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aspirin and Reye syndrome

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101. Management of diabetes

8.1 Epidemiology 70 8.2 Cardiovascular risk factors 70 8.3 Primary prevention of coronary heart disease 71 8.4 Management of patients with diabetes and acute coronary syndromes 73 8.5 Management of patients with diabetes and heart failure 76 8.6 Management of patients with diabetes and stable angina 79 8.7 Management of acute stroke 81 8.8 Peripheral arterial disease 81 8.9 Checklist for provision of information 81 9 Management of kidney disease in diabetes 83 9.1 Definitions 83 9.2 Prevalence (...) systolic blood pressure in people with diabetes is 40 years regardless of baseline cholesterol. A Intensive lipid-lowering therapy with atorvastatin 80 mg should be considered for patients with diabetes and acute coronary syndromes, objective evidence of coronary heart disease on angiography or following coronary revascularisation procedures. 2.6 MANAGEMENT OF KIDNEY DISEASE IN DIABETES A Reducing proteinuria should be a treatment target regardless of baseline urinary protein excretion. However

2010 SIGN

102. Management of sore throat and indications for tonsillectomy

concerning the safety and efficacy of this combination in adults is lacking, but is available in children (see section 5.2). 5.2 Pain relief in children No RCTs were identified on the specific use of paracetamol, ibuprofen, or diclofenac alone or in comparison with each other in the treatment of acute sore throat in children. The recognised complications of aspirin therapy, including Reye’s syndrome in children, make this agent less suitable for general use, and its use as an analgesic is contraindicated (...) are superior to paracetamol and aspirin in reducing throat pain as early as one hour post dose. 24-26 Ibuprofen is available over the counter and is only slightly more expensive than paracetamol. A large blinded randomised controlled trial (RCT) involving 8,633 European adults showed that ibuprofen is as well tolerated as paracetamol and produces fewer serious gastrointestinal adverse effects, irrespective of patient age, in short courses for acute pain. 27 Ibuprofen should not be routinely given to adults

2010 SIGN

103. Extracranial Carotid and Vertebral Artery Disease: Guideline on the Management of Patients With

of Hyperlipidemia e37 6.4. Management of Diabetes Mellitus e39 6.4.1. Recommendations for Management of Diabetes Mellitus in Patients With Atherosclerosis of the Extracranial Carotid or Vertebral Arteries e39 6.5. Hyperhomocysteinemia e39 6.6. Obesity and the Metabolic Syndrome e40 6.7. Physical Inactivity e40 6.8. Antithrombotic Therapy e40 6.8.1. Recommendations for Antithrombotic Therapy in Patients With Extracranial Carotid Atherosclerotic Disease Not Undergoing Revascularization e40 6.8.2. Nonsteroidal (...) Interventions for Vertebral Artery Disease e63 9. Diseases of the Subclavian and Brachiocephalic Arteries e64 9.1. Recommendations for the Management of Patients With Occlusive Disease of the Subclavian and Brachiocephalic Arteries e64 9.2. Occlusive Disease of the Subclavian and Brachiocephalic Arteries e64 9.3. Subclavian Steal Syndrome e64 9.4. Revascularization of the Brachiocephalic and Subclavian Arteries e65 e18 Brott et al. JACC Vol. 57, No. 8, 2011 ECVD Guideline: Full Text February 22, 2011:e16

2011 American College of Cardiology

104. Guideline on the management of patients with extracranial carotid and vertebral artery disease

of Hyperlipidemia .e75 6.3.1. Recommendations for Control of Hyperlipidemia .e75 6.4. Management of Diabetes Mellitus .e76 6.4.1. Recommendations for Management of Diabetes Mellitus in Patients With Atherosclerosis of the Extracranial Carotid or Vertebral Arteries .e76 6.5. Hyperhomocysteinemia .e77 6.6. Obesity and the Metabolic Syndrome .e77 6.7. Physical Inactivity .e77 6.8. Antithrombotic Therapy .e78 6.8.1. Recommendations for Antithrombotic Therapy in Patients With Extracranial Carotid Atherosclerotic (...) and Brachiocephalic Arteries .e102 9.3. Subclavian Steal Syndrome .e102 e56 Circulation July 26, 2011 Downloaded from http://ahajournals.org by on March 27, 20199.4. Revascularization of the Brachiocephalic and Subclavian Arteries .e102 10. Special Populations .e103 10.1. Neurological Risk Reduction in Patients With Carotid Artery Disease Undergoing Cardiac or Noncardiac Surgery .e103 10.1.1. Recommendations for Carotid Artery Evaluation and Revascularization Before Cardiac Surgery .e103 10.1.2. Neurological Risk

2011 American Academy of Neurology

105. Guideline on the Management of Patients with Extracranial Carotid and Vertebral Artery Disease

of Hyperlipidemia .e75 6.3.1. Recommendations for Control of Hyperlipidemia .e75 6.4. Management of Diabetes Mellitus .e76 6.4.1. Recommendations for Management of Diabetes Mellitus in Patients With Atherosclerosis of the Extracranial Carotid or Vertebral Arteries .e76 6.5. Hyperhomocysteinemia .e77 6.6. Obesity and the Metabolic Syndrome .e77 6.7. Physical Inactivity .e77 6.8. Antithrombotic Therapy .e78 6.8.1. Recommendations for Antithrombotic Therapy in Patients With Extracranial Carotid Atherosclerotic (...) and Brachiocephalic Arteries .e102 9.3. Subclavian Steal Syndrome .e102 e56 Circulation July 26, 2011 Downloaded from http://ahajournals.org by on March 27, 20199.4. Revascularization of the Brachiocephalic and Subclavian Arteries .e102 10. Special Populations .e103 10.1. Neurological Risk Reduction in Patients With Carotid Artery Disease Undergoing Cardiac or Noncardiac Surgery .e103 10.1.1. Recommendations for Carotid Artery Evaluation and Revascularization Before Cardiac Surgery .e103 10.1.2. Neurological Risk

2011 Congress of Neurological Surgeons

106. Oral anticoagulation with warfarin - 4th edition

the INR target to 3·5 (2C). 1.2 Antiphospholipid syndrome (APS) A retrospective study of 147 patients (54% with venous thrombosis) had suggested that a target INR of 3·5 was preferable to a target INR of 2·5 ( ). There are two prospective randomized trials. randomized 114 patients with antiphospholipid antibodies (aPL) and thrombosis (76% venous, 24% arterial) to a target INR of 2·5 or 3·5 and followed them for a mean of 2·7 years. Recurrences were 2/58 (3·4%) in the low intensity group and 6/56 (10·7 (...) ) The risk of cardio‐embolic stroke should be assessed by considering concurrent risk factors that predict stroke risk. These include a history of previous transient ischaemic attack (TIA) or stroke, hypertension, diabetes, heart failure and consideration of the patient’s age. Patients at low risk of cardio‐embolic stroke may be treated with aspirin while increasing stroke risk favours treatment with the more effective warfarin ( ; ). Evidence comparing the efficacy of different anticoagulation regimens

2011 British Committee for Standards in Haematology

107. DuoPlavin - clopidogrel / acetylsalicylic acid

, respectively. Repeat dose toxicity data for ASA show specific effects of ASA on other target organs comprising the central nervous, cardiovascular and respiratory systems, sensory organs, kidney and in Reye’s syndrome. The main toxicological finding at doses up to 400 mg/kg/day clopidogrel correspond to increased liver weight associated with hypertrophy of the smooth endoplasmic reticulum in centrilobular hepatocytes corresponding to an effect on hepatic enzymes. The no-effect level, based on increased (...) for the following indication: DuoPlavin is indicated for the prevention of atherothrombotic events in adult patients already taking both clopidogrel and acetylsalicylic acid (ASA). DuoPlavin is a fixed-dose combination product for continuation of therapy in: ? Non-ST segment elevation acute coronary syndrome (unstable angina or non-Q-wave myocardial infarction) including patients undergoing a stent placement following percutaneous coronary intervention ? ST segment elevation acute myocardial infarction

2010 European Medicines Agency - EPARs

108. DuoCover - clopidogrel / acetylsalicylic acid

data for ASA show specific effects of ASA on other target organs comprising the central nervous, cardiovascular and respiratory systems, sensory organs, kidney and in Reye’s syndrome. The main toxicological finding at doses up to 400 mg/kg/day clopidogrel correspond to increased liver weight associated with hypertrophy of the smooth endoplasmic reticulum in centrilobular hepatocytes corresponding to an effect on hepatic enzymes. The no-effect level, based on increased liver weight, is 27 mg/kg/day (...) indication: DuoCover is indicated for the prevention of atherothrombotic events in adult patients already taking both clopidogrel and acetylsalicylic acid (ASA). DuoCover is a fixed-dose combination product for continuation of therapy in: ? Non-ST segment elevation acute coronary syndrome (unstable angina or non-Q-wave myocardial infarction) including patients undergoing a stent placement following percutaneous coronary intervention ? ST segment elevation acute myocardial infarction in medically treated

2010 European Medicines Agency - EPARs

109. Teething

, lethargy, and photophobia following excessive use of choline salicylate 8.7% gel (one 15 g tube over 24 hours, equivalent to 930 mg aspirin) [ ]. A diagnosis of suspected Reye's syndrome was made by the authors of the case report after exclusion of metabolic disorders and because the systemic salicylate concentration was just above the therapeutic range. However, a review by the MHRA and CHM concluded that a diagnosis of salicylate toxicity was more likely, given the high dose of salicylate (...) and the fact that the diagnostic criteria for Reye's syndrome were not fully met [ ]. In line with advice for aspirin, they recommended that topical oral salicylate preparations should be contraindicated in children younger than 16 years of age, because: Although the threshold salicylate concentration to precipitate Reye's syndrome is unknown, there is a theoretical risk that the excessive use of choline salicylate gels could increase the risk of Reye's syndrome. There are alternative treatment options

2014 NICE Clinical Knowledge Summaries

110. A Trial on the Efficacy, Safety and Immunogenicity of Live-Attenuated Influenza Vaccine (LAIV)

to any component of the LAIV, including egg or egg products. Severe allergic reactions after vaccination (including anaphylactic shock, allergic laryngeal edema, allergic purpura, local allergic necrosis). Acute diseases , infections or febrile diseases (axillary temperature ≥37.1℃) on the day of vaccination. Obvious coagulation dysfunction or History of anticoagulant therapy Aspirin is being used(Salicylates are a potential risk factor for Reye syndrome) Known or suspected immune deficiency diseases (...) or device) was used within 30 days, or planned to be used during the trial. have been vaccinated with any influenza vaccine within 6 months, or plan to be vaccinated during the trail. Immunosuppressive agents or other immunomodulatory drugs (defined as continuous use for more than 14 days) were used over a 3-month period. Immunoglobulins and / or any blood products were used within 3 months, or planned to be used before blood collection. History of Guillain-Barré syndrome; History of hypersensitivity

2016 Clinical Trials

111. J K Aronson – The Hitchhiker’s Guide to Clinical Pharmacology Part 2

Etomidate 1983 Adrenal suppression Uses restricted Zimeldine 1983 Hypersensitivity Withdrawn Zomepirac 1983 Anaphylaxis Withdrawn Fenclofenac 1984 Lyell’s syndrome Withdrawn Indoprofen 1984 Gastrointestinal bleeding/perforation Withdrawn Osmosin ® 1984 Gastrointestinal ulceration/perforation Withdrawn Phenylbutazone 1984 Blood dyscrasias Uses restricted; later withdrawn Aspirin 1986 Reye’s syndrome (children) Uses restricted Bupropion 1986 Seizures Withdrawn; later reintroduced Nomifensine 1986 (...) -glucuronide Procainamide Acecainide Spironolactone Canrenone Sulfasalazine Mesalazine Terfenadine Fexofenadine Other drugs that were discovered independently and that are metabolized to active compounds include codeine, diamorphine, and tramadol (all metabolized to morphine), tamoxifen (metabolized to 4-hydroxytamoxifen), and aspirin (metabolized to salicylate). In some cases active metabolites cause adverse effects; these include the metabolites of lidocaine (the glycine xylidides) and pethidine

2016 CEBM blog

112. Guidelines on Diagnosis and Treatment of Pulmonary Hypertension

haemangiomatosis remain dif?cult disorders to classify since they share some Table 6 Clinical classi?cation of congenital, systemic-to-pulmonary shunts associated with pulmonary arterial hypertension A. Eisenmenger’s syndrome Eisenmenger’s syndrome includes all systemic-to-pulmonary shunts due to large defects leading to a severe increase in PVR and resulting in a reversed (pulmonary-to-systemic) or bidirectional shunt.Cyanosis,erythrocytosis,andmultipleorganinvolvementare present. B. Pulmonary arterial (...) in PAH patients with a personal or family history of hereditary haemorrhagic telangiectasia (Osler– Weber–Rendu syndrome). 31 A number of risk factors for the development of PAH have been identi?ed and are de?ned as any factor or condition that is suspected to play a predisposing or facil- itating role in the development of the disease. Risk factors were classi?ed as de?nite, likely, possible, or unlikely based on the strength of their association with PH and their probable causal role. 1 A de?nite

2009 European Society of Cardiology

113. Vaccine safety and adverse events following immunisation

drugs around the time of vaccination may lower antibody responses to some vaccines (Prymula et al., 2009). Aspirin, or medicines that contain aspirin should never be given to children under 16 years old because of the risk of developing Reye’s syndrome. Thiomersal Thiomersal is a mercury based compound has been used as a preservative in the manufacture of some vaccines for many years. In the UK, none of the routine childhood vaccines contain thiomersal. Two vaccines (Anthrax and the Green Cross

2009 The Green Book

114. Upper Respiratory Tract Infection (Overview)

. Lymphadenitis may follow or accompany URI. Guillain-Barré syndrome may manifest as an ascending polyneuropathy a few days or weeks after a URI. In children or adolescents, the use of aspirin during a viral infection may rarely cause Reye syndrome. Aspirin is contraindicated for the management of fevers in children or adolescents. URI, especially with fever, may increase the work of the heart, adding strain to persons with suboptimal cardiovascular status, and can lead to cardiovascular decompensation (...) > Upper Respiratory Tract Infection Updated: Jun 21, 2018 Author: Anne Meneghetti, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP Share Email Print Feedback Close Sections Sections Upper Respiratory Tract Infection Overview Practice Essentials Upper respiratory tract infection (URI) represents the most common acute illness evaluated in the outpatient setting. URIs range from the common cold—typically a mild, self-limited, catarrhal syndrome of the nasopharynx—to life-threatening illnesses

2014 eMedicine.com

115. Viral Infections of the Mouth (Overview)

multiforme. [ ] Patients should be counseled about the routes of infectivity. Medical care for primary HHV-1/HHV-2 The goals of treatment are to make the patient comfortable and to prevent secondary infections or worsening systemic illness. The patient should maintain fluid intake and a balanced diet with the use of liquid food replacement if necessary. Analgesics, such as acetaminophen, may make the patient more comfortable. Aspirin should be avoided in pediatric patients because of the possibility

2014 eMedicine.com

116. Dengue (Overview)

and supportive care, fatalities are rare. Convalescence is slow. Aspirin and NSAIDs are discouraged owing to potential platelet dysfunction causing bleeding. Children who receive aspirin are at risk of developing Reyes syndrome; therefore, they should never receive aspirin when Dengue fever is suspected. The mortality rate of DSS is reported to be 2%. Exposure to a serotype besides the 4 mentioned can lead to DHF or DSS, which have serious complications and may be fatal. DSS can occur after DHF (...) in limited areas of Africa. Previous Next: Epidemiology Occurrence in the United States In the continental United States, dengue occurs only in the season when mosquitoes breed actively (warm weather). Since the 1970s, outbreaks of dengue fever, dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) have increased in frequency and severity in the Caribbean and the Americas. In the past 2 years, an increasing number of reports of dengue fever have occurred in the United States, particularly from

2014 eMedicine.com

117. Chickenpox (Overview)

and immunocompromised populations. Previous Next: Patient Education Parents of infected children should be instructed to trim their children’s fingernails to minimize skin damage from scratching and the associated complications of bacterial superinfection. Also, it is important to advise parents not to use aspirin for fever control, because the development of Reye syndrome is associated with salicylate administration in children with chickenpox. For patient education resources, see the . Also, see the patient (...) immune globulin (VZIG) is indicated for use in highly susceptible, VZV-exposed immunocompromised or immunosuppressed populations. A live attenuated varicella vaccine (Oka strain) was approved by the US Food and Drug Administration in 1995 for prophylactic use in healthy children and adults. (See , , and .) Next: Background The varicella-zoster virus (VZV) (see the image below) is the etiologic agent of the clinical syndrome of chickenpox (varicella). Zoster, a different clinical entity, is caused

2014 eMedicine.com

118. Toxicity, Salicylate (Overview)

. Repackaging has decreased children's accessibility to lethal amounts, and salicylate's association with Reye syndrome has significantly decreased its use. Still, more than 10,000 tons of aspirin are consumed in the United States each year. Aspirin or aspirin-equivalent preparations (in milligrams) include children's aspirin (80-mg tablets with 36 tablets per bottle), adult aspirin (325-mg tablets), methyl salicylate (eg, oil of wintergreen; 98% salicylate), and Pepto-Bismol (236 mg of non-aspirin (...) to moderate pain. Aspirin is used as an antipyretic and as an anti-inflammatory agent for the treatment of soft tissue and joint inflammation and vasculitides such as acute rheumatic fever and Kawasaki disease. Aspirin is also used to treat acute coronary syndrome. Low-dose aspirin helps to prevent thrombosis. Acetylsalicylic acid is colorless or white in crystalline, powder, or granular form. The chemical is odorless and is soluble in water. Salicylate is available for ingestion as tablets, capsules

2014 eMedicine.com

119. Drug-Induced Hepatotoxicity (Overview)

, myalgia, stiffness, weakness, elevated creatine kinase level) Procainamide - Antinuclear antibodies (ANAs) Gold salts, propylthiouracil, chlorpromazine, chloramphenicol - Marrow injury Amiodarone, nitrofurantoin - Associated pulmonary injury Gold salts, methoxyflurane, penicillamine, paraquat - Associated renal injury Tetracycline - Fatty liver of pregnancy Contraceptive and anabolic steroids, rifampin - Bland jaundice Aspirin - Reye syndrome Sodium valproate - Reyelike syndrome Pathological (...) or Gilbert syndrome. Conjugated hyperbilirubinemia (>50% of the total bilirubin is direct) suggests hepatocellular dysfunction or cholestasis. When the bilirubin level is above 25-30 mg/dL, extrahepatic cholestasis is an unlikely diagnosis; because the predominantly conjugated bilirubin is water soluble, it is easily excreted by the kidney in extrahepatic cholestasis. Subfulminant hepatic failure most commonly results from acetaminophen, halothane, methoxyflurane, enflurane, trovafloxacin, troglitazone

2014 eMedicine.com

120. Head Injury (Overview)

, and primitive reflexes; may be manifestations of a localized contusion or an early herniation syndrome See for more detail. Diagnosis Bedside cognitive testing In the acute setting, measurements of the patient's level of consciousness, attention, and orientation are of primary importance. Some patients acutely recovering from head trauma demonstrate no ability to retain new information. Mental status assessments have validated the prognostic value of the duration of posttraumatic amnesia; patients (...) Trails B test: Allows further qualitative testing of frontal functioning Laboratory studies Sodium levels: Alterations in serum sodium levels occur in as many as 50% of comatose patients with head injuries [ ] ; hyponatremia may be due to the syndrome of inappropriate antidiuretic hormone (SIADH) or cerebral salt wasting; elevated sodium levels in head injury indicate simple dehydration or diabetes insipidus Magnesium levels: These are depleted in the acute phases of minor and severe head injuries

2014 eMedicine.com

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