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Pharmacotherapy 3 Exam 2 > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

What are two major factors that can cause cirrhosis?

A

Hepatitis and alcohol

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2
Q

True or False? A patient with cirrhosis may be asymptomatic

A

True

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3
Q

What clinical presentation can be seen in a patient with cirrhosis?

A

Abdominal discomfort, weakness, malaise, ascites, jaundice

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4
Q

What lab values may be abnormal in a patient with cirrhosis?

A

Prolonged prothrombin time (increased INR), decreased albumin, thrombocytopenia

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5
Q

What are the ranges of scores for a “Child-Pugh Score” and what do they represent?

A

5-6: Class A (well-compensated) - 100% survival
7-9: Class B (significant compromise) - 80% survival
10-15: Class C (decompensated) - 45% survival

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6
Q

True or False? Cirrhosis can cause portal hypertension

A

True. This can cause structural changes and vascular tone changes

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7
Q

How do you calculate a hepatic venous pressure gradient (HVPG)?

A

HVPG = Wedged Hepatic Venous Pressure (WHVP) - Free Hepatic Venous Pressure (FHVP)

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8
Q

What is a normal HVPG and what score determines if someone has portal hypertension? What score puts you at risk of hemorrhage?

A

Normal: < 5mmHg
Portal hypertension: >= 6mmHg
Risk of hemorrhage: > 12mmHg

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9
Q

True or False? Varices put you at a lower risk of bleeding

A

False. They put you at a higher risk

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10
Q

What % of cirrhotic patients have varices?

A

50%

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11
Q

Patients with varices have a goal HVPG of < ___mmHg or ___% of baseline and ___ heart rate

A

<12mmHg
20%
Decreased

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12
Q

What are first line agents for lowering heart rate in patients with cirrhosis?

A 
Non-selective beta blockers:
Nadolol 20-40mg QD
Propranolol 20-40mg BID
Carvedilol 6.25mg QD
These will reduce the heart rate and variceal bleeding by 50%
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13
Q

What is a serious adverse effect of beta blockers in reducing variceal bleeding?

A

Spontaneous bacterial peritonitis

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14
Q

The goal of variceal hemorrhage therapy is to prevent ___ week mortality

A

6

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15
Q

What is an example of non-pharmacologic therapy to reduce varices?

A

Endoscopic variceal ligation (EVL) every 2 to 8 weeks until varices are gone. This is an elastic band around the varix

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16
Q

What are first line pharmacologic therapies for variceal hemorrhage?

A

Ocreotide (1st line), vasopressin

17
Q

What antibiotics are given as prophylaxis to treat variceal hemorrhages?

A

Ceftriaxone 1g IVPB Q24hr for 7 days

Cipro 400mg IVPB Q12hr for 7 days

18
Q

What medications are given as secondary prophylaxis to variceal hemorrhage?

A 
Non-selective beta blockers:
Nadolol 20-40mg QD
Propranolol 20-40mg BID
Carvedilol 6.25mg QD
These are used in both variceal bleeding and variceal hemorrhage
19
Q

What is the clinical presentation of ascites?

A

Weight gain, increased abdomen size, shortness of breath

20
Q

Ascites is present in cases of cirrhosis due to retention of ___ and ___

A

Na

Water

21
Q

How do you calculate a serum ascites albumin gradient (SAAG)?

A

SAAG = serum albumin – ascites albumin

22
Q

If SAAG is > ___mg/dL, the patient has portal hypertension

A

1.1mg/dL

23
Q

___ replenishment is necessary for a patient with ascites

A

Albumin

24
Q

How is ascites treated?

A

Na restriction (<2g daily)
Fluid restriction
Ratio of 40 mg furosemide: 100 mg spironolactone
(if low weight, 20mg furosemide: 50mg spironolactone)

25
Q

___ to ___% of people with spontaneous bacterial peritonitis are asymptomatic

A

10-20%

26
Q

What are symptoms of spontaneous bacterial peritonitis?

A

Fever, abdominal pain, change in mental status

27
Q

In order to diagnose spontaneous bacterial peritonitis, a patient’s polymorphonuclear cell count (PMN) must be > ___

A

250

28
Q

What antibiotics are given to treat spontaneous bacterial peritonitis?

A

Ceftriaxone 2g IVPB Q24hr

Cefotaxime 2g IVPB 18hr

29
Q

___ must be replenished in patients with spontaneous bacterial peritonitis in order to prevent renal failure

A

Albumin

30
Q

What antibiotics are given as prophylaxis for patients with spontaneous bacterial peritonitis?

A

Cipro or bactrim

31
Q

A complication of cirrhosis is hepatic encephalopathy (liver damage). What are symptoms of this?

A

Memory loss, decreased concentration, decreased sleep, increased lethargy

32
Q

What is used for treatment of hepatic encephalopathy?

A

Lactulose (1st line). If not working, add rifaximin

33
Q

A complication of cirrhosis is hepatorenal syndrome. What are the differences between type 1 and type 2 hepatorenal syndrome?

A

Type 1 - rapid and progressive decrease in renal function

Type 2 - Gradual and slow decrease in renal function

34
Q

How do you treat hepatorenal syndrome?

A

A combinaton of midodrine, ocreotide, albumin

Pharmacotherapy 3 Exam 2 (4 decks)

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