroke) and differ in prognosis from unprovoked seizures. , , , This practice guideline considers the evidence for prognosis and treatment of adults with an unprovoked first seizure; a 2003 guideline addresses this for children. We posed 3 questions: (1) What are the risks for seizure recurrence after a first seizure? (2) Does

2015 American Epilepsy Society

138. Acute Pain Management: Scientific Evidence

4.4.3 Local anaesthetic toxicity 109 4.5 Inhalational agents 111 4.5.1 Nitrous oxide 111 4.5.2 Methoxyflurane 114 4.6 NMDA-receptor antagonists 116 4.6.1 Systemic NMDA-receptor antagonists 116 4.6.2 Regional NMDA-receptor antagonists 121 4.7 Antidepressant medicines 122 4.7.1 Acute pain 122 4.7.2 Chronic pain 123 4.7.3 Specific pain conditions 123 4.8 Anticonvulsant medicines 125 4.8.1 Acute pain 125 4.8.2 Chronic pain 126 4.9 Alpha-2 agonists 127 4.9.1 Systemic alpha-2 agonists 127 4.9.2 Regional

2015 Clinical Practice Guidelines Portal

139. Renal replacement therapy in the management of intoxications in children: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) workgroup. (Abstract)

, methotrexate, phenytoin, acetaminophen, salicylates, valproic acid, and aminoglycosides. (...) experts from the PCRRT (Pediatric Continuous Renal Replacement Therapy) workgroup assessed titles, abstracts, and full-text articles for extraction of data. The data from the literature search was shared with the PCRRT workgroup and two expert toxicologists, and expert panel recommendations were developed.We have presented the recommendations concerning the use of RRTs for treatment of intoxications with toxic alcohols, lithium, vancomycin, theophylline, barbiturates, metformin, carbamazepine

2019 Pediatric Nephrology

140. A sub-chronic Xysmalobium undulatum hepatotoxicity investigation in HepG2/C3A spheroid cultures compared to an in vivo model. (Abstract)

kinase (AK). Sprague Dawley rats were treated with the same compounds over 21 days, with evaluation of in vivo toxicity effects on serum chemistry.The results from the in vitro study clearly indicated hepatotoxic effects and possible liver damage following treatment with valproic acid, with associated growth inhibition, loss of cell viability and increased cytotoxicity as indicated by reduced intracellular ATP levels and increased AK levels. These results were supported by the increased in vivo (...) the hepatotoxic and anti-prolific effects of the crude X. undulatum aqueous extract during a sub-chronic study (21 days), in both a 3D HepG2/C3A spheroid model and the Sprague Dawley rat model.HepG2/C3A spheroids were treated with a known hepatotoxin, valproic acid, and crude X. undulatum aqueous extract for 21 days with continuous evaluation of cell viability and proliferation. This was done by evaluating cell spheroid growth, intracellular adenosine triphosphate (ATP) levels and extracellular adenylate

2019 Journal of Ethnopharmacology

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