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Therapeutics Fall Semester P3 > Cumulative Final - Hepatology (Isaacs) > Flashcards

Cumulative Final - Hepatology (Isaacs) Flashcards

1
Q

What are true markers for liver function?

A

AST
ALT
Alk phos

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2
Q

Estimated incidence of DILI

A

The estimated incidence of DILI is 14-19 cases per 100,000 people

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3
Q

Mechanisms/classifications of different types of DILI?

A

Direct hepatotoxicity, idiosyncratic hepatotoxicity, and indirect hepatotoxicity

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4
Q

What medications are highest risk for causing DILI (See Table 3)?

A

Acetaminophen and anti-infectives (isoniazid, beta lactam antibiotics, fluoroquinolone antibiotics, macrolide antibiotics)

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5
Q

What is considered high doses of APAP?

A

> 8 grams acetaminophen

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6
Q

High doses of APAP can result in toxic levels of _____

A

NAPQI (can cause direct hepatotoxicity)

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7
Q

Tx for APAP DILI

A

Reverse toxic metabolite with NAC (if in grey part on graph) – binds NAPQI

Activated charcoal (if < 2H since ingestion)

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8
Q

What do we monitor for APAP DILI?

A

AST
ALT
S/Sx of OD

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9
Q

NAC SE

A

N/V, GI issues
** If pt cannot handle these, give IV NAC

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10
Q

What should be done if APAP DILI was intentional OD?

A

Psych evaluation is appropriate and monitor for s/sx of depression

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11
Q

What is cirrhosis?

A

Severe, chronic, irreversible fibrosis of the liver

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12
Q

1 causative factor of cirrhosis in the US

A

Chronic alcohol use

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13
Q

What is a unique symptom for someone with cirrhosis?

A

Jaundice

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14
Q

Other symptoms of cirrhosis

A

Weight loss
Ascites
Jaundice
-megaly
Encephalopathy (confusion)

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15
Q

How is cirrhosis diagnosed?

A

Liver biopsy

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16
Q

What values do we look at to determine severity of cirrhosis?

A

Bilirubin
Albumin
Ascites
Encephalopathy
Prothrombin time
(all part of the child-pugh score)

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17
Q

What model do we look at for assessing the severity of cirrhosis?

A

MELD (predicts 3-month mortality)
**Used in transplant prioritizations
**Not used to adjust medications

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18
Q

Is cirrhosis reversible?

A

NO!!!!

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19
Q

What are ascites?

A

Fluid accumulation in the peritoneal space

20
Q

What medication class should we avoid in patients with cirrhosis?

A

NSAIDs

21
Q

Non-pharm options for ascites management

A

Na+ restriction (< 2 grams/day)
Assess MELD score

22
Q

First line option for ascites

A

Aldosterone antagonist (spironolactone) + loop diuretic (furosemide)

23
Q

Recommended ratio of spironolactone: furosemide

A

100:40

24
Q

Max ratio of spironolactone:furosemide

A

400:160

25
Q

Second line option for ascites management

A

Paracentesis
TIPS

26
Q

Aldosterone antagonists _____ potassium and loop diuretics ____ potassium levels

A

Increase
Decrease

27
Q

Both, spironolactone and furosemide, can cause

A

AKI

28
Q

What is given for pts that get more than 5 L removed via paracentesis?

A

ALBUMIN (helps retain fluid in vasculature)

29
Q

If more than 5L is removed via paracentesis, how much albumin do we give?

A

6-8 g/L of fluid removed of 25% albumin

30
Q

What is monitored for ascites tx?

A

S/Sx of ascites
Renal function
Potassium (goal: 3.5-5)

31
Q

What are esophageal varices?

A

Compensatory “varices” or small offshoots
-Dilation of EV can cause variceal bleeding

32
Q

Variceal bleeding prophylaxis

A

NSBB
EVL
CHOOSE 1 OR THE OTHER

33
Q

Titrate NSBB to a HR goal of ____, but maintain a SBP ____

A

< 60 bpm
> 90 mmHg

34
Q

NSBB options for EV

A

Nadolol
Propranolol
Carvedilol

35
Q

Are PPI recommended for variceal bleeding?

A

NO; only used in non-variceal bleeding

36
Q

Upon presentation of EV bleeding, what should be done?

A
  1. Transfusion (Hgb > 7)
  2. Octreotide 2-5d
  3. Ceftriaxone 7d
    ***Until we can get surgery
37
Q

What surgery is done for EV bleed?

A

EVL

38
Q

After EVL, what is done?

A

Secondary prophylaxis with NSBB AND EVL

39
Q

Underlying patho of HE

A

Ammonia accumulation – leads to neuronal dysfunction and HE

40
Q

S/Sx of HE

A

Jaundice precedes delirium, convulsions

41
Q

Recommended tx for acute management of HE

A

Lactulose 25 ml BID

42
Q

We adjust lactulose to ___ BM/day

A

3

43
Q

Diagnosis for SBP

A

Therapeutic paracentesis
**PMN > 250 cells/mm3

44
Q

PMN equation

A

PMN = WBC from fluid x (% neutrophils)

45
Q

SBP tx

A

Ceftriaxone IV x 7d + Albumin IV

46
Q

After intial tx for SBP, what is secondary prophylaxis protocol?

A

Bactrim (SMX/TMP) QD indefinitely
Ciprofloxacin QD

Therapeutics Fall Semester P3 (7 decks)

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