Drugs And Treatment In Heaptic Disorders Flashcards

1
Q

Why does ascites occur in patients with liver cirrhosis?

A

Hypoalbuminemia is present and increased portal HTN is also present

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2
Q

Treatment fo ascites

A

Low sodium diet

Diuretics

Paracentesis
- go in and drain the blood from the veins

Surgical shunts

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3
Q

How does potassium sparing and loop diuretics differ with MOA?

A

Potassium sparing (spironolactone):

  • antagonizes aldosterone
  • targets distal renal tubules

Loop (furosemide):

  • antagonizes the Na/K/2Cl co-transporter
  • targets ascending loop of Henle
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4
Q

What is spontaneous bacterial peritonitis?

A

Occurs when ascites is present secondary to bacterial infections
- ascites varices rupture and poor bacteria into peritoneum

Most common pathogens:

  • E. Coli
  • klebsella
  • pneumococci

Treatment =

  • cefotaxime (1st line)
  • fluroquinolones (ciprofloxacin/ofloxacin) (2nd line)
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5
Q

What does ascites in liver cirrhosis generally imply?

A

If its moderate-large volume = end stage organ failure

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6
Q

What are common prophylaxis treatment for esophageal varices?

A

Beta blockers
- Nadolol (tends to be #1), propranolol, carvedilol

Sclerotherpy
- injection of sodium tetradecyl sulfate and polidocanol

Endoscopic variceal ligation (EVL)
- uses rubber bands

EVL is safer than sclerotherpy

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7
Q

What is the regiment for active esophageal varices ruptures?

A

Octrotide or vasopressin and Omeprazole

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8
Q

What is the underlying mechanism behind hepatic encephalopathy?

A

Overwhelming buildup of ammonia (NH3) in the blood
- liver fails to metabolize enough or any of it depending on how much liver failure is present

Ammonia reaches brain which is toxic

Treatment = Lactulose and antibiotics

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9
Q

What are the 3 antibiotics used for hepatic encephalopathy?

A

Rifaximin, neomycin, metronidazole

amoung other functions, all three work to decrease growth of urease producing bacteria

Urease = CO2 + ammonia (need to kill these bacteria in hepatic encephalopathy)

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10
Q

Hep A vaccines

A

HAVRIX and VAQTA

ADRs:
- pain at injection site/nausea/fatigue/fever

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11
Q

Hep B vaccines

A

Adults only:

  • Recombivax HB
  • Engerix B
  • TWINRIX (combo A/B vaccine)

Children only:

  • Comvax
  • Pediarix

ADRs:

  • pain at injection site
  • nausea
  • fatigue
  • fever
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12
Q

What is the difference interferon-alpha and pegylated interferon-alpha

A

Pegylated = wayyy higher half life (3-days)

- better for patients since they dont have to take it twice a day, only once a day

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13
Q

What are the three steps in viral Hep C replication that direct-acting antivirals can target to kill the virus?

A

Translation/processing

  • NS3/4A protease inhibitors
  • includes paritaprevir

Replication

  • NS5B polymerase inhibitors
  • includes Dasaburvir and sofosbuvir

Morphogenesis

  • NS5A inhibitors (unknown MOA though)
  • includes Ombitasvir and ledipasvir
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14
Q

What does the 4 drug regiment for hep C infection include?

A

Ombitasvir/paritaprevir/ritovair/dasaburvir

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15
Q

What is the 3 drug regiment for hep C infections?

A

Ombitasivr/paritaprevir/ritovair

same as 4 regiment except substract dasaburvir

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16
Q

What is the 2 drug regiment for Hep C infections

A

Ledipasvir/sofosbuvir

17
Q

What is the MOA of ritovair?

A

Doesn’t actually work on Hep C itself, works to inhibit CYP3A4 which increases serum levels of paritaprevir
- amplifies its effect