ACI Exam 4

Question 1

Mode of Action: vasopressin (Pitressin) & octreotide (Sandostatin) - Cirrhosis Drugs

Answer 1

Hemostasis and control of bleeding in esophageal and gastric varices, constriction of splanchnic arterial bed

Question 2

Mode of Action: propranolol (Inderal) & nadolol (Corgard) - Cirrhosis Drugs

Answer 2

Reduction of portal venous pressure, reduction of esophageal varices bleeding

Question 3

Mode of Action: lactulose (Cephulac) - Cirrhosis Drug

Answer 3

Acidification of feces in bowel and trapping of ammonia, causing its elimination in feces

Question 4

Mode of Action: rifaximin (Xifaxan) & neomycin sulfate - Cirrhosis Drugs

Answer 4

Decrease in bacterial flora, decreased formation of ammonia

Question 5

Mode of Action: magnesium sulfate - Cirrhosis Drug

Answer 5

Magnesium replacement, hypomagnesemia is possible with liver dysfunction

Question 6

Mode of Action: Vitamin K - Cirrhosis Drug

Answer 6

Correction of clotting abnormalities from decreased levels of this vitamin

Question 7

Mode of Action: proton pump inhibitors (pantoprazole [Protonix]) - Cirrhosis Drug

Answer 7

Decrease in gastric acidity

Question 8

Mode of Action: spironolactone (Aldactone) - Cirrhosis Drug

Answer 8

Blocks the action of aldosterone, potassium sparring

Question 9

Mode of Action: furosemide (Lasix) - Cirrhosis Drug

Answer 9

Acts on distal tubule and loop of Henle to decrease reabsorption of sodium and water

Question 10

Mode of Action: propranolol (Inderal) - Esophageal & Gastric Varices Drug

Answer 10

Decreased BP and preload

Question 11

Mode of Action: octreotide (Sandostatin) - Esophageal & Gastric Varices Drug

Answer 11

Vasoconstricts the sphlanic bed to decrease bleeding

Question 12

Mode of Action: vasopressin (Pitressin) - Esophageal & Gastric Varices Drug

Answer 12

IV administration of VP produces vasoconstriction of the splanchnic arterial bed, decreases portal blood flow, and decreases portal hypertension

Question 13

Side effects of vasopressin

Answer 13

decreased coronary blood flow, dysrhythmias, & increased BP

Question 14

Mode of Action: IV nitroglycerin - Esophageal & Gastric Varices Drug

Answer 14

Reduces the adverse effects of vasopressin while enhancing it’s beneficial effect

Question 15

Mode of Action: Albumin - Ascites Drug

Answer 15

Adequate intravascular volume and colloid osmotic pressure

Question 16

What needs to be monitored with Albumin?

Answer 16

Vital signs, especially hemodynamics

Question 17

Mode of Action: Diuretics (spironolactione [Aldactone], furosemide [Lasix], amiloride [Midamor], triamterene [Dyrenium]) - Ascites Drugs

Answer 17

Reduces circulating volume, promote loss of excess fluid, decrease preload and afterload.

Question 18

What needs to be monitored when taking diuretic drugs?

Answer 18

electrolytes and cardiac rhythm

Question 19

Mode of Action: lactulose (laxative) - hepatic encephalopathy

Answer 19

Traps ammonia in the gut, laxative effect of the drug expels the ammonia from the colon

Question 20

How can lactulose be given?

Answer 20

Orally, as an enema, or through an NG tube

Question 21

Mode of Action: rifaximin (antibiotic) - hepatic encephalopathy

Answer 21

Stops the growth of bacteria that produce toxins - may also be given in patients who do not respond to lactulose

Question 22

Mode of Action: corticosteroids (methylprednisolone [Solu-Medrol]) - Liver Transplant: immunosuppression

Answer 22

SUPPRESS INFLAMMATORY RESPONSE, inhibit cytokine production (IL-1, IL-6, TNF) and T-cell activation and proliferation

Question 23

Side effects of corticosteroids

Answer 23

Peptic ulcers, hypertension, osteoporosis, sodium and water retention, muscle weakness, easy bruising, delayed healing, hyperglycemia, INCREASE RISK FOR INFECTION

Question 24

Mode of Action: Calcineurin Inhibitors: cyclosporine - Liver Transplant: immunosuppression

Answer 24

Acts on T-helper cells to prevent production and release of IL-2 and y-interferon. Inhibits production of T cytotoxic lymphocytes and B cells

Question 25

Side Effects of Calcineurin Inhibitors (cyclosporine & tacrolimus)

Answer 25

NEPHROTOXICITY, INCREASED RISK FOR INFECTION, NEUROTOXICITY (tremors, seizures), HEPATOTOXICITY, lymphoma, hypertension, tremors, hirsutism, LEUKOPENIA, GINGIVAL HYPERPLASIA

Question 26

Mode of Action: Calcineurin Inhibitors: tacrolimus -Liver Transplant: immunosuppression

Answer 26

Same as cyclosporine: Acts on T-helper cells to prevent production and release of IL-2 and y-interferon. Inhibits production of T cytotoxic lymphocytes and B cells BUT MORE EFFECTIVE

Question 27

Mode of Action: Antispasmodics (dicyclomine [Bentyl]) - Acute Pancreatitis

Answer 27

Decrease vagal stimulation, motility, pancreatic outflow (decrease volume & concentration of bicarbonate and enzyme secretion)

Question 28

Antispasmodics (dicyclomine) contraindication

Answer 28

Paralytic Ileus

Question 29

Mode of Action: Carbonic anhydrase inhibitor (acetazolamide [Diamox]) - Acute Pancreatitis

Answer 29

Decrease volume and bicarbonate concentration of pancreatic secretion

Question 30

Mode of Action: Antacids - Acute Pancreatitis

Answer 30

Neutralization of gastric hydrochloric (HCl) acid secretion

Decrease production and secretion of pancreatic enzymes and bicarbonate

Question 31

Mode of Action: Proton Pump Inhibitors - Acute Pancreatitis

Answer 31

Decreases HCl acid secretion

Question 32

Mode of Action: Pancreatic enzyme products - Chronic Pancreatitis

Answer 32

Replacement therapy for pancreatic enzymes

Question 33

Assessment for administration of Calcium - Chronic Pancreatitis

Answer 33

Assess the patient for a positive Chvostek’s sign or Trousseau’s sign

Question 34

Calcium gluconate (as ordered) should be given to treat symptomatic ____________

Answer 34

Hypocalcemia

Question 35

Treatments for cholecystitis and cholelithiasis

Answer 35

Morphine or Toradol (pain control)

Antiemetics (N/V)

Ursodiol (dissolution of stones)