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Effectiveness of inpatient and treatment of acute discount levitra with dapoxetine 40/60 mg free shipping, uncomplicated pelvic inflammatory disease cheap 40/60mg levitra with dapoxetine otc. Am J Obstet Gynecol for moxifloxacin versus ofloxacin/metronidazole for first-line treatment 2002 buy levitra with dapoxetine 40/60mg;186:929–37. A serological study of inflammatory disease and on efficacy of ambulatory oral therapy. Am the role of Mycoplasma genitalium in pelvic inflammatory disease and J Obstet Gynecol 1999;181:1374–81. Is Mycoplasma genitalium in immunodeficiency virus-1 infection on treatment outcome of acute women the “New Chlamydia? Accuracy of five different diagnostic intrauterine devices in women who acquire pelvic inflammatory disease: techniques in mild-to-moderate pelvic inflammatory disease. Available at the status of cancer, 1975-2009, featuring the burden and trends in http://www. Human papillomavirus vaccination coverage among adolescent pregnancy is strongly predictive of juvenile-onset recurrent respiratory girls, 2007–2012, and postlicensure vaccine safety monitoring, papillomatosis. Frequency of occult quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine. Infect Dis Obstet intraepithelial neoplasia: natural history and effects of treatment Gynecol 2011;2011:806105. Imiquimod 5% cream induced background and consensus recommendations from the College of psoriasis: a case report, summary of the literature and mechanism. American Pathologists and the American Society for Colposcopy and Br J Dermatol 2011;164:670-2. Use of the cytobrush for Papanicolaou smear order on Chlamydia trachomatis and Neisseria gonorrhoeae test screens in pregnant women. J Natl after hysterectomy for reasons other than malignancy: a systematic Cancer Inst 2009;101:1120–30. European guidelines for quality colposcopy, and human papillomavirus testing in adolescents. J Adolesc assurance in cervical cancer screening: recommendations for collecting Health 2008;43(4 Suppl):S41–51. The psychosocial impact of and human papillomavirus testing in anal cancer screening. Pap smear versus A epidemiology in the United States-implications for vaccination speculum examination: can we teach providers to educate patients? Long-term immunogenicity triage methods for the management of borderline abnormal cervical of hepatitis A virus vaccine in Alaska 17 years after initial childhood smears: an open randomised trial. Natural history of chronic hepatitis B virus for the management of women with abnormal cervical cancer screening infection. European guideline for the management of estimate global hepatitis B disease burden and vaccination impact. Lindane toxicity: a comprehensive review transmission of hepatitis B virus in a rural district in Ghana. Curr Opin efficacy 24 years after the start of hepatitis B vaccination in two Gambian Infect Dis 2010;23:111–8. Etiology of clinical proctitis among evaluation of the efficacy of fewer than three doses of a bivalent men who have sex with men. Permethrin-resistant human exposures to human immunodeficiency virus and recommendations head lice, Pediculus capitis, and their treatment. Prevalence of human use among Ontario female adolescent sexual assault victims: a papillomavirus in the oral cavity/oropharynx in a large population of prospective analysis. Prospective cohort study of detection of Trichomonas vaginalis in urine specimens. Child sexual abuse, links to later sexual transmitted infections in suspected child victims of sexual assault. Guidelines for the use of antiretroviral agents Trichomonas vaginalis: a case report. Postexposure prophylaxis in children and adolescents for transmission of Chlamydia trachomatis. Paper copy subscriptions are available through the Superintendent of Documents, U. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U. The editors and subject matter experts are committed to timely changes in this document because so many health care providers, patients, and policy experts rely on this source for vital clinical information. All changes are developed by the subject matter groups listed in the document (changes in group composition are also promptly posted). These changes are reviewed by the editors and by relevant outside reviewers before the document is altered. In addition, these agents have a higher incidence of toxicities than other recommended treatments. In addition, Table 1, Table 2 and Table 3 were updated to include preferred and alternative treatment regimens, and drug-drug interactions with commonly used medications. Malaria: The epidemiology and treatment sections were updated to include more recent statistics and data regarding treatment. Recently, Table 5 was updated to add potential drug interactions between anti-malarial medications and commonly used medications, including hepatitis C direct acting agents, antibiotics, and antifungals. Drugs used for the treatment of hepatitis C virus infection and malaria are added to this table. Table 6 has been updated with the inclusion of adverse effects associated with drugs for the treatment of hepatitis C virus infection and malaria. Recommended Doses of First-Line Drugs for Treatment of Tuberculosis in Adults and Adolescents. Significant Pharmacokinetic Interactions for Drugs Used to Treat or Prevent Opportunistic Infections. Common or Serious Adverse Reactions Associated With Drugs Used for Preventing or Treating Opportunistic Infections. Dosing Recommendations for Drugs Used in Treating or Preventing Opportunistic Infections Where Dosage Adjustment is Needed in Patients with Renal Insufficiency. Summary of Pre-Clinical and Human Data on, and Indications for, Opportunistic Infection Drugs During Pregnancy. The inclusion of ratings that indicate both the strength of each recommendation and the quality of supporting evidence allows readers to assess the relative importance of each recommendation. The co-editors appointed a leader for each working group, which reviewed the literature since the last publication of these guidelines, conferred over a period of several months, and produced draft revised recommendations. The names and affiliations of all contributors as well as their financial disclosures are provided in the Panel roster and Financial Disclosure section (Appendix C). Panel members are selected from government, academia, and the healthcare community by the co-editors and assigned to a working group for one or more the guideline’s sections based on the member’s area of subject mater expertise. Members serve on the panel for a 4-year term, with an option to be reappointed for additional terms. A list of management of these disclosures and their last update is available in Appendix C.

Neuropathic Pain Pain caused by a lesion or disease of the somatosensory nervous system purchase levitra with dapoxetine 40/60 mg otc. Neuropathic pain is divided into ‘peripheral’ (originating in the peripheral nervous system) and ‘central’ (originating in the brain or spinal cord) order levitra with dapoxetine 40/60 mg otc. Neuropathic pain is often described as “burning generic levitra with dapoxetine 40/60mg fast delivery, tingling, electrical, stabbing or pins and needles”. Glossary 3 Nociceptive Pain Arises from stimulation of pain receptors within tissue, which has been damaged or involved in an infammatory process. Nociceptive pain may be divided into: a) Somatic pain - generally well-localized pain that results from the activation of peripheral nociceptors without injury to the peripheral nerve or central nervous system, characterized by sharp, hot or stinging pain which is usually localized to the area of injury. It is felt as a poorly localized aching or cramping sensation and is often referred to cutaneous sites. Non-pharmacological methods Includes such techniques as superfcial heat and cold, massage, relaxation, imagery, prayer/spiritual practices, pressure or vibration, and therapeutic communication. Opioids Class of drugs originally derived from the opium poppy that are generally prescribed to manage pain. Opioid-Induced Neurotoxicity Is a multifactorial syndrome that causes a spectrum of symptoms from mild confusion or drowsiness to hallucinations (often visual or tactile), delirium, hyperalgesia (an increased sensitivity to pain), allodynia (pain due to a stimulus which does not normally provoke pain such as light touch or rubbing), sedation, and myoclonus (characterized by ‘muscle jerking’ that can be localized or generalized). Patients with renal impairment and patients on opioids with active metabolites appear to be at a higher risk. Physical Dependence A state of adaptation manifested by a drug class-specifc withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood levels of the drug, and/or administration of an antagonist. Pseudoaddiction Is a term that describes patient’s behaviors that may occur when pain is undertreated. Patients with unrelieved pain may become focused on obtaining medications, may “clock watch” and may otherwise seem inappropriately “drug seeking”. Even such behaviors as illicit drug use and deception can occur in the patient’s eforts to obtain relief. Pseudoaddiction can be distinguished from true addiction in that the behaviors resolve when pain is efectively treated. Glossary 4 Referral Patient is being sent to a specialist for not only evaluation, but for ongoing care with little or no long-term involvement by the primary care (referring) physician. Sufering Is severe distress associated with events that threaten the patient’s perception of wholeness, is identifed within the spiritual dimensions of quality of life but it transcends all dimensions, often occurring when pain is not controlled. Tolerance Is a physiological state characterized by a decrease in the efects of a drug (e. This Clinical Practice Guideline should be perceived as refecting the current state of knowledge in the feld of pain assessment and management. Best practice demands that health care providers be guided by best available evidence. The grading system used in this guideline has been adapted from the Canadian and U. These types of studies include observational studies, cohort studies, prevalence studies and case control studies. Examples include clinical series, databases or registries; care reviews, case reports and expert opinion. Examples include: observational studies, cohort studies, prevalence studies and case controlled studies. In order to understand the strength of the evidence, each recommendation has been cited with a level of recommendation, as follows: Level 1 This recommendation is convincingly justifable on the available scientifc information alone. Level 2 This recommendation is reasonably justifable by scientifc evidence and strongly supported by expert opinion. Level 3 This recommendation is supported by available data but adequate scientifc evidence is lacking. This type of recommendation is useful for educational purposes and in guiding future studies. Screening should occur at frst contact and be repeated as indicated depending on the person’s condition, setting, care goals, etc. Pain assessment should also include assessment of behavioral indicators of pain for non-verbal individuals. This will facilitate their contributions to the treatment plan and will promote continuity of efective pain management across all settings. The health care provider supports his/her recommendations with appropriate evidence, providing a clear rationale for the need for change which can include: • Intensity of pain using a validated scale; • Change in severity of pain scores in last 24 hours; • Change in severity and quality of pain following administration of analgesic and length of time analgesic is efective; • Amount of regular and breakthrough pain medication taken in last 24 hours; • Patient’s goals for pain relief; • Efect of unrelieved pain on the patient; • Absence/presence of adverse efects or toxicity; and • Suggestions for specifc changes to the treatment plan that are supported by evidence. Ensure that the selection of analgesics is individualized to the patient, taking into account: • The type of pain (eg. Using agents in combination can ofer advantages such as: • Lower doses of some agents, thus reducing the risk of adverse efects; • Inhibition of nociceptive processing at multiple (i. Patients should be taking and tolerating the equivalent of 60 mg of oral morphine equivalent per day with stable symptoms and expected longer-term pain before initiating the transdermal 25 mcg/h patch; • Should be reserved for chronic, stable pain. Due to its delayed onset of action, when transdermal fentanyl is frst initiated the previous opioid should be continued for an approximate 12 hour overlap time period. This would typically equate to 3 doses of a short- acting opioid given q4h, or a fnal dose of a long-acting opioid. Acute Pain: • If severe pain is expected for 48 hours post-operatively, routine administration may be needed for that period of time. A simple increase in an infusion will not achieve steady state for approximately 5 half-lives of the drug (i. Chronic Pain: • Opioids are not indicated in all chronic pain conditions, and medication alone is often insufcient to manage chronic pain. Other efective pharmacologic and non-pharmacologic treatments should also be considered. This may need individual titration according to efectiveness, as ultimately the correct breakthrough dose is the one that works; • Breakthrough analgesic doses should be changed when the scheduled medication is changed, in order to ensure continued proportionality to the total daily opioid dose; • Consider increasing the scheduled dose if 3 or more breakthrough doses are used in 24 hours; • Consider decreasing the scheduled dose if pain control is consistently good and no breakthrough doses are being used, particularly if there are dose-dependent adverse efects such as sedation; • Non-pharmacological methods and adjuvant co-analgesics may be useful in the management of breakthrough pain episodes. Tailor the route to the individual pain situation taking into consideration the urgency for symptom management, patient preferences, and limitations of the care setting. It is convenient, fexible and associated with stable drug levels with regular administration. For patients who cannot swallow capsules or tablets, many opioids are available in oral liquid formulations. Elevated temperature, such as through fever or externally applied heat sources, can dangerously accelerate absorption. The rectal route is relatively contraindicated in neutropenia, thrombocytopenia, and rectal pathology. It provides a stable efect that can attain steady blood concentration levels with regular administration. However, in patients with com- promised venous access, this route may be difcult to maintain. Topical route could be considered for locally circumscribed neuropathic or musculo-skeletal pain. Expected adverse efects could include: • Constipation; Patients starting opioid treatment should be placed on bowel regimens concurrently to avoid constipation. For chronic pain these side efects may be present for 1 to 2 weeks; • Mild hypotension.

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If there is no laboratory diagnosis to confirm the presence of amoebae buy levitra with dapoxetine 40/60mg with amex, first line treatment is for shigellosis discount levitra with dapoxetine 40/60mg on-line. Prevention – Breastfeeding reduces infant morbidity and mortality from diarrhoea and the severity of diarrhoea episodes generic levitra with dapoxetine 40/60mg. Shigella dysenteriae type 1 (Sd1) is the only strain that causes large scale epidemics. Clinical features Bloody diarrhoea with or without fever, abdominal pain and tenesmus, which is often intense. Patients with at least one of the following criteria have an increased risk of death: – Signs of serious illness: • fever > 38. After confirming the causal agent, antimicrobial susceptibility should be monitored monthly by culture and sensitivity tests. Organise home visits for daily monitoring (clinically and for compliance); hospitalise if the patient develops signs of serious illness. Shigellosis is an extremely contagious disease (the ingestion of 10 bacteria is infective). Note: over the past few years, Sd1 epidemics of smaller scale and with lower case fatality rates (less than 1%) have been observed. Transmission is faecal-oral, by ingestion of amoebic cysts from food or water contaminated with faeces. Usually, ingested cysts release non-pathogenic amoebae and 90% of carriers are asymptomatic. In 10% of infected patients, pathogenic amoebae penetrate the mucous of the colon: this is the intestinal amoebiasis (amoebic dysentery). The clinical picture is similar to that of shigellosis, which is the principal cause of dysentery. Occasionally, the pathogenic amoebae migrate via the blood stream and form peripheral abscesses. Clinical features – Amoebic dysentery • diarrhoea containing red blood and mucus • abdominal pain, tenesmus • no fever or moderate fever • possibly signs of dehydration – Amoebic liver abscess • painful hepatomegaly; mild jaundice may be present • anorexia, weight loss, nausea, vomiting • intermittent fever, sweating, chills; change in overall condition Laboratory – Amoebic dysentery: identification of mobile trophozoites (E. Treatment – First instance, encourage the patient to avoid alcohol and tobacco use. Gastric and duodenal ulcers in adults Clinical features Burning epigastric pain or epigastric cramps between meals, that wake the patient at night. They are most characteristic when they occur as episodes of a few days and when accompanied by nausea and even vomiting. Gastrointestinal bleeding Passing of black stool (maelena) and/or vomiting blood (haematemesis). Gastric lavage with cold water is not essential, but may help evaluate persistence of bleeding. If a diagnosis of ulcer is probable, and the patient has frequent attacks requiring repeated treatment with antiulcer drugs or, in cases of complicated ulcers (perforation or gastrointestinal bleeding) treatment to eradicate H. Dyspepsia is most commonly functional, linked with stress and not linked to the quantity of gastric acid (antiacids and antiulcer drugs are ineffective). Treatment If the symptoms persist, short term symptomatic treatment may be considered. Note: consider and treat possible intestinal parasites (taeniasis, ascariasis, ancylostomiasis, giardiasis, amoebiasis). Prolonged or painful stomatitis may contribute to dehydration or may cause loss of appetite with denutrition, particularly in children. In infants, examine routinely the mouth in the event of breast refusal or difficulties in sucking. In all cases: – Maintain adequate hydration and feeding; offer foods that will not irritate the mucosa (soft, non-acidic). Use a nasogastric tube for a few days if pain is preventing the patient from eating. Oral and oropharyngeal candidiasis Infection due to Candida albicans, common in infants, immunocompromised or diabetic patients. Other risk factors include treatment with oral antibiotics or high-dose inhaled corticosteroids. Clinical features White patches on the tongue, inside the cheeks, that may spread to the pharynx. Show the mother how to treat since, in most cases, candidiasis will be treated at home. Primary infection typically occurs in children aged 6 months-5 years and may cause acute gingivostomatitis, sometimes severe. After primary infection, the virus remains in the body and causes in some individuals periodic recurrences which are usually benign (herpes labialis). Local lesions are usually associated with general malaise, regional lymphadenopathy and fever. Both forms of herpes are contagious: do not touch lesions (or wash hands afterwards); avoid oral contact. Other infectious causes See Pharyngitis (Chapter 2), Diphtheria (Chapter 2), Measles (Chapter 8). It is common in contexts of poor food quality or in populations completely dependent on food aid (refugee camps). Other lesions resulting from a nutritional deficiency Other vitamin deficiencies may provoke mouth lesions: angular stomatitis of the lips and glossitis from vitamin B2 (riboflavin), niacin (see Pellagra, Chapter 4) or vitamin B6 (pyridoxine) deficiencies. They must be treated individually or collectively, but must also be considered as indicators of the sanitary condition of a population. A high prevalence of infectious skin diseases may reflect a problem of insufficient water quantity and lack of hygiene in a population. Dermatological examination 4 – Observe the type of lesion: • Macule: flat, non palpable lesion that is different in colour than the surrounding skin • Papule: small (< 1 cm) slightly elevated, circumscribed, solid lesion • Vesicle (< 1 cm), bulla (> 1 cm): clear fluid-filled blisters • Pustule: vesicle containing pus • Nodule: firm, elevated palpable lesion (> 1 cm) that extend into the dermis or subcutaneous tissue • Erosion: loss of the epidermis that heals without leaving a scar • Excoriation: erosion caused by scratching • Ulcer: loss of the epidermis and at least part of the dermis that leaves a scar • Scale: flake of epidermis that detaches from the skin surface • Crust: dried serum, blood, or pus on the skin surface • Atrophy: thinning of the skin • Lichenification: thickening of the skin with accentuation of normal skin markings – Look at the distribution of the lesions over the body; observe their arrangement: isolated, clustered, linear, annular (in a ring). At this stage, primary lesions and specific signs may be masked by secondary infection. In these cases, it is necessary to re-examine the patient, after treating the secondary infection, in order to identify and treat the underlying skin disease. It exists in two forms: ordinary scabies, relatively benign and moderately contagious; and crusted scabies, favoured by immune deficiency, extremely contagious and refractory to conventional treatment. Person to person transmission takes place chiefly through direct skin contact, and sometimes by indirect contact (sharing clothing, bedding). The challenge in management is that it must include simultaneous treatment of both the patient and close contacts, and at the same time, decontamination of clothing and bedding of all persons undergoing treatment, in order to break the transmission cycle. Clinical features Ordinary scabies In older children and adults – Itching, worse at night, very suggestive of scabies if close contacts have the same symptom and – Typical skin lesions: • Scabies burrows (common): fine wavy lines of 5 to 15 mm, corresponding to the tunnels made by the parasite within the skin.

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Adherence to Refills and Medications Scale the reading difficulty of the instrument levitra with dapoxetine 40/60mg discount. How often do you change the dose of your medicines to suit your needs (like when you take a more or less pill than you’re supposed to)? How often do you forget to take your medicine when you are supposed to take it more than once a day? How often do you put off refilling your medicines because they cost too much money? The subjects an- correlated more strongly with measures of refill adher- swering the respective question that they had never ence than did the Morisky scale order levitra with dapoxetine 40/60mg on-line. Lexile analysis demonstrated that the to disease suitable for measuring adherence at certain instrument had a favorable reading difficulty level below diseases and in Table 7 are Cronbach a discount levitra with dapoxetine 40/60mg line, coefficient com- the eight grades. The mostly population, with good performance characteristics even scales have good internal consistency reliability, because among low-literacy patients. The questionnaire listed 16 com- mon reasons for nonadherence and study subjects had to N o Scale answer questions on each of these reasons as the possible 1. These answers were used to ana- B M Q lyze the impact of each of these reasons for nonadherence. It can be nevertheless concluded that the most fre- There are many self-report scales for measuring med- quently used is a Medication Adherence Questionnaire ication adherence and their derivatives (or subscales). Naro~ito su pogodna ispitivanja koja se svode na iskazivanje samih pacijenata s obzirom da su jeftina i neposredna, a ujedno dolazimo do stavova pacijenata o uzimanju lijekova. Ograni~enja takvih istra`ivanja su mogu}a nedovoljna razumljivost pitanja od strane pacijenata te nepovjerenje i strah pacijenata vezanih uz objavljivanja podataka o uzimanju lijekova. Pretra`ivanjem PubMeda uz klju~ne rije~i adherence, compliance i persistence (ustrajnost) te self-report questionnaire do{lo se do svih do sada poznatih skala za mjerenje ustrajnosti. Kriterij uklju~enja bio je mogu}nost primjene kod utvr|ivanja ustrajnosti u kroni~nih bolesti i relativno visoki koeficijent unu- tarnje konzistentnosti (Cronbach a). U ~lanku se prikazuju pojedine skale zajedno sa svojim prednostima i nedostacima te se raspravlja o mogu}nostima identifikacije uzroka neustrajnosti kod pojedinih kroni~nih bolesti. In recent years, a variety of new agents with novel mechanisms of action have been approved for the treatment of type 2 diabetes. While this provides more options for the treatment of these patients, it may lead to confusion as to which agents should be used. However, for patients who fail metformin monotherapy, a broad variety of agents can be used in combination with metformin, or as monotherapy in those who cannot use metformin. For additional details on cardiovascular benefits associated with drugs for type 2 diabetes, see our chart, Diabetes Medications and Cardiovascular Impact. Users of this resource are cautioned to use their own professional judgment and consult any other necessary or appropriate sources prior to making clinical judgments based on the content of this document. Our editors have researched the information with input from experts, government agencies, and national organizations. Information and internet links in this article were current as of the date of publication. Saxagliptin and cardiovascular outcomes in patients Level Definition with type 2 diabetes mellitus. C Consensus Long-term safety, tolerability, and weight loss Expert opinion associated with metformin in the Diabetes Prevention D Anecdotal evidence Program Outcomes Study. Saxagliptin Management of hyperglycemia in type 2 diabetes, and cardiovascular outcomes in patients with type 2 2015: a patient-centered approach. Medical Risk of fatal and nonfatal lactic acidosis with management of hyperglycemia in type 2 diabetes: a metformin in type 2 diabetes mellitus. A study of the effects of hypoglycemic agents on vascular complications in patients with adult-onset Cite this document as follows: Clinical Resource, Drugs for Type 2 Diabetes. The guidelines use a variety of 1-3 A1C cutoffs for treatment recommendations, such as when to initiate insulin or consider dual therapy. Ultimately, medication selection should be based on the patient’s clinical presentation, blood glucose levels or A1C, and patient specific factors (e. Consider using these strategies to initiate therapy for any patient with new-onset type 2 diabetes, even those presenting with a very high blood glucose level (e. First Step: Patient Assessment  Assess patient stability and need for urgent treatment. If 1 necessary, check autoimmune markers as type 1 diabetes is defined by the following markers: Islet cell autoantibodies Insulin autoantibodies (e. See our commentary, Self- Monitoring of Blood Glucose in Patients with Type 2 Diabetes. However, there are no data to show that initial combination therapy improves outcomes compared to 5 sequential therapy in otherwise asymptomatic patients. Example: 7 o Increase insulin daily by 1 unit, if fasting blood glucose remains elevated. Combination of professional judgment and consult any other necessary saxaglipitin and metformin is effective as initial or appropriate sources prior to making clinical therapy in new-onset type 2 diabetes mellitus with severe hyperglycemia. Clinical considerations for use from experts, government agencies, and national of initial combination therapy in type 2 diabetes. Diabetes Association standards of medical care in Hyperglycemic crises in adult patients with diabetes – 2016. Canadian Diabetes Association Clinical Practice Consensus statement by the American Association Guidelines Expert Committee, Goguen J, Gilbert J. Cite this document as follows: Professional Resource, Management of New-Onset Type 2 Diabetes. Rath Department of Ophthalmology, Western Galilee – Nahariya Medical Center, Israel 1. Drug-induced glaucoma is a form of secondary glaucoma induced by topical and systemic medications. The differential diagnosis, prognosis and several future directions for research will be discussed. Ophthalmologists should be aware of these types of glaucoma, which to my opinion are becoming more common in a busy glaucoma clinic. These studies have also shown that these12 numbers are directly related to the frequency of the administration and duration of usage of this medication. At higher risk are patients with primary open-angle glaucoma, their first-degree relatives, diabetic patients, highly myopic individuals, and patients with connective tissue disease, specifically rheumatoid arthritis. In addition, patients with angle recession glaucoma are more susceptible to corticosteroid-induced glaucoma. The risk factors include preexisting primary open-angle glaucoma, a family history of glaucoma, high myopia, diabetes mellitus and young age. These drugs will incite an attack in individuals with very narrow anterior chamber angles that are prone to occlusion, especially when the pupils are dilated. The classes of medications that have the potential to induce angle-closure are topical anticholinergic or sympathomimetic pupil dilating drops, tricyclic antidepressants, monoamine oxidase inhibitors, antihistamines, anti-Parkinson drugs, antipsychotic medications and antispasmolytic agents. Patients with narrow or wide open angles are potentially susceptible to this rare and idiosyncratic reaction.

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