Objectives. VZV breaks out of the nerve cell body and travels down the nerve axons causing an infection of the skin in the region of the nerve
|
|
- Doris Murphy
- 6 years ago
- Views:
Transcription
1 Deena B. Hollingsworth MSN, FNP-BC ENT Specialists of Northern Virginia Falls Church, Virginia Objectives Describe common signs and symptoms of herpes zoster Discuss the pathophysiology and diagnosis of herpes zoster involving the head and neck A virus by any other name Herpes Zoster Zoster Shingles Zona Ramsey Hunt Discuss the pharmacologic management of herpes zoster Participate in an interactive discussion of the care of patients with herpes zoster. Cutaneous eruption of a viral disease characterized by a painful, unilateral, linear rash. Chicken pox Caused by varicella zoster virus ( VZV) Original infection acute, short lived Usually in children VZV becomes latent in the nerve cell bodies without symptoms Reactivates years later as zoster VZV breaks out of the nerve cell body and travels down the nerve axons causing an infection of the skin in the region of the nerve Can spread from one or more ganglia and infect the corresponding dermatome
2 More common in individuals: over age 60 Varicella infection under 1 year Immune compromised Signs & Symptoms Early symptoms are nonspecific and may lead to incorrect diagnosis (headache, fever, malaise) Followed by sensations of burning pain, itching, hyperesthesia, or parathesia Pain can vary from mild to extreme in the affected dermatome Stinging, tingling, aching, numbing or throbbing sensations with intermittent quick stabbing pain Initial phase pain, parathesia Lasts 1-2 days but up to 3 weeks Rash appears more commonly on the torso but follows the affected dermatome face, eyes, ears,neck Often painless in children Rash starts as red patches followed by small blisters Blisters break to form small ulcerations that begin to dry and form crusts Photos: Dermnet.com
3 General ill feeling Abdominal pain Chills Joint pain Lymphadenopathy Visual problems Taste problems Other Symptoms Loss of eye movement Hearing Loss Herpes zoster ophthalmicus Involves the orbit of the eye 10-25% of the cases Caused by reactivation in the ophthalmic branch of the trigeminal nerve Conjunctivtis Keratitis Uveitis Herpes zoster oticus Ramsey Hunt Syndrome type II Results from the virus spreading from the facial nerve to the vestibulocochlear nerve Hearing loss Vertigo Zoster sine herpete Vesiculation/ulceration of external ear & ipsilateral anterior 2/3 of tongue and soft palate Classic Ramsey Hunt Syndrome Vesicular rash of ear /mouth Facial paresis or paralysis Vertigo and ipsilateral hearing loss Tinnitus Otalgia Headaches Dysarthria Gait ataxia Fever Cervical adenopathy
4 Complete history Diagnosis Skin exam ( unique presentation) Lab studies/ otologic studies Tsanck smear does not differentiate between HSV and VZV Specific IgM antibodies to VZV present only during active infection ( chickenpox or shingles) Audiometry- SNHL Unilateral caloric weakness on ENG Weakness or absence of nerve excitability Zostavax ( live vaccine) Prevention 2005 New England Journal of Medicine decreased incidence by ½ and post herpetic neuralgia by 2/ Vaccine projected a significant annual savings in health care costs ( million) As of October 2007 officially recommended for healthy adults 60 yrs of age or older Exposure to children with chickenpox provides a natural boost Treatment Goals Limit the severity and duration of the pain Shorten the duration of the shingles episode Reduce complications Understanding Neuropathic Pain Nociceptive Pain Terminology Nociceptive pain Neuropathic pain Acute pain Chronic pain
5 Neuropathic Pain Produced by damage to nerve fibers Continuous or paroxysmal Hallmarks are chronic allodynia and hyperalgesia Only partially responds to opioids Examples: trigeminal neuralgia, post herpetic neuralgia, phantom limb pain Acute Pain Self limiting Provides a warning of ongoing tissue damage Symptom of a disease process Minimal psychological sx Nociceptive in nature Caused by chemical, mechanical or thermal stimulation of pain receptors Unrelenting Chronic pain No protective biological function Is the disease process Chronic anxiety, depression, insomnia, impaired social interaction Neuropathic ( involves damage to the central or peripheral nervous system) Tricyclic antidepressants Amitriptyline (Elavil) Inhibits norepinephrine and serotonin reuptake Effective in 2/3 of patients Dosage: Up to mg at bedtime. Start with 10 mg and titrate up. Taper to dc. Side Effects: severe dry mouth, sedation, trouble thinking and dizziness Metabolism: Primarily in liver CYP450. Excreted in urine and stool Tricyclic antidepressants Nortriptyline ( Pamelor) Inhibits norepinephrine and serotonin reuptake Effective in 2/3 of patients Dosage: Up to 150 mg at bedtime. Start with mg and titrate up. Taper to dc. Side Effects: severe dry mouth, sedation, blurred vision, constipation, urinary retention, trouble thinking and dizziness Metabolism: Primarily in liver CYP450. Excreted in urine and stool Tricyclic antidepressants Desipramine (norpramin) Inhibits norepinephrine and serotonin reuptake Effective in 2/3 of patients Dosage: Up to 150 mg at bedtime. Start with mg and titrate up. Taper to dc. Side Effects: severe dry mouth, sedation, blurred vision, constipation, urinary retention, trouble thinking and dizziness Metabolism: Primarily in liver CYP450. Excreted in urine and stool
6 Anticonvulsants Gabapentin (Neurontin) Very effective, considered first line Mechanism of action unknown Does not interact with many other medications Dosage: mg tid. Start with 300 mg first day, increase to bid day 2, increase to tid day 3. Max : mg/d. Taper over 7 days to dc. Side effects: Somnolence, dizziness, edema, dry mouth Metabolism: none - 100% excreted in the urine Anticonvulsants Pregabalin ( Lyrica) Approved by FDA in 2004 specifically for neuropathic pain of DM and shingles Mechanism of action not clear. Thought to reduce neurotransmitter release Dosage: mg /d divided bid /tid. Start with 50 mg tid or 75 mg bid. Increase to 300 mg over 7 d. Max: 600 mg/d. Increase after 2-4 weeks at 300/d ineffective. Taper over 7 d to dc. Side effects: dizziness, sleepiness Metabolism: None 90% excreted in urine Do not use with ginko biloba Opioids Garroway et.al. reported several reviews that found controlled release oxycodone reduced pain by 50% Long acting morphine/methadone and tramadol reduced pain only slightly more than placebo Side effect profile ( constipation, N&V, sedation and dependence) vs efficacy makes these drugs a poor choice. Topical Analgesics Insufficient evidence to support the use of topicals 5% lidocaine patch may be effective in cases with associated allodynia. Needs to be applied 3-4 times/d. Associated with skin reactions. Some use in elderly with small areas of pain. Capsaicin cream 0.075% reduced pain by 20% Associated with paradoxical burning pain. Antivirals Acyclovir ( Zovirax) Most effective if started within 72 hours of onset Inhibits DNA polymerase ( prevents replication) Dosage: 800 mg po 5 times/d for 7 days Side effects: N&V, headache, malaise, dizziness, arthralgia Metabolism: CYP 450 Valacyclovir ( Valtrex) Advantage of tid dosing Antivirals Dosage: 1000mg po every 8 hours for 7 days Side effects: N&V, headache, malaise, dizziness, arthralgia, elevated liver enzymes, thrombocytopenia, neutropenia Metabolism: liver, GI tract Excreted in feces and urine
7 Decreases inflammation Corticosteroids Questions Give larger dose acutely then taper Interacts with multiple medications Contraindicated in severe infections, peptic ulcer disease, hepatic dysfunction References Dublinsky RM. Kabanni H, El-Chami Z, Boutwell C, Ali H. ( 2008) Practice parameter: an evidence based report of the Quality Standards subcommittee of the American Academy of Neurology Garroway N, et.al.(2009) What measures relieve post herpetic neuralgia? Journal of Family Practice 58(7) 384d-f. Johnson RW, and Dworkin RH ( 2003) Clinical Review: Treatment of herpes zoster and post herpetic neuralgia. BMJ 326(7392): 748. Miravalli AA ( 2009) Ramsey Hunt Syndrome. Medscape.com Oxman MN, Levin MJ, et. Al. ( 2005) A vaccine to prevent herpes zoster and post herpetic neuralgia in older adults. New England Journal of Medicine 253(22): Pellisier JM, Brisson M, Levin MJ ( 2007) Evaluation of the cost effectiveness in the United States of a vaccine to prevent herpes zoster and post herpetic neuralgia in older adults. Vaccine 25(49): Richeimer, Steven ( 2000) Understanding Neuropathic Pain. Universe.com. Tyring, SK ( 2007) Management of herpes zoster and post herpetic neuralgia. Journal American Academy of Dermatology 57(6) : Urman CO, Gottlieb AB ( 2008) New viral vaccines for dermatologic disease. Journal of the American Academy of Dermatology. 58(3): PHOTOS Merck Shingle Info.com DermNet.com
Understanding and Treating Post- Herpetic Neuralgia (PHN)
Understanding and Treating Post- Herpetic Neuralgia (PHN) Mary Lynn McPherson, Pharm.D., BCPS Professor University of Maryland School of Pharmacy mmcphers@rx.umaryland.edu This program has been supported
More informationTreatment of Neuropathic Pain: What Does the Evidence Say? or Just the Facts Ma am
Treatment of Neuropathic Pain: What Does the Evidence Say? or Just the Facts Ma am Tim R Brown, PharmD, BCACP, FASHP Director of Clinical Pharmacotherapy Cleveland Clinic Akron General Center for Family
More information28 Nursing made Incredibly Easy! July/August
Shingles: 28 Nursing made Incredibly Easy! July/August 2012 www.nursingmadeincrediblyeasy.com Chicken pox revisited Herpes zoster, or shingles, is often seen in older and immunocompromised patients. We
More informationGRALISE (gabapentin) oral tablet
GRALISE (gabapentin) oral tablet Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy Coverage
More informationHerpes zoster. Diagnosis, Complications, Treatment, Prevention 서울대학교병원 FM R2 임하연
Herpes zoster Diagnosis, Complications, Treatment, Prevention 2018.04.14 서울대학교병원 FM R2 임하연 1 2 Overview reactivation of lat ent VZV along sensory nerve VZV(varicella-zoster virus) Human herpes virus-3
More informationApproximately 25% of people develop shingles during their lifetime, with the majority of cases occurring in those over 50 years of age.
ÜNZÜLE ALPASLAN WHAT IS SHINGLES? Shingles is an infection of an individual nerve and the skin surface that is supplied by the nerve; it is caused by the varicella-zoster virus - the same virus that causes
More informationShingles (Herpes zoster)
Shingles (Herpes zoster) Introduction When the itchy red spots of childhood chickenpox disappear and life returns to normal, the battle with the virus that causes chickenpox seems to be won. But for all
More informationIF I M NOT TREATING WITH OPIOIDS, THEN WHAT AM I SUPPOSED TO USE?
NON-OPIOID TREATMENT OPTIONS FOR CHRONIC PAIN Alison Knutson, PharmD, BCACP Medication Management Pharmacist Park Nicollet Creekside Clinic Dr. Knutson indicated no potential conflict of interest to this
More informationCondition: Herpes Zoster Ophthalmicus (HZO)
Condition: Herpes Zoster Ophthalmicus (HZO) Description: Herpes zoster represents a reactivation of the varicella zoster virus (VZV) which leads to characteristic skin lesions and, in many cases, ocular
More informationChickenpox: The Varicella Zoster Virus 2.0 Contact Hours Presented by: CEU Professor
Chickenpox: The Varicella Zoster Virus 2.0 Contact Hours Presented by: CEU Professor 7 www.ceuprofessoronline.com Copyright 8 2007 The Magellan Group, LLC All Rights Reserved. Reproduction and distribution
More informationSubunit adjuvanted zoster vaccine: why the fuss?
Subunit adjuvanted zoster vaccine: why the fuss? Soren Gantt, MD PhD MPH Pediatric Infectious Diseases Vaccine Evaluation Center BC Children s Hospital University of British Columbia Disclosures Research
More informationLYRICA FOR THE TREATMENT OF NEUROPATHIC PAIN DISORDERS
Volume 20, Issue 7 April 2005 LYRICA FOR THE TREATMENT OF NEUROPATHIC PAIN DISORDERS Tanja Lepir, Pharm.D. Candidate Nervous system dysfunction leading to neuropathic pain can occur from many causes: infection,
More informationPostherpetic neuralgia *
Section 1 Chapter 1 Neurological Disorders Postherpetic neuralgia * Alan David Kaye and Charles E. Argoff Case study A 78-year-old male with a history of postherpetic neuralgia (PHN) as well as hypertension
More informationMedChem401 Herpesviridae. Herpesviridae
MedChem401 Herpesviridae Members of the herpesvirus family have been identified in more than 80 different animal species Eight have been identified as human pathogens Herpes viruses are a leading cause
More informationMedications for the Treatment of Neuropathic Pain
Medications for the Treatment of Neuropathic Pain February 23, 2011 Jinny Tavee, MD Associate Professor Neurological Institute Cleveland Clinic Foundation Neuropathic Pain Pain, paresthesias, and sensory
More informationDisseminated shingles acyclovir
Disseminated shingles acyclovir The Borg System is 100 % Disseminated shingles acyclovir Two developed disseminated herpes zoster, one developed cytomegalovirus. Reduced response to acyclovir,. Disseminated
More informationBackground Rationale for resource
Background The Joint Committee on Vaccination and Immunisation 1 reviewed all the available medical, epidemiological and economic evidence as well as vaccine safety and efficacy relevant to offering a
More informationNeuropathic Pain Treatment Guidelines
Neuropathic Pain Treatment Guidelines Background Pain is an unpleasant sensory and emotional experience that can have a significant impact on a person s quality of life, general health, psychological health,
More informationAntiviral treatment for shingles and its complications in immunocompetent adults
Quality Improvement Scotland In response to an enquiry from NHS Greater Glasgow & Clyde Number 21 January 2008 Antiviral treatment for shingles and its complications in immunocompetent adults Description
More informationZostavax vaccine: now fully subsidised
Dermatology Infections Older person s health Virology Zostavax vaccine: now fully subsidised Zostavax is a herpes zoster (shingles) vaccine that will become fully subsidised from 1 April, 2018 for people
More informationHerpes Zoster Ophtalmicus in a HIV positive patient: A Case Report
ISPUB.COM The Internet Journal of Neurology Volume 9 Number 2 Herpes Zoster Ophtalmicus in a HIV positive patient: A Case Report G Lopez Bejerano, Y Graza Fernandez Citation G Lopez Bejerano, Y Graza Fernandez..
More informationNEUROPATHIC CANCER PAIN STANDARDS AND GUIDELINES
NEUROPATHIC CANCER PAIN STANDARDS AND GUIDELINES GENERAL PRINCIPLES Neuropathic pain may be relieved in the majority of patients by multimodal management A careful history and examination are essential.
More informationRamsay Hunt syndrome. and facial palsy
Ramsay Hunt syndrome and facial palsy What is Ramsay Hunt syndrome? Facial Palsy UK is a national charity for anyone affected by facial palsy, whatever the cause. We have produced this guide to Ramsay
More informationJane is not alone. Each year, about 1 million US residents. Battling shingles: Fine-tune your care
Battling shingles: Fine-tune your care Which of the 3 antiviral agents works best for accelerating rash healing and reducing pain? And what about corticosteroids are they a good idea, or not? Read on.
More informationRoadmap: PIFP and PTTN
Persistent Idiopathic Facial Pain & Painful Traumatic Trigeminal Neuropathy Dr. Rafael Benoliel Professor, Department of Diagnostic Sciences Rutgers School of Dental Medicine USA No Disclosures Roadmap:
More informationShingles and Post Herpetic Neuralgia
Group on Immunization Education Society of Teachers of Family Medicine CLINICAL SCENARIO SERIES ON IMMUNIZATION Shingles and Post Herpetic Neuralgia Written by: Donald B. Middleton, MD Department of Family
More informationTo provide guidance on prevention and control of illness caused by varicella-zoster virus (VZV).
Effective Date: 04/18 Replaces: 0 4 / 1 3 / 1 7 Page 1 of 4 POLICY: To provide guidance on prevention and control of illness caused by varicella-zoster virus (VZV). DEFINITIONS Two syndromes occur from
More informationPostherpetic Neuralgia Diagnosis And Treatment Mayo Clinic
Postherpetic Neuralgia Diagnosis And Treatment Mayo Clinic 1 / 6 2 / 6 3 / 6 Postherpetic Neuralgia Diagnosis And Treatment Lifestyle and home remedies. The following over-the-counter medications may ease
More informationNortriptyline vs amitriptyline in elderly
Nortriptyline vs amitriptyline in elderly Amitriptyline (Elavil ) vs other antidepressants - comparative analysis amitriptyline vs divalproate, amitriptyline vs trazodone. Learn what other patients are
More informationShingles: Good Practice Guide. Advice and guidance on how to improve shingles vaccination uptake
Shingles: Good Practice Guide Advice and guidance on how to improve shingles vaccination uptake Shingles Shingles, also known as herpes zoster, is caused by the reactivation of a latent varicella zoster
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Neuropathic pain pharmacological management: the pharmacological management of neuropathic pain in adults in non-specialist
More informationCONCORD INTERNAL MEDICINE. Peripheral Neuropathy. April 22, 2012
CONCORD INTERNAL MEDICINE Peripheral Neuropathy Douglas G. Kelling, Jr., MD C. Gismondi-Eagan, MD, FACP George C. Monroe, III, MD April 22, 2012 The information contained in this protocol should never
More informationBy: Zenessa Morrison and Denise Bailey
By: Zenessa Morrison and Denise Bailey Shingles which is also known as Herpes Zoster is a painful skin rash caused by the Varicella virus. The Varicella virus belongs to the herpesviridae family. The structure
More informationAged 70 or 78? There s a vaccine to help protect you from the pain of shingles
Aged 70 or 78? There s a vaccine to help protect you from the pain of shingles This leaflet describes shingles and the benefits of the vaccination and who is eligible for the vaccine this year. There is
More informationShingles. A Guide to Understanding Herpes Zoster. By Sarah Weis, PharmD Candidate 2012
Shingles A Guide to Understanding Herpes Zoster Information Every Elder Should Know By Sarah Weis, PharmD Candidate 2012 Herpes zoster, also known as shingles, effects up to 1 million people every year
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Lidoderm, ZTlido) Reference Number: CP.PMN.08 Effective Date: 09.01.06 Last Review Date: 08.18 Line of Business: Commercial, HIM, Medicaid Revision Log See Important Reminder at the end
More informationDescribe Identify Compare Recognize
Goal To educate nurses about the challenges associated with treating chronic pain and the safety and efficacy of alternative therapy options in relation to Opioids. Objectives Describe the challenges associated
More informationNon-opioid and adjuvant pain management
Non-opioid and adjuvant pain management ALLISON JORDAN, MD, HMDC MEDICAL DIRECTOR OF PALLIATIVE CARE SERVICES CHRISTIAN AND ALTON MEMORIAL HOSPITALS ASSOCIATE MEDICAL DIRECTOR, BJC HOSPICE ASSISTANT PROFESSOR
More informationHERPES ZOSTER VACCINATION
HERPES ZOSTER VACCINATION Herpes Zoster (shingles) is a reactivation of the varicella zoster infection in some-one who has previously had varicella(chicken pox) disease Painful, unilateral, self-limiting
More informationShingles: Using Interventional Treatment Therapies to Treat Post- Herpetic Neuralgia Julie W. Anderson, PhD, RN Heidi J. Shannon, MS, FNP-BC
Shingles: Using Interventional Treatment Therapies to Treat Post- Herpetic Neuralgia Julie W. Anderson, PhD, RN Heidi J. Shannon, MS, FNP-BC Disclosures Disclosures regarding non-fda approved uses of medications...
More informationIssues in the Treatment of Neurological Conditions Caused by Reactivation of Varicella Zoster Virus (VZV)
Neurotherapeutics (2016) 13:509 513 DOI 10.1007/s13311-016-0430-x REVIEW Issues in the Treatment of Neurological Conditions Caused by Reactivation of Varicella Zoster Virus (VZV) Peter G. E. Kennedy 1
More informationBackground Rationale for resource
Slide 1 Background The Joint Committee on Vaccination and Immunisation 1 reviewed all the available medical, epidemiological and economic evidence as well as vaccine safety and efficacy relevant to offering
More informationChallenging Anterior Segment Cases. Benjamin P. Casella, OD, FAAO
Challenging Anterior Segment Cases Benjamin P. Casella, OD, FAAO Bpc81@aol.com Disclosures Have lectured or been a consultant for: Allergan Carl Zeiss Hydrogel Vision 31yoWM My eye is irritated, and I
More informationProf Dr Najlaa Fawzi
1 Prof Dr Najlaa Fawzi is an acute highly infectious disease, characterized by vesicular rash, mild fever and mild constitutional symptoms. is a local manifestation of reactivation of latent varicella
More informationPharmacologic Management Part 1: Better-Studied Neuropathic Pain Diseases
PAIN MEDICINE Volume 5 Number S1 2004 Pharmacologic Management Part 1: Better-Studied Neuropathic Pain Diseases Misha-Miroslav Backonja, MD,* Jordi Serra, MD *University of Wisconsin Hospital and Clinics,
More informationAlphaherpesvirinae. Simplexvirus (HHV1&2/ HSV1&2) Varicellovirus (HHV3/VZV)
Alphaherpesvirinae Simplexvirus (HHV1&2/ HSV1&2) Varicellovirus (HHV3/VZV) HERPES SIMPLEX VIRUS First human herpesvirus discovered (1922) Two serotypes recognised HSV-1 & HSV-2 (1962) HSV polymorphism
More informationPain is one of the most frequent clinical problems
Easing the Ouch: Relieving Short-Term Pain By Brian Goldman, MD, MCFP(EM) As presented at the Family Medicine Forum, Montreal, Quebec (November 8, 2002) Pain is one of the most frequent clinical problems
More informationPain CONCERN. Medicines for long-term pain. Antidepressants
Pain CONCERN Medicines for long-term pain Antidepressants Many people living with long-term pain (also known as chronic or persistent pain) are worried about using medicines like antidepressants. They
More informationINTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND BIO-SCIENCE
Amar PP,, 2014; Volume 3(3): 123-127 INTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND BIO-SCIENCE A REVIEW ON HERPES ZOSTER AMAR PP 1, AJINKYA C 2, TOHID NB 2, ROHIDAS P 2, AVINASH C 2 1. Assistant
More informationNeuropathic Pain in Palliative Care
Neuropathic Pain in Palliative Care Neuropathic Pain in Advanced Cancer Affects 40% of patients Multiple concurrent pains are common Often complex pathophysiology with mixed components Nocioceptive Neuropathic
More informationIf Not Opioids then LEAH EDMONDS CSHP OCTOBER 26, 2017
If Not Opioids then what LEAH EDMONDS CSHP OCTOBER 26, 2017 Disclosure Nothing to disclose Objectives Identify various non-opioid options for the treatment of chronic non cancer pain Choose appropriate
More informationSpinal Cord Injury Pain. Michael Massey, DO CentraCare Health St Cloud, MN 11/07/2018
Spinal Cord Injury Pain Michael Massey, DO CentraCare Health St Cloud, MN 11/07/2018 Objectives At the conclusion of this session, participants should be able to: 1. Understand the difference between nociceptive
More informationCondition: Herpes Simplex Keratitis
Condition: Herpes Simplex Keratitis Description: Herpes simplex infection is very common but usually remains latent. When the virus is reactivated it travels along the trigeminal nerve to cause local infection
More informationElements for a Public Summary
VI.2 Elements for a Public Summary VI.2.1 Overview of disease epidemiology Generalised anxiety disorder Generalised anxiety disorder (GAD) is an umbrella term that covers a wide range of anxiety disorders
More informationDilemmas in Zoster Eye Disease Stephanie Klemencic, OD, FAAO
Dilemmas in Zoster Eye Disease Stephanie Klemencic, OD, FAAO Please silence all mobile devices and remove items from chairs so others can sit. Unauthorized recording of this session is prohibited. Disclosure
More informationHerpes Zoster. The Clinic a l Problem
clinical practice Caren G. Solomon, M.D., M.P.H., Editor Herpes Zoster Jeffrey I. Cohen, M.D. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting
More information5.9. Rehabilitation to Improve Central Pain
5.9. Rehabilitation to Improve Central Pain Evidence Tables and References Canadian Best Practice Recommendations for Stroke Care 2011-2013 Update Last Updated: June 25 th, 2013 Contents Search Strategy...
More informationPain Signaling Neuropathic Pain Distinctly different from nociceptive pain Sustained by abnormal processing of sensory input by the peripheral or cent
Objectives Pharmacologic Management of Neuropathic Pain Joseph R. Ineck, Pharm.D.,., CPE Pharmacist: St. Luke s Health System At the conclusion of this presentation, pharmacists will be able to: 1. Differentiate
More informationLearning Objectives:
Viral keratitis and antivirals Learning Objectives: Recognise and distinguish different types of viral keratitis HSV HZO Adenovirus Discuss the use of antiviral agents in the treatment of herpetic infections
More informationWhere is your pain located? Please use the diagram below to indicate where most of your pain is located.
Name: Address: Social Security Number: Email Address: Emergency Contact: Primary Care Physician: Name: Address: Phone Number: Date of Birth: Today's date: Cell Phone Number: Phone #: Referring Physician:
More informationAged 70 or 78? There s now a vaccine to help protect you against shingles
Aged 70 or 78? There s now a vaccine to help protect you against shingles This leaflet describes shingles and the benefits of the vaccination. The new shingles vaccine is being phased in over the next
More informationNeuropathic Pain. Griffith Research Online. Author. Published. Journal Title. Copyright Statement. Downloaded from. Link to published version
Griffith Research Online https://research-repository.griffith.edu.au Neuropathic Pain Author Hall, Tony Published 2010 Journal Title Australian Journal of Pharmacy Copyright Statement Copyright 2010 Australian
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Lyrica) Reference Number: ERX.NPA.10 Effective Date: 06.01.15 Last Review Date: 08.17 Line of Business: Commercial [Prescription Drug Plan] Revision Log See Important Reminder at the
More informationExecutive Summary Pregabalin (Lyrica by Pfizer) Formulary Review
Executive Summary Pregabalin (Lyrica by Pfizer) Formulary Review Lyrica (pregabalin) is a new prescription medication indicated for use in painful diabetic peripheral neuropathy (DPN), post-herpetic neuralgia,
More informationUnitedHealthcare Pharmacy Clinical Pharmacy Programs
UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2018 P 3019-9 Program Step Therapy Medication Lyrica capsules, Lyrica Solution, Lyrica CR tablets* (pregabalin) P&T Approval Date 1/08,
More informationGET THE MOST FROM YOUR LYRICA TREATMENT
GET THE MOST FROM YOUR LYRICA TREATMENT Answers and information to help you get started on LYRICA. Please see Full Prescribing Information, including Medication Guide, starting on page 8 of this PDF. Please
More informationCE Prn. Pharmacy Continuing Education from WF Professional Associates ABOUT WFPA LESSONS TOPICS ORDER CONTACT PHARMACY EXAM REVIEWS
CE Prn Pharmacy Continuing Education from WF Professional Associates ABOUT WFPA LESSONS TOPICS ORDER CONTACT PHARMACY EXAM REVIEWS SHINGLES: Pharmacy Perspective January 2016 Shingles (Herpes Zoster) is
More informationCase Report Varicella-Zoster-Mediated Radiculitis Reactivation following Cervical Spine Surgery: Case Report and Review of the Literature
Hindawi Publishing Corporation Case Reports in Infectious Diseases Volume 2013, Article ID 647486, 5 pages http://dx.doi.org/10.1155/2013/647486 Case Report Varicella-Zoster-Mediated Radiculitis Reactivation
More information3/1/2018. Disclosures. Objectives. Clinical advisory board member- Daiichi Sankyo
Adjuvant pain medications in geriatrics Thomas B. Gregory, Pharm.D., BCPS, CPE, FASPE Clinical Pharmacy Specialist Pain Management CoxHealth Springfield, MO Disclosures Clinical advisory board member-
More informationGET THE MOST FROM YOUR LYRICA TREATMENT
GET THE MOST FROM YOUR LYRICA TREATMENT Answers and information to help you get started on LYRICA. Please see Full Prescribing Information, including Medication Guide, starting on page 8 of this PDF. Please
More informationHuman Herpesviruses. Medical Virology, 27 Nov 2015.
Human Herpesviruses Assoc.Prof. Murat Sayan Kocaeli Üniversitesi, Rutin PCR Lab. Sorumlu Öğt.Üyesi Yakın Doğu Üniversitesi, DESAM Kurucu Öğrt. Üyesi sayanmurat@hotmail.com 0533 6479020 Medical Virology,
More information21 st June BDS BASHD Therapeutics Pain and Analgesia. BASHD Therapeutics Analgesics and Pain Management. Links to other BASHD content
Volume of Prescribing by Dentists 2011 ( a reminder) BASHD Therapeutics Analgesics and Pain Management Analgesics account for 1 in 80 dental prescriptions made A lot more analgesics will be suggested for
More informationOverview of Essentials of Pain Management. Updated 11/2016
0 Overview of Essentials of Pain Management Updated 11/2016 1 Overview of Essentials of Pain Management 1. Assess pain intensity on a 0 10 scale in which 0 = no pain at all and 10 = the worst pain imaginable.
More informationShingles prophylaxis acyclovir
Shingles prophylaxis acyclovir Search 27-2-2018 Detailed Acyclovir dosage information for adults and TEENren. Includes dosages for Herpes Simplex - Suppression, Herpes Simplex Labialis, Herpes Zoster.
More informationHerpetic Eye Disease Jason Duncan, OD, FAAO Diplomate, American Board of Optometry Associate Professor, Southern College of Optometry
Herpetic Eye Disease Jason Duncan, OD, FAAO Diplomate, American Board of Optometry Associate Professor, Southern College of Optometry I have what?! How to break the news Meet the Herpes Quick virology
More informationMANAGEMENT OF DIABETIC NEUROPATHY. Chungnam University Hospital Soo-Kyung, Bok, M.D., Ph.D.
MANAGEMENT OF DIABETIC NEUROPATHY Chungnam University Hospital Soo-Kyung, Bok, M.D., Ph.D. The Diabetic neuropathy cannot be reversed Not to restore function to damaged nerve Slowly progress no initial
More information5/24/17. ***Varicella-Zoster Virus*** Herpes DNA virus that causes 2 distinct syndromes
Nathan Lighthizer, O.D., F.A.A.O. Assistant Dean, Clinical Care Services Director of Continuing Education Chief of Specialty Care Clinics Chief of Electrodiagnostics Clinic Oklahoma College of Optometry
More informationAcyclovir dose for chicken pox
Buscar... Acyclovir dose for chicken pox Acyclovir (Zovirax) treats infections caused by the herpes viruses including genital herpes, cold sores, shingles and chicken pox. Includes Acyclovir side effects.
More informationVARICELLA. Dr Louise Cooley Royal Hobart Hospital
VARICELLA Dr Louise Cooley Royal Hobart Hospital Varicella Zoster Virus (VZV): The Basics Herpes virus Exclusively human infection Primary infection: varicella (chickenpox) Neurotropic, establishing latency
More information1/3/17. ***Varicella-Zoster Virus*** Herpes DNA virus that causes 2 distinct syndromes
Nathan Lighthizer, O.D., F.A.A.O. Assistant Dean, Clinical Care Services Director of Continuing Education Chief of Specialty Care Clinics Chief of Electrodiagnostics Clinic Oklahoma College of Optometry
More informationIntroduction to Viruses That Infect Humans: The DNA Viruses
Chapter 24 Introduction to Viruses That Infect Humans: The DNA Viruses Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 24.1 Viruses in Human Infections and Diseases
More information3/3/2015 CHRONIC PAIN MARGARET ZOELLERS, MSN, APRN
CHRONIC PAIN MARGARET ZOELLERS, MSN, APRN 1 Pain that persists or recurs > 3-6 months Pain that persists >1 month after injury/event Commonly seems out of proportion to the physical process Cause may be
More informationPsychology of Pain DR. ARNEL BANAGA SALGADO,
Psychology of Pain DR. ARNEL BANAGA SALGADO, Doctor of Psychology (USA) FPM (Ph.D.) Psychology (India) Doctor of Education (Phl) Master of Arts in Nursing (Phl) Master of Arts in Teaching Psychology (PNU)
More informationCase Series Drug Analysis Print Name: Vaxigrip, Fluarix, Inflexal V og Influenzacvaccine 01Sep Oct2014
- 16Oct2014 Report Run Date: 20-Oct-2014 Data Lock Date: 16-Oct-2014 19:00:06 Earliest Reaction Date: 28-Oct-2009 MedDRA Version: MedDRA 17.0 Vaxigrip, Fluarix, Inflexal V og Influenzacvaccine : Alle cases
More informationUnmet Need in the Treatment of Postherpetic Neuralgia
n report n Unmet Need in the Treatment of Postherpetic Neuralgia Gerald M. Sacks, MD Postherpetic Neuralgia Postherpetic neuralgia (PHN) is a chronic pain syndrome that can develop following an episode
More informationA Review of Non Opioid Medications for Pain Management
SCSHP 2014 Annual Meeting A Review of Non Opioid Medications for Pain Management Danielle Bowen, PharmD, BCPS Clinical Pharmacist, Ambulatory Care Ralph H. Johnson VA Medical Center Objectives for Pharmacy
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Lyrica) Reference Number: HIM.PA.64 Effective Date: 12/14 Last Review Date: 08/17 Line of Business: Health Insurance Marketplace Revision Log See Important Reminder at the end of this
More informationNeuropathic Pain. Scott Magnuson, MD Pain Management of North Idaho, PLLC
Neuropathic Pain Scott Magnuson, MD Pain Management of North Idaho, PLLC Pain is our friend "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described
More informationPERIPHERAL NEUROPATHY. Maureen Gallagher Jesse James Maldonado
PERIPHERAL NEUROPATHY Maureen Gallagher Jesse James Maldonado Objectives What is peripheral neuropathy? Symptoms Causes Treatment goals What are the available treatment options? Prescription drug therapy
More informationFirefighting: Burning Mouth Syndrome and Burning Vulva (vulvodynia)
Firefighting: Burning Mouth Syndrome and Burning Vulva (vulvodynia) Rochelle Torgerson, MD, PhD Chair of Education Department of Dermatology Mayo Clinic, Rochester, MN DISCLOSURE OF RELEVANT RELATIONSHIPS
More informationSkin and soft tissue infections 2 M Al Madadha Sources :
Skin and soft tissue infections 2 M Al Madadha Sources : Harrisons infectious diseases 2 nd edition, Oxford Handbook of Infectious Diseases and Microbiology 2 nd edition Infections Associated with Vesicles
More informationPain Assessment & Management. For General Nursing Orientation
Pain Assessment & Management For General Nursing Orientation April 2012 Overview Definition of pain Barriers to effective pain management Types of pain Objective pain assessment Approaches to management
More informationPAIN EDUCATION Module 5: Neuropathic pain
PAIN EDUCATION Module 5: Neuropathic pain 2013 Excerpta Medica BV The material presented in this teaching slide deck is for educational purposes only. If you wish to reproduce, transmit in any form or
More informationNorovirus in Healthcare Settings
ST. JAMES HEALTHCARE DECEMBER 2012 INFECTION PREVENTION NEWSLETTER INSIDE THIS ISSUE: Norovirus in Healthcare Settings The Impacts of Unsafe Medical Injections in the U.S. Preparing Your Skin Before Surgery:
More informationHow It Spreads Symptoms Can Include Complications
OUR BEST SHOT: The Importance of Vaccines for Older Adults VACCINES QUICK GUIDE TO VACCINATION FOR ADULTS AGES 60+ Vaccines are an important step in protecting your health and the health of your family.
More informationAcyclovir for ear infections
Acyclovir for ear infections The Borg System is 100 % Acyclovir for ear infections User feedback about Acyclovir side effects covering chicken pox, fatigue, shingles, hair loss, HSV2, dosage, anemia, ear
More informationThe clinical landscape of painful diabetic neuropathy therapy: perspectives for clinicians from clinical practice guidelines
The clinical landscape of painful diabetic neuropathy therapy: perspectives for clinicians from clinical practice guidelines Clin. Invest. (2012) 2(5), 483 489 Painful diabetic neuropathy (PDN) is highly
More informationSUMMARY OF ARIZONA OPIOID PRESCRIBING GUIDELINES FOR THE TREATMENT OF CHRONIC NON-TERMINAL PAIN (CNTP)
9 SUMMARY OF ARIZONA OPIOID PRESCRIBING GUIDELINES FOR THE TREATMENT OF CHRONIC NON-TERMINAL PAIN (CNTP) SUMMARY OF ARIZONA OPIOID PRESCRIBING GUIDELINES FOR THE TREATMENT OF ACUTE PAIN NONOPIOID TREATMENTS
More informationUC Davis Dermatology Online Journal
UC Davis Dermatology Online Journal Title Disseminated varicella-zoster virus in an immunocompetent adult Permalink https://escholarship.org/uc/item/3cz2x99b Journal Dermatology Online Journal, 21(3) Authors
More information