Al-Mehdi: Hepatobiliary Pharm Flashcards
____used for emulsification of fat (breakdown and absorption)
bile acids
cholic acid
deoxycholic acid
chenodeoxycholic acid
human bile acids
cholesterol gallstone formation in a nutshell
cholesterol into larger vesicles and then cholesterol crystal
why can a gallstone cause pain that comes and goes
the pain is due to the contraction of gallbladder by CCK
what blocks CCK from being released from I cells
Trypsin
oral dissolution therapy used to treat cholesterol gallstones
URSODIOL
used in cholestatic disease (primary biliary cholangitis)
URSODIOL
simple gallstone is _____ predominant
female
chronic pancreatitis is _____ predominant
male
diagnostic tests for chronic pancreatitis
IV secretin (for volume and HCO3-)
IV CCK (for pancreatic digestive enzymes)
elevation in anti-smooth muscle antibody
autoimmune pancreatitis
COX 3 inhibitor used to treat pain in chronic pancreatitis
acetaminophen
u-opioid agonist used to treat pain in chronic pancreatitis
tramadol
alpha2 subunit VGCC N-type inhibitors used to treat pain in chronic pancreatitis
Gabapentin and pregabalin
drug used to treat pain + loss of exocrine function in chronic pancreatitis
PANCRELIPASE
____ cells can be stimulated and transformed and produce collagen, leading to fibrosis of liver
stellate cells
highly specific for hepatocyte and cholangiocyte membranes and used if ALP is elevated to distinguish from bone damage
GGTP
hepatocellular damage markers
ALT/AST
This 43-year-old man with 3-year history of mild UC presents with pruritus and an ↑ serum ALP. 7 months later, jaundice and weight loss developed. ERCP: a 2-cm mass obstructing the common hepatic duct (arrows). A catheter passed beyond the obstructing mass shows marked dilatation of the left main duct proximal to the obstruction; the right main duct is completely occluded.
primary sclerosing cholangitis
young men
autoimmune/toxic trigger (LPS)
strong association with IBD
primary sclerosing cholangitis
jaundice, hepatomegaly, pruritis, fatigue, abd pain
pANCA +
AMA -
primary sclerosing cholangitis
primary sclerosing cholangitis
UDCA (Ursodiol) has no benefit treating what
primary sclerosing cholangitis
high risk for cholangiocarcinoma
PSC
3 ways to Rx PSC:
- vanco + metronidazole
- fecal microbiota transplant
- FXR agonist
_____ activation decreases synthesis of bile acids and also increases their transport out of hepatocytes
FXR
FXR agonist (used to treat primary biliary cholangitis)
OBETICHOLIC ACID
middle-aged elderly women
anti-microbial antibodies
chronic granulomatous inflammation
fatigue, pruritis, cirrhosis
AMA +
pANCA -
primary biliary cholangitis
first line treatment for primary biliary cholangitis
UDCA (ursodiol)
2nd line treatment for primary biliary cholangitis
FXR agonist (OBETICHOLIC ACID)
portal tract expanded and lymphocytes surrounding destructive granulomatous rxn centered on bile duct
primary biliary cholangitis
major labs for biliary obstruction
ALP and GGT
major lab elevation for hepatitis
AST/ALT
alcohol and enzyme-inducing drugs elevate what lab
GGT
level of bilirubin to see jaundice clinically
3.0
what is characteristic for bacterial infection
neutrophil bands
immature neutrophils produced by bone marrow that are increased in the blood when your body is fighting infection
neutrophil bands
charcot triad in cholangitis
jaundice + abd pain + fever
raynolds pentad in cholangitis
charcot triad + confusion + hypotension
to treat autoimmune hepatitis
PREDNISONE + AZATHIOPRINE
ALP > ALT/AST
biliary obstruction
palmar erythema is pathognomonic for what
liver disease
Asterixis (“flapping tremor”) is pathognomonic for what
liver disease
to treat alcoholic hepatitis
PREDNISONE
PENTOXYFILLINE
non specific TNF inhibitor to treat alcoholic hepatitis
PENTOXYFILLINE
to treat non-alcoholic fatty liver disease
no drugs approved yet
vitamin E
pentoxyfilline
metformin
pioglitazone
used to help in non-alcoholic liver disease but doesn’t treat
GLP-2 analogue used to treat short bowel syndrome
TEDUGLUTIDE
multiple protein kinase inhibitor used to treat hepatocellular carcinoma
SORAFENIB
HFE gene mutation
loss of hepcidin (increase of iron release and absorption)
hereditary hemochromatosis
Rx hereditary hemochromatosis
phlebotomy
how to deal with iron overload in thalassemia major
blood transfusions
DESFEROXAMINE
ATP7B mutation
Wilson Disease
hepatolenticular degeneration (basal ganglia damage)
Wilson’s Disease
Rx Menkes disease
copper
pathognomonic for what
Wilson Disease
Rx Wilson Disease
copper chelators (TRIENTINE)
splanchnic vasoconstrictor used to treat variceal bleeds
Octreotide
to Rx ascites
Spironolactone (K+ sparing diuretic)
Furosemide (loop diuretic)
bacteria produce NH3 from proteins in the gut, cirrhotic liver cannot convert NH3 to urea—–> hyperammonemia
hepatic encephalopathy
Asterixis (“flapping tremor”), lethargy, confusion, ataxia, slurred speech, coma
hepatic encephalopathy
Rx hepatic encephalopathy
LACTULOSE (ammonia to ammonium)
RIFAXIMIN (inhibits RNA polymerase)
ACARBOSE
avoid copper____ in patients with wilson’s disease
IUD
