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Notes Product Name: Upneeq [a] Approval Length Therapy Stage Guideline Type 12 month(s) Reauthorization Prior Authorization Page 740 Approval Criteria 1 - Documentation of positive clinical response to therapy Notes [a] State mandates may apply blood pressure er order 75mg triamterene visa. Background Benefit/Coverage/Program Information Background: Upneeq (oxymetazoline) 0 blood pressure medication verapamil discount triamterene 75 mg on-line. Criteria Product Name: Vascepa* [a] Diagnosis Cardiovascular Risk Reduction Page 743 Approval Length Therapy Stage Guideline Type 12 month(s) Initial Authorization Prior Authorization Approval Criteria 1 - Vascepa will be approved based on all of the following criteria: 1 pulse pressure range normal buy 75mg triamterene with amex. Product Name: Vascepa* [a] Diagnosis Approval Length Therapy Stage Guideline Type Cardiovascular Risk Reduction 12 month(s) Reauthorization Prior Authorization Approval Criteria 1 - Vascepa will be approved based on all of the following criteria: 1 arrhythmia university cheap 75mg triamterene otc. Any federal regulatory requirements an d the member specific benefit plan coverage may also impact coverage Page 747 criteria. Revision History Date 4/6/2021 Notes Modified pre-treatment triglyceride levels for cardiovascular risk reducti on. Indications Drug Name: Vecamyl (mecamylamine) Moderately Severe to Severe Essential Hypertension Indicated for the management of moderately severe to severe essential hypertension and uncomplicated cases of malignant hypertension. Criteria Product Name: Vecamyl Diagnosis Approval Length Therapy Stage Hypertension 12 month(s) Initial Authorization Page 750 Guideline Type Notification Approval Criteria 1 - One of the following: 1. Background Benefit/Coverage/Program Information Background: Vecamyl (mecamylamine) is indicated for the management of moderately severe to severe essential hypertension and uncomplicated cases of malignant hypertension. The product was withdrawn in September 2009; withdrawal was not due to safety concerns. Indications Drug Name: Veregen (sinecatechins) Warts Indicated for the treatment of external genital and perianal warts in immunocompetent patients. Criteria Product Name: Veregen [a] Approval Length Guideline Type 4 month(s) Step Therapy Page 753 Approval Criteria 1 - Patient has a history of failure, contraindication, or intolerance to one of the following: · · Imiquimod (generic Aldara) Podofilox (generic Conylox) [a] State mandates may apply. Background Benefit/Coverage/Program Information Background: Veregen (sinecatechins) is indicated for the treatment of external genital and perianal warts in immunocompetent patients. This program requires a member to try imiquimod or podofilox prior to receiving coverage for Veregen. Verquvo has a boxed warning for embryo-fetal toxicity and should not be used during pregnancy. Use of automated approval and re-approval processes varies by program and/or therapeutic class. Criteria Product Name: Vyleesi Approval Length Therapy Stage 2 month(s) Initial Authorization Page 763 Guideline Type Prior Authorization Approval Criteria 1 - Diagnosis of one of the following: 1. Background Benefit/Coverage/Program Information Background: Anti-obesity agents are indicated in the management of obesity as an adjunct to lifestyle modifications including diet, exercise and behavioral modification. Medication therapy may provide modest weight reduction in conjunction with lifestyle modifications and therapy selection may be based on a specific medications side effects and warnings. National Institutes of Health, National Heart, Lung, and Blood Institute, and North American Association for the Study of Obesity. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline. Indications Drug Name: Winlevi (clascoterone) Acne Vulgaris Indicated for the topical treatment of acne vulgaris in patients 12 years of age and older. Background Benefit/Coverage/Program Information Background: Winlevi (clascoterone) is an androgen receptor inhibitor indicated for the topical treatment of acne vulgaris in patients 12 years of age and older. Guidelines from the American Academy of Dermatology recommend topical therapies including retinoids, antibiotics in combination with benzoyl peroxide, azelaic acid and dapsone for mild to moderate acne. Systemic antibiotics are first-line in moderate to severe acne with concomitant topical therapy of benzoyl peroxide or a retinoid. Hepatic encephalopathy Indicated for the risk reduction of hepatic encephalopathy recurrence in adults. Off Label Uses: Inflammatory bowel diseases There is some limited data to support the off label use of Xifaxan for the treatment of inflammatory bowel diseases. Product Name: Xifaxan [a] Diagnosis Approval Length Therapy Stage Guideline Type Hepatic Encephalopathy 12 month(s) Reauthorization Prior Authorization Approval Criteria 1 - Documentation of positive clinical response to Xifaxan therapy Notes [a] State mandates may apply.
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Iron overload can affect the heart as a result of hereditary hemochromatosis or hemosiderosis prehypertension caffeine triamterene 75 mg without a prescription. Grossly the heart is a rust-brown color and resembles the heart in idiopathic dilated cardiomyopathy hypertension prognosis order triamterene 75 mg online. In hypothyroidism the heart is characteristically flabby hypertension nos 4019 order 75 mg triamterene otc, enlarged blood pressure wrist cuff purchase triamterene 75mg amex, and dilated, which results in decreased cardiac output. This reduced circulation results in a characteristic symptom of Cardiovascular System Answers 205 hypothyroidism, cold sensitivity. Histologically there is an interstitial mucopolysaccharide edema fluid within the heart. Most of the secondary cardiomyopathies result in a dilated cardiomyopathy that is characterized by congestion and four-chamber dilation with hypertrophy. Examples of the latter include cobalt, which has been used in beer as a foam stabilizer; anthracyclines; cocaine; and iron, the deposition of which is seen in patients with hemochromatosis. The anthracycline Adriamycin, which is used in chemotherapy, causes lipid peroxidation of myofiber membranes. Other forms of cardiomyopathies include a hypertrophic form, a restrictive form, and an obliterative form. These changes produce hypercontractility that predisposes patients to the risk of sudden death. Patients may experience dyspnea, lightheadedness, and chest pain, especially upon physical exertion; however, many patients appear to be asymptomatic, although sudden, unexpected death occurs not infrequently, especially following or during physical exertion. This risk is increased with factors that either increase the contractility of the heart or decrease the volume of the left ventricle (both of which increase the left ventricular outflow obstruction). Treatment for patients 206 Pathology with hypertrophic cardiomyopathy, therefore, is with drugs that decrease contractility. Examples of these types of drugs include -adrenergic blockers and calcium channel blockers. In individuals with hypertrophic cardiomyopathy, agents that increase contractility are contraindicated. Epinephrine and -adrenergic agonists, which increase cardiac output by increasing stroke volume and heart rate, would also be contraindicated. Diuretics would also be dangerous, as they would decrease intravascular volume, and this would accentuate the bad effects of the septal hypertrophy because of the decreased left ventricular volume. In contrast, dilated (congestive) cardiomyopathy results in a flabby, hypocontractile heart. Constrictive (restrictive) cardiomyopathy is associated in the United States with amyloidosis and endocardial fibroelastosis. It is so named because of the infiltration and deposition of material in the endomyocardium and the layering of collagen and elastin over the endocardium. This deposition affects the ability of the ventricles to accommodate blood volume during diastole. Endocardial fibroelastosis, which occurs mainly in infants during the first 2 years of life, is associated with a prominent fibroelastic covering over the endocardium of the left ventricle. There may be associated aortic coarctation, ventricular septal defects, mitral valve defects, and other abnormalities. In contrast, endomyocardial fibrosis is a form of restrictive cardiomyopathy that is found mainly in young adults and children in Southeast Asia and Africa. It differs from endocardial fibroelastosis in the United States in that elastic fibers are not present. It is characterized by a prominent and hypertrophic interventricular septum that is out of proportion to the thickness of the left ventricle. Histologically the myocardial fibers exhibit disarray, caused by wide fibers with unusual orientation, and prominent hyperchromatic nuclei. There is an increased incidence of hypertrophic cardiomyopathy within families, and there is evidence that it may be an autosomal dominant disorder. The disease is thought to result from a mutation in the cardiac -myosin heavy chain gene.
Becker muscular dystrophy Metabolic Diseases · diabetes insipidus · Lesch-Nyhan syndrome Other Diseases · red-green color blindness · fragile X syndrome 24 heart attack vol 1 pt 4 cheap triamterene 75mg visa. Paternal deletion Prader-Willi syndrome · mental retardation · short stature and obesity · small hands and feet · hypogonadism · may be due to two copies of maternal 15 chromosome (paternal uniparental disomy) 27 blood pressure device proven 75 mg triamterene. Transposition of the great vessels · need shunt to be present in order to survive heart attack damage buy triamterene 75mg amex. Diabetes mellitus Nephritic Syndrome · hematuria (red blood cells and red blood cell casts in urine) · variable proteinuria and oliguria · retention of salt and water (hypertension and edema) High-Yield Facts 29 Examples (proliferative glomerular disease): 1 blood pressure under 100 order triamterene 75 mg with visa. Psammoma body: · papillary carcinoma of the thyroid · papillary tumors of the ovary · meningioma 2. Increased lipolysis of fat stores, which can result from starvation, diabetes mellitus, or corticosteroid use, is most likely to cause steatosis (fatty liver) through which one of the listed mechanisms? Decreased free fatty acid excretion from the liver leads to free fatty acid accumulation in hepatocytes b. Increased free fatty acid delivery to the liver leads to triglyceride accumulation in hepatocytes d. Inhibition of apoprotein synthesis by the liver leads to phospholipid accumulation in hepatocytes. In an evaluation of an 8-year-old boy who has had recurrent infections since the first year of life, findings include enlargement of the liver and spleen, lymph node inflammation, and a superficial dermatitis resembling eczema. To treat her symptoms, you advise her to take indomethacin in the hopes that it will reduce her pain by interfering with the production of a. Which one of the listed statements is the best histologic definition of an abscess? A localized defect that results from the sloughing of necrotic inflammatory tissue from the surface of an organ c. A 25-year-old female presents with a history of losing four pregnancies in the past 5 years. She also has a history of recurrent pains in her legs secondary to recurrent thrombosis. Evaluation of a pedigree for a certain abnormality reveals the following information: there are skipped generations with male-to-male transmission; females are affected at the same rate as are males; and the disease is produced in the homozygous state, while heterozygous individuals are carriers. Autosomal dominant Autosomal recessive X-linked dominant X-linked recessive Mitochondrial 8. You obtain a detailed family history from this patient and produce the associated pedigree (dark circles or squares indicate affected individuals). Autosomal recessive Autosomal dominant X-linked recessive X-linked dominant Mitochondrial 38 Pathology 9. A 10-month-old baby is being evaluated for visual problems and motor incoordination. Talking to the family of this visually impaired 10-month-old infant, you find that they are Jewish and their family is from the eastern portion of Europe (Ashkenazi Jews). Based on this specific family history, which one of the following enzymes is most likely to be deficient in this infant? Aryl sulfatase -glucocerebrosidase Hexosaminidase A Hexosaminidase B Sphingomyelinase 10. A 4-year-old male with mental retardation, self-mutilation, and hyperuricemia is likely to have a deficiency of an enzyme involved in the a. A young boy is being evaluated for developmental delay, mild autism, and mental retardation. Physical examination reveals the boy to have large, everted ears and a long face with a large mandible. An 8-month-old male infant is admitted to the hospital because of a bacterial respiratory infection. The infant responds to appropriate antibiotic therapy, but is readmitted several weeks later because of severe otitis media. Over the next several months, the infant is admitted to the hospital multiple times for recurrent bacterial infections. During a routine physical examination, a 45-year-old male is found to have microscopic hematuria. This mass is resected and reveals a tumor composed of a uniform population of cells with clear cytoplasm.
As indicated on page 248 blood pressure chart low bp purchase 75mg triamterene with amex, a measured osmolality higher than the calculated osmolality indicates a substantial concentration of an unmeasured osmolar substance blood pressure on apple watch buy triamterene 75 mg free shipping, usually a toxin arteria labialis superior buy 75mg triamterene fast delivery. Only a few agents are equally and rapidly distributed throughout the body water arrhythmia death buy triamterene 75 mg mastercard. This property is used clinically when mannitol (a nonmetabolizable sugar) is injected intravenously to draw fluid out of the brain and temporarily decrease cerebral edema. However, the brain has protective mechanisms against osmolar shifts,355 including slow redistribution of solutes, so that rapid changes in serum osmolality produce more prominent neurologic symptoms than slow changes. Interestingly, in the patients studied who had chronic hyponatremia (mean serum sodium 120 mEq/L), there was no increase in water content. However, subacute changes in serum osmolalities below about 260 mEq/L, or above about 330 mEq/L over hours or a few days, are likely to produce cerebral symptoms. In addition, cerebral symptoms can be produced by sudden restorations of osmolality toward normal when an illness has produced a sustained osmolar shift away from normal. Hypo-osmolar States Sodium is the most abundant serum cation, and for practical purposes, systemic hypoosmolarity occurs only in hyponatremic states. For example, hyponatremia may be hyperosmolar, as with severe hyperglycemia (see page 171), or isoosmolar, as, for example, during transurethral prostatic resection when large volumes of sodium-free irrigants are systemically absorbed. Hyponatremia or ``water intoxication' can cause delirium, obtundation, and coma, examples being encountered annually in almost all large hospitals. Symptoms result from water excess in the brain, hence the name water intoxication (Figure 59A). The pathogenesis of the symptoms caused by hyponatremia is probably multifactorial. In an attempt to compensate, sodium and potassium are excreted from cells via a sodium-potassium Partial restitution of brain volume occurs within a few hours as electrolytes enter the brain cells (rapid adaptation). The normalization of brain volume is completed within several days as a result of the intracellular accumulation of organic osmolytes (slow adaptation). Slow correction of the hypertonic state re-establishes normal brain osmolality without inducing cerebral edema, as the dissipation of accumulated electrolytes and organic osmolytes keeps pace with water repletion. In contrast, rapid correction may result in cerebral edema as water uptake by brain cells outpaces the dissipation of accumulated electrolytes and organic osmolytes. Such overly aggressive therapy carries the risk of serious neurologic impairment due to cerebral edema. Seizures may lead to hypoxia, but whether hypoxia plays a significant role in the development of the clinical symptoms is unclear. The reason appears to be that the brain adapts to the hyponatremia by decreasing organic osmols within the cell, especially amino acids. With more severe or more rapidly developing hyponatremia, asterixis and multifocal myoclonus often appear. Coma is a late and life-threatening phase of water intoxication, and both coma and convulsions are more common with acute than chronic hyponatremia. Neurologic symptoms are rare with serum sodium above 120 mg/L and convulsions or coma generally do not occur until the serum sodium values reach 95 to 110 mEq/L (again, the more rapidly the serum sodium falls, the more likely the symptoms are to occur at a higher level). Permanent brain damage may follow hypona- Table 519 Clinical Manifestations of Hyponatremic Encephalopathy Early* Anorexia Headache Nausea Emesis Muscular cramps Weakness Impaired response to verbal stimuli Impaired response to painful stimuli Bizarre (inappropriate) behavior Hallucinations (auditory or visual) Asterixis Obtundation Incontinence (urinary or fecal) Respiratory insufficiency Decorticate and/or decerebrate posturing Bradycardia Hyper- or hypotension Altered temperature regulation (hypo- or hyperthermia) Dilated pupils Seizure activity (usually grand mal) Respiratory arrest Coma Polyuria (secondary to central diabetes insipidus) Advanced* Far advanced* *Any manifestation may be observed at any stage, and some patients will have only minimal symptoms. Fraser and Arieff measured plasma sodium in 136 patients with hyponatremic encephalopathy. Premenopausal women developed severe symptoms at higher sodium levels than either postmenopausal women or men. She had been working regularly until 2 days prior to admission when she Multifocal, Diffuse, and Metabolic Brain Diseases Causing Delirium, Stupor, or Coma stayed home with nausea and vomiting. Two hours before admission she was noted to be dysarthric when speaking on the telephone. Her blood pressure was 130/180 mm Hg, her pulse 140 per minute, her respirations 24 per minute and regular, and her body temperature 38.
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