Target Audience: Pharmacists
Activity Type: Application Release Date: January 11, 2019 Expiration Date: January 11, 2020 Estimated Time to Complete Activity: 3.0 hours Fee: This lesson is offered for free at www.pharmacytimes.org. https://www.pharmacytimes.org/on-demand/pharmacists-reaching-out-optimizing-patient-management-in-hr-her2-advanced-breast-cancer-the-role-of-cdk46-inhibition Introduction Breast cancer is the most common cancer in women and the second leading cause of cancer death in the United States. In 2018, there were an estimated 268,670 new cases of breast cancer and 41,400 deaths due to breast cancer in the United States. Despite advances in detection and treatment of early-stage breast cancer, 20% to 50% of cases recur with distant metastasis, and 6% of patients initially present with metastatic disease. For recurrent metastatic breast cancer, the average survival is 2.81 years, while for de novo metastatic breast cancer, the average survival is 5.03 years. The goals of care for advanced breast cancer, defined as metastatic or locoregionally recurrent disease not amenable to curative treatment, are to prolong survival and to improve quality of life. Clinical treatment decisions are guided by the presence (+) or absence (–) of the hormone receptor (HR), which encompasses the estrogen receptor (ER) and the progesterone receptor (PR), and the human epidermal growth factor 2 receptor (HER2). More than 70% of invasive breast cancers are HR+ and grow in response to estrogen. Estrogen is a steroidal hormone that regulates cell growth and the differentiation of tissues, such as the mammary gland and uterus. In premenopausal women, the ovaries are the main source of estrogen production. In postmenopausal women, androgens released by the adrenal glands are converted to estrogen by aromatase primarily in the adipose tissue and muscle. Review Questions A 65-year-old postmenopausal woman presents with newly diagnosed HR+, HER2–metastatic breast cancer. Which one of the following options is most appropriate? A) Tamoxifen and ribociclib B) Everolimus and palbociclib C) Letrozole and abemaciclib D) Palbociclib monotherapy Which of the following CDK4/6 inhibitors is most associated with QTc prolongation? A) Palbociclib B) Abemaciclib C) Ribociclib D) All the CDK4/6 inhibitors Which of the following CDK4/6 inhibitors is recommended to always be taken with food? A) Palbociclib B) Abemaciclib C) Ribociclib D) All the CDK4/6 inhibitors
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Intended Audience: Pharmacists and managed care professionals.
Release date: August 16, 2018 Expiration date: August 16, 2019 Estimated time to complete activity: 3.0 hours Type of activity: Application Medium: Print with Internet-based posttest, evaluation, and request for credit Fee: Free https://www.pharmacytimes.org/on-demand/scientific-advances-in-als Amyotrophic Lateral Sclerosis: Disease State Overview Amyotrophic lateral sclerosis (ALS) is a disease that results in the progressive deterioration and loss of function of the motor neurons in the brain and spinal cord, leading to paralysis. ALS affects approximately 16,000 individuals, with a prognosis for survival of 2 to 5 years. There are 2 types of ALS differentiated by genetics: familial and sporadic (idiopathic). Diagnosis is determined by excluding other conditions and utilizing clinical examinations, laboratory tests, and nerve conduction/ electromyography studies. Due to the collection of information from the participation of patients with ALS in registries, biomarkers and genes associated with ALS have been discovered. The best practices for the management of ALS include an interdisciplinary approach aimed at addressing the physical and psychological needs and desires of patients and their families and caregivers. Disease-Modifying Treatment of Amyotrophic Lateral Sclerosis Currently, there is no cure for amyotrophic lateral sclerosis (ALS) and the foundation of ALS management revolves around symptomatic and palliative care. Early diagnosis offers the best prognosis for a longer, quality life while living with the disease. Many medications are used to relieve symptoms but there are only 2 pharmacologic agents indicated for the management of ALS. For 2 decades, riluzole had been the mainstay of disease-modifying therapy, but in 2017, edaravone became the second agent approved in the management of patients with ALS. The mechanism of either agent is not well known. Riluzole is thought to reduce damage to motor neurons through an inhibitory effect on glutamate release, while edaravone is thought to act as a neuroprotective agent that prevents oxidative stress damage as a free radical scavenger. With the lack of treatment options, it is imperative for healthcare professionals to understand the nuances of using these 2 agents to optimize therapy and quality of life for patients with ALS. ALS Managed Care Considerations As a chronic neurological disorder characterized by the progressive deterioration of neuromuscular function, amyotrophic lateral sclerosis (ALS) renders significant physical, psychological, and emotional tolls on patients, their families, and caregivers. Coupled with and contributing to the severe impact on quality of life are the substantial economic costs, which can be direct and indirect, and personal as well as societal. Understanding the magnitude and specifics of the costs accompanying ALS will provide useful perspectives to pharmacists who treat patients with ALS. Review Questions Which one of the following is a gene associated with ALS development? A) Glutamate B) Urinary p75 C) SOD1 D) Nogo-A What is the presumed mechanism of neuroprotective action of edaravone? A) Voltage-gated Ca2+ channel blocker B) Antioxidant C) SOD1 inhibitor D) Antiglutamatergic With such a debilitating disease as ALS, early diagnosis can be beneficial in a number of ways. Which of the following is a potential benefit to early diagnosis of ALS? A) Reduced risk for tracheostomy B) Increased cure rate C) Extended time to medication initiation D) Reduction in overall healthcare costs Target Audience: Retail and health-system pharmacists Activity Type: Application Release Date: April 15, 2019 Expiration Date: May 15, 2020 Estimated Time to Complete Activity: 3.0 hours OVERVIEW OF INFLUENZA Influenza (also commonly called the flu) is an acute, contagious upper respiratory tract illness caused by influenza viruses A, B, or C that infect the nose, throat, and sometimes the lungs. It can range from a mild illness that does not require extensive medical care to a severe illness that requires hospitalization and can lead to death. In the United States, the highest rates of influenza illness occur during the fall and winter (October to May), and it typically peaks in February. Review Questions Which of the following patients has an increased risk of inuenza complications? A) A 12-year-old adolescent boy who periodically takes an intranasal corticosteroid for allergic rhinitis B) A 35-year-old female oce worker who is attempting to become pregnant C) A 43-year-old man who has diabetes, but is otherwise healthy D) A 55-year-old man who is overweight and works as a long-distance trucker Which of the following is true regarding the use of baloxavir with OTC antacids containing calcium? A) Using an OTC antacid is appropriate as baloxavir does not have any drug interactions. B) OTC antacids increase the exposure of baloxavir, which may improve its ecacy to treat inuenza. C) The use of an OTC antacid with baloxavir should be avoided because baloxavir may substantially reduce exposure of the antacid. D) The use of an OTC antacid with baloxavir should be avoided because the antacid may reduce the ecacy of baloxavir Which of the following statements about the role of pharmacists in managing seasonal influenza is most accurate? A) Pharmacists should take a leadership role in reducing the rampant overuse of anti-influenza antiviral drugs that has been recently documented in the United States. B) Pharmacists do not have an important role in diagnosing seasonal influenza because laboratory testing for influenza must be conducted by a hospital laboratory. C) Pharmacists should recommend all individuals receive the influenza vaccine annually regardless of age. The ACIP recommends the inactivated influenza vaccine preferentially. D) Pharmacists should recommend point-of-care influenza testing when applicable and educate patients on the importance of starting treatment as quickly as possible after symptom onset.
Credits: 2.0 hour (0.2 ceu)
Type of Activity: Application Media: Internet Fee Information: There is no fee for this educational activity. Estimated time to complete activity: 120 minutes https://www.powerpak.com/course/preamble/117699 INTRODUCTION Gaucher disease is a rare genetic disease. It is within the category of genetic disorders called inborn errors of metabolism, which are disorders that do not allow the body to turn food into energy. Gaucher disease affects the recycling of glycolipids because of a deficiency of the lysosomal enzyme glucocerebrosidase. More than 40 hereditary lysosomal storage disorders exist, but Gaucher disease is the most common. An estimated 1 in 57,000 to 1 in 111,000 people will develop Gaucher disease. It has a higher prevalence in Ashkenazi Jews, occurring in approximately 1 in 885 people. The effects of Gaucher disease are classified into 3 categories (types 1, 2, and 3) on the basis of the presence of neurologic deterioration, age of presentation, and rate of disease progression. Type 1 Gaucher disease is the most common form, accounting for 95% of cases.2 This form is non-neuronopathic. Most patients are diagnosed before the age of 20 years old. Signs and symptoms at diagnosis include myelosuppression, hepatosplenomegaly, bone disease, pubertal delay, and growth retardation. This form is also associated with a hypermetabolic state, which results in poor weight gain. Types 2 and 3 disease are neuronopathic and, together, affect the other 5% of patients with Gaucher disease. Patients with these types are more likely to be of Asian and middle Eastern descent. Type 2 Gaucher disease is often called acute neuronopathic Gaucher disease and affects newborns and infants. Profound neurologic symptoms include involuntary horizontal eye movement, as well as hypotonia, spasticity, and seizures. Most of these patients die by the age of 2 years. Type 3 Gaucher disease is a chronic neuronopathic form, with 3 subtypes (a, b, and c). Each subtype has more progressive neurologic involvement. Patients with type 3 disease survive longer than those with type 2 disease. Clusters of patients with type 3 disease have been found in Northern Europe, Egypt, and East Asia, but it can affect any ethnic group. This activity is for pharmacists and is sponsored by Postgraduate Healthcare Education, LLC (PHE).
https://www.powerpak.com/course/preamble/114158 Credits: 3.0 hours (0.30 ceu) Published: February 21, 2017 Updated: February 22, 2019 Expires: February 21, 2020 Type of Activity: Knowledge Media: Internet Fee Information: $6.97 INTRODUCTION To understand West Virginia's prescription drug abuse problem–often described as epidemic in proportion and exploding in magnitude–pharmacists need to understand specific trends and realities both at the national level and in West Virginia (WV). Epidemiologists noted sharp increases in nonmedical use of opioid analgesics between 2002 and 2011. Recreational drug users and addicts often use benzodiazepines as companion drugs when they misuse opioids, so they are part of the problem.1 Although the problem seems to have stabilized or declined in some areas, it is still a public health crisis. EPIDEMIOLOGY OF CHRONIC PAIN AND OPIOID ABUSE In 2012, opioid prescribing reached a peak in the United States, with American physicians writing more than 255 million prescriptions for these agents, a prescribing rate of 81.3 per 100 persons. This has since declined to 191 million (58.7 prescriptions per 100 persons), according to 2017 data. West Virginia ranked third in the country in 2012 in prescribed opioid usage, with 137.6 prescriptions per 100 persons. By 2017, this rate had declined to 81.3 opioid prescriptions per 100 persons; while still above the national average and in the top 10 states in terms of usage, the decline showed substantial progress in addressing the opioid crisis in West Virginia. However, this rate fails to capture the use of illicit opioids, a problem that has worsened during this time period. CONCLUSION The sharply increasing rates in opioid analgesic nonmedical use, overdose deaths, and treatment-seeking during 2002–11 have been followed by declining or stable rates nationwide and in West Virginia during subsequent years. Accounting for this trend is abuser migration from opioid analgesics to heroin following introduction of tamper- resistant opioid analgesic formulations, and greater use of state PDMPs. More difficult to measure is impact from other recently implemented risk reduction strategies. This activity is sponsored by Postgraduate Healthcare Education, LLC (PHE) and supported by an educational grant from Arbor Pharmaceuticals.
https://www.powerpak.com/course/content/114939 Credits: 2.0 hours (0.20 ceu) Published: May 31, 2017 Expires: May 31, 2019 Type of Activity: Knowledge Media: Internet INTRODUCTION Acetaminophen (APAP) is a common analgesic and antipyretic, and it is one of the most common active ingredients in prescription and over-the-counter medications in the United States (U.S.). APAP treats a wide range of conditions and ailments, including joint pain, headache, and fever, and it is frequently formulated in combination with decongestants, antihistamines, sleep aids, and other analgesics. APAP is formulated in tablets, liquids for oral administration, rectal suppositories, and liquids for intravenous (IV) administration. APAP is an attractive and common medication choice because it is inexpensive, well tolerated, and readily available.1 More than 25 billion doses of APAP are sold annually in the U.S. and, each week, more than 60 million Americans ingest APAP. APAP MISUSE AND MEDICATION ERRORS APAP poisoning is a major public health problem in the U.S. When used as directed, APAP is safe and effective, and it has few side effects at therapeutic levels, but the consequences of an overdose—intentional or unintentional—can be extremely serious and may result in hepatotoxicity and acute liver failure. APAP is the most frequent cause of acute liver failure in Europe and North America and the second most common cause of liver failure requiring transplantation in the U.S. APAP hepatotoxicity can occur after single high-dose ingestion of APAP or after several days of high therapeutic or supratherapeutic doses for persistent pain or fever; even therapeutic doses of APAP can cause elevations in serum aminotransferase levels, which denotes liver cell death. Chronic therapy with APAP doses of 4000 mg daily causes transient elevations in serum aminotransferase levels beginning approximately 3 to 7 days after initiating therapy; these elevations, which peak at more than 3 times normal levels in 39% of patients, are usually asymptomatic and resolve rapidly once the APAP dose is reduced or discontinued. In adolescents and adults, a single dose of 7.5 g or more is considered an acute toxic dose. Stages of hepatotoxicity Four sequential stages of APAP-induced hepatotoxicity have been described, but clinical symptoms and laboratory results depend on many factors, including formulation of APAP (e.g., combination or single-ingredient product, extended-release or regular-release product, etc.), doses of APAP ingested, other substances that are ingested (e.g., alcohol, herbal supplements, other medications, etc.), and the existence of liver disease.
CONCLUSION APAP is an inexpensive, widely available drug that is available in myriad prescription and over-the-counter products. Chronic use of pain relievers, often in the setting of cancer pain and musculoskeletal disorders, has led to the widespread use of APAP alone and in combination products by adults and it is a common choice for treatment of many childhood conditions and ailments. Health care professionals, including pharmacists, must be vigilant to monitor for complications of long-term and/or high-dose APAP use. Target Audience: Managed care pharmacists.
Activity Type: Application Release Date: October 14, 2018 Expiration Date: October 14, 2019 Estimated Time to Complete Activity: 3.0 Hours Fee: Free Severity of Peanut Allergy and the Unment Gaps in Care: A Call to Action CLICK HERE to view Article 1. Peanut allergy is one of the most common food allergies in children, with a prevalence that has been increasing over the past several decades. The allergy is a type I, immunoglobulin E (IgE)-mediated reaction that commonly presents in childhood and can be associated with an anaphylactic response. There are many theories that attempt to explain the increasing prevalence, including dietary changes, improvements in hygiene, and intentional allergen avoidance. Diagnosis is made through a combination of a thorough patient history, peanut-specific serumspecific IgE levels, peanut skin-prick test, and, if necessary, an oral food challenge. Guidelines based on the landmark 2015 Learning Early About Peanut Allergy trial suggest that peanuts should be introduced into the diet as early as 4 to 6 months of age in infants who are at highest risk of developing peanut allergy. It is important for providers to recognize risk factors for the development of peanut allergy, identify associated clinical symptoms, and provide an accurate diagnosis of patients to effectively manage them and their families and prevent future reactions Management of Peanut Allergy: A Focus on Novel Immunotherapies CLICK HERE to view Article 2. The management of peanut allergy involves strict avoidance, prompt recognition of allergic reactions, and rapid initiation of epinephrine and other supportive therapy for anaphylaxis. Avoidance presents several challenges and burdens to quality of life and daily activities. Currently, no treatment options are available for peanut allergy apart from epinephrine, which is the treatment of choice for severe allergic reactions. In recognition of the need for improved treatment options among patients with peanut allergy, several novel immunotherapies are undergoing clinical development, and clinicians must be knowledgeable about the safety and efficacy of these agents. This educational activity will provide an overview of current practices in peanut allergy management and novel immunotherapies with potential to improve outcomes among children and adults with peanut allergy The Economic Impact of Peanut Allergies CLICK HERE to view Article 3. The prevalence of peanut allergies, the most common food allergy in children, has tripled in the past 2 decades. Today, up to 2.5% of the pediatric population has been diagnosed with a peanut allergy. Peanut allergies result in significant medical, out-of-pocket, and opportunity costs to payers, parents, and employers. They are also a leading cause of food allergy–related deaths in children. Although there is evidence that peanut oral immunotherapy may be effective in reducing the severity of the allergy, such approaches require a long intervention with no standardized protocol available. The introduction of biologic compounds to treat peanut allergies has the potential to revolutionize how these patient cases are managed. Their anticipated high cost, however, raises several issues for payers as to how to integrate these new therapies into formularies and treatment continuums. CLICK HERE FOR REVIEW QUESTIONS AND ANSWERS Target Audience: Pharmacists
Activity Type: Application Release Date: November 16, 2018 Expiration Date: November 16, 2019 Estimated Time to Complete Activity: 3.0 hours Fee: Free Understanding the Prevalence, Burden, and Impact of Major Depressive Disorder Major depressive disorder (MDD) is a mental health condition that is commonly encountered at the primary care office. Often, a chief “physical symptom” complaint may be a manifestation of this psychiatric condition, and, if the primary care provider is aware of the sometimes subtle physiologic symptoms of depression, routine screening for depression at medical office visits can often identify this potentially disabling condition. Beyond the hallmark symptoms of depressed mood or loss of interest or pleasure, changes in weight, sleep patterns, and increased complaints of pain can all be associated with MDD and may continue residually in patients treated for depression who experience only a partial response to therapy. The incidence of MDD fluctuates over a lifetime. The highest incidence of depression is reported in adults aged 18 to 25 years, with roughly 10.9% of the individuals in the United States within this age bracket having experienced 1 or more major depressive episodes within the past year. This is compared with roughly 4.8% of adults older than 50 years. Evaluating data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III, Hasin et al estimated that the 12-month and lifetime prevalence of MDD is 10.4% and 20.6%, respectively. Despite efforts to increase awareness and decrease the stigma associated with mental illness, MDD continues to be underreported, underdiagnosed, and, often, undertreated. New Epidemiologic Data and Trends MDD is now understood to be a disease of the brain caused by both environmental and genetic factors that determine the course of the disease. Genomic research has identified 44 genetic variants linked to depression, some of which are associated with other serious mental illnesses, such as schizophrenia. The genetic similarities in the comorbid mental illnesses, coupled with new information about specific genetic targets, foster hope that the genome-wide association research will result in more individualized treatments for those with a diagnosis of MDD. Pharmacogenomic testing is now more widely available; however, because large-scale, randomized controlled trials to explore the absolute clinical value are lacking, the routine use of such testing is not yet recommended. Other studies explore the use of a more algorithmic approach, investigating demographic and clinical factors to establish pretreatment characteristics that will identify individuals who may be more likely to benefit preferentially from selective serotonin reuptake inhibitor (SSRI) treatment, which will further promote the goal of personalizing treatment selection for patients with MDD. Treatment Resistance Despite the advances in pharmacotherapy, there are patients who will not respond to standard treatment interventions. Symptom profiles are highly heterogeneous, and severity of illness can range significantly. The complexity of treatment challenges providers to address the unmet needs of symptom relief and restoration of quality of life to those who experience MDD. Treatment resistance is generally recognized as a failure of treatment to produce a response or remission after 2 or more attempts using different antidepressant agents of an adequate dose and duration. Introduction
Over the past 25 years, more than 100 studies have documented hazardous drug (HD) contamination in health care facilities (HCFs). The National Institute for Occupational Safety and Health (NIOSH) estimates, based on occupation, that about 9 million American health care workers (HCWs) are currently exposed to HDs in the workplace. CAREX Canada recently estimated that approximately 75,000 Canadians are exposed to antineoplastic drugs in the workplace, of which at least 75% are women. As the population ages over the next few decades, the number of patients who require chemotherapy to treat cancer is expected to increase. Cancer cases in the United States are forecasted to increase by 56% between 2010 and 2035. The World Health Organization estimates the annual number of new cancer cases worldwide will increase by more than 60% between 2018 and 2040. The number of HCWs exposed to HDs is expected to increase in tandem with this trend. With these projected increases in the need for cancer care, reducing occupational exposure to antineoplastic drugs is a crucial issue. Since guidance on cytotoxic drug safe handling from the American Society of Health-System Pharmacists (ASHP; formerly American Society of Hospital Pharmacists) was published in 1983, at least 20 US guidelines have made recommendations about aspects of HD safe handling. Faced with persistent reports of HD contamination in HCFs, the United States Pharmacopoeia (USP) saw the need for an enforceable standard for safe HD handling across all health care settings. Building on previous guidance from the ASHP, NIOSH, Oncology Nursing Society (ONS), and Occupational Safety and Health Administration (OSHA), the organization created USP <800> Hazardous Drugs—Handling in Healthcare Settings.8 The goal of USP <800> is to provide a standard for HD handling that promotes patient safety by protecting HDs from contamination, promotes worker safety by protecting HCWs from HD exposure, and protects the environment from HD contamination. Evolution of USP <800> The USP is a non-governmental organization that develops standards to improve the quality of pharmaceuticals. Although the organization has no regulatory authority, USP standards are generally adopted and enforced by federal and state government agencies. The USP first addressed safe HD handling in a substantial way when a 2008 revision of USP <797> Pharmaceutical Compounding—Sterile Preparations was revised to align with recommendations from the NIOSH 2004 Safety Alert on HD handling. Recognizing that a document was needed to address sterile and nonsterile HDs across all health care settings, the organization started work on USP <800> in 2010. Under the supervision of the USP Compounding Expert Committee, this work culminated with publication of the final draft in 2016. In the meantime, USP <795> and <797> were undergoing revisions. In September 2017, USP announced that a July 2018 implementation date for USP <800> would be delayed to synchronize implementation of the USP <797> update in December 2019. Conclusion Members of the oncology community face a myriad of complex challenges as they strive to achieve compliance with the “should” and “must” recommendations laid out in USP <800>. Council discussions identified key unmet needs related to this goal.
CLICK HERE FOR REVIEW QUESTIONS AND ANSWERS UNDERSTANDING TRAVELERS’ DIARRHEA
Travelers’ diarrhea (TD) is the most frequent health problem experienced by individuals traveling internationally, most often due to poor hygiene practices in local restaurants. TD is estimated to impact up to 70% of travelers, depending on the location and season of travel. Based on tourism travel projections, TD can affect up to 20 million travelers annually. TD has equal incidence among men and women. There are several environmental factors, often found in resource-challenged countries, that promote TD. Tropical environments with large populations and poor plumbing or sanitation systems may have environmental solid waste contamination. Countries with inadequate electrical capacity and inconsistent refrigeration systems may have food storage conditions that promote bacterial growth. Regions that lack purified or safe drinking water may have microbial water contamination. Lack of running water as a regular resource may also lead to absent or infrequent hand hygiene practices and poor cleaning of utensils and cooking surfaces for foods, which may expose restaurant patrons and food consumers to microbial organisms from poor food handling.1 It is also important to note that, while less common, TD may also still occur during travel to more industrialized countries, perhaps due to poor personal food and beverage choices. As a result, all travelers to international destinations need to take appropriate precautions to prevent or minimize their risk of TD. Epidemiology There are several factors that influence the risk for TD, the most important being destination. Globally, regions are identified as low, intermediate, or high risk for TD. The highest risk areas include Asia, the Middle East, Africa, Mexico, and Central and South America. Intermediate-risk areas include eastern Europe, South Africa, and some Caribbean islands. Low-risk countries include the United States, Canada, Australia, New Zealand, Japan, and northern and western Europe. Other risk factors for TD include type of travel, duration of stay, and age of the traveler. Individuals on vacation or honeymoons have a higher incidence of TD than business travelers. TD rates are also higher for a duration of stay greater than 1 week. However, recent travel within 6 months to a tropical country may have a protective effect for TD. The age groups most susceptible to TD are infants, toddlers, and young adults aged between 13 and 30 years. Additionally, the type of accommodations may also influence risk, with adventure travel having the highest rates followed by tour group trips and beach vacations at a resort having the lowest rates. Individuals who take acid-suppressing medications, such as proton pump inhibitors, are also at an increased risk for TD. TD Symptoms Symptoms of TD range in severity and may be defined via a classical symptom framework or by functional impact. The classical definition of moderate TD is passage of 3 or more unformed stools within 24 hours. An alternate method of classification defines the severity of TD based on the impact on the traveler’s regularly scheduled activities and the need for changes or adjustment to a planned itinerary. However, any diarrhea that occurs while traveling overseas is considered TD. Acute TD is defined as mild, moderate, or severe. Persistent TD is defined as diarrhea that continues for greater than 2 weeks. TD may be accompanied by other symptoms, such as abdominal pain and cramping, severe flatulence, nausea, vomiting, defecation urgency, passing bloody stools, or fever. Dysentery, which is a severe form of TD characterized by grossly bloody stool and often accompanied by fever, may also occur. Short-term consequences of TD include dehydration, incapacitation, and in rare cases, hospitalization. Potential long-term, but rare, systemic complications may include reactive arthritis, Guillain-Barré syndrome (GBS), and irritable bowel syndrome (IBS). Reactive arthritis as a complication of TD is described as symptom onset 1 to 4 weeks after enteric infection and may persist for months to years. The arthritis most often impacts joints of the lower extremities. Salmonella, Shigella, Campylobacter, and Yersinia are the pathogens most often associated with reactive arthritis. GBS is an autoimmune response targeting peripheral nerves. The advancement of GBS leads to peripheral neuropathy and neuromuscular failure. Neurologic symptoms include limb weakness, bulbar palsy, and eye-movement disorders. Severe GBS can progress to respiratory weakness requiring ventilatory support. Campylobacter infections are most often associated with post-infectious GBS. The incidence of GBS following enteric infection is approximately 1 case for every 1000 Campylobacter infections. CLICK HERE FOR REVIEW QUESTIONS AND ANSWERS |
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