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PHRM 864 > E4 hepatology > Flashcards

E4 hepatology Flashcards

1
Q

3 objective markers for liver injury

A

aspartate transaminase (AST)
alanine transaminase (ALT)
Alkaline phosphatase (Alk phos)

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2
Q

AST normal range

A

0-50

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3
Q

ALT normal range

A

0-50

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4
Q

Alk phos normal range

A

30-120

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5
Q

T or F:
Term LFTs are true markers of liver function

A

False, “are NOT”

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6
Q

elevated ______ can be a sign of acute and/or chronic liver issues

A

bilirubin

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7
Q

chronic liver disease can decrease liver production of ______ resulting in what?

A

protein
dec albumin, inc INR and/or inc bilirubin * quiz question

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8
Q

how much acetaminophen to result in toxic levels of NAPQI

A

> 8g

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9
Q

s/sxs of acetaminophen DILI

A

ab pain
jaundice
N/V/D

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10
Q

how do you assess severity of acetaminophen DILI? (3)

A

AST
ALT
acetaminophen conc

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11
Q

what is the reversal agent for aceta DILI?

A

NAC +/- activated charcoal

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12
Q

MOA of NAC

A

binds to NAPQI, decreasing hepatotoxic effects

also something with glutathione

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13
Q

NAC is based on conc of aceta >_ hours after ingestion and timing since ingestion

A

4

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14
Q

when dosing NAC what form(s) do you use?

A

start with an oral loading dose then do IV after for 72 hours

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15
Q

monitoring for NAC

A

liver enzymes and s/sxs of acute liver injury

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16
Q

T or F:
Cirrhosis is reverisble

A

nope, irreversible

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17
Q

1 cause of cirrhosis

A

alcohol

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18
Q

chronic use of what two drugs can cause cirrhosis (not tylenol)

A

amiodarone and MTX

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19
Q

what is jaundice caused by

A

accumulation of bilirubin

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20
Q

what does MELD (model for end-stage liver disease) predict? *

A

3 month mortality

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21
Q

4 s/sxs of ascites

A

ab distension
ab pain
sob
nausea

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22
Q

compensatory mechanisms from portal htn result in ?

A

inc fluid retention

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23
Q

what can uncontrolled ascites cause

A

SBP and hepatorenal syndrome

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24
Q

2 non-pharm things for ascites management

A

Na restriction (<2g/day)
assess for liver transplant

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25
Q

first line for ascites management

A

spiro + furo

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26
Q

2nd line for ascites

A

paracentesis
TIPS

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27
Q

avoid ______ in pts with cirrhosis

A

NSAIDs no shit

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28
Q

rec ratio for spiro and furo for ascites

A

100:40

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29
Q

T or F:
furosemide is superior to spiro in cirrhosis

A

false, other way around

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30
Q

3 side effects with spiro

A

AKI
inc K
gynecomastia

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31
Q

2 side effects furo

A

AKI
dec K

32
Q

3 monitoring things for ascites

A

s/sxs of ascites
SCr
K

33
Q

when is paracentesis indicated?

A

refractory/resistant ascites or in AKI*

34
Q

when do you administer albumin with paracentesis

A

if >5L is removed

35
Q

what percentage of albumin do you give IV?

A

25%

36
Q

how much albumin to give per liter removed?

A

6-8 g

37
Q

portal htn causes hepatic/splanchnic _________ resulting in decreased perfusion

A

vasodilation

38
Q

if you see offshoots what do you think about

A

EV

39
Q

4 risk factors for variceal bleeding

A

varices size
cirrhosis
red color markings from endoscopy
alcohol use

40
Q

what is EVL

A

endoscopic variceal ligation

41
Q

T or F:
NSBBs and EVL showed a decrease in variceal and Gi bleeding with mortality benefit

A

false, no effect on mortality

42
Q

primary prophylaxis for variceal bleeding

A

NSBB or EVL (not in combo tho)

43
Q

B2 antagonism =

A

splanchnic vasoconstriction

44
Q

B1 antagonism=

A

dec HR and dec CO

45
Q

3 NSBBs

A

NPC

46
Q

3.5 side effects of NSBB

A

drowsiness/insomnia
bradycardia
hypotension

47
Q

HR goal for NSBBs

A

55-60

48
Q

BP goal for NSBBs (SBP)

A

SBP > 90

49
Q

esophageal varices are asymptomatic, how do you visualize them?

A

endoscopy

50
Q

5 s/sxs under variceal bleeding clinical presentation

A

hematemesis
melena
fatigue
lightheaded/dizzy
hypotension

51
Q

somatostatin analog that vasoconstricts

A

ocreotide

52
Q

tx of variceal bleeding:
- octreotide
- _________ prophylaxis

A

blood transfusions*
antibiotic

53
Q

what is not recommended for variceal bleeds

A

PPis

54
Q

octreotide inhibits release of ____________ resulting in splanchnic ___________ and decreased blood flow

A

vasodilatory peptides
vasoconstriction

55
Q

indications of ocrtreotide

A

acute variceal bleed (not any other types of GI bleeds)

56
Q

in practice, when do you usually stop octreotide?

A

24 hours after successful EVL

57
Q

4 side effects under octreotide

A

N/V
htn
bradycardia
hyperglycemia

58
Q

4 things to monitor for octreotide

A

s/sxs
BP
HR
BG

59
Q

what is the gold standard for variceal bleeding cessation

A

EVL

60
Q

how fast do you want to complete an EVL upon presentation

A

12 hours

61
Q

what antibiotic recommended for prophylaxis for variceal bleedign

A

ceftriaxone

62
Q

1 side effect ceftriaxone

A

diarrhea

63
Q

T or F:
ceftriaxone is renally adjusted in CrCl <50

A

false dumbass its not renally cleared

64
Q

duration of ceftriaxone

A

until hemorrhage resolution (max of 7 days)

65
Q

secondary prophylaxis for varices

A

EVL every 1-4 weeks (how tf does this work?)
NSBBs indefinitely

66
Q

what is the proposed patho of HE

A

accumulation of ammonia

67
Q

primary s/sxs of HE

A

altered mental status and a bunch of other mental shit

68
Q

first line HE

A

lactulose

69
Q

counseling for lactulose

A

GI side effects, hydrate mucho

70
Q

what thing under SBP clinical presentation did isaacs say was unique to SBP 10 times?

A

abdominal pain/ tenderness

71
Q

diagnosis of SBP

A

ascitis fluid with >250 cells with PMN

72
Q

SBP treatment

A

ceftriaxone again yay + albumin dec mortality

73
Q

how to dose albumin for SBP

A

Day 1: 1.5g/kg x 1 (within 6 hours of diagnosis)
Day 3: 1g/kg x 1

74
Q

SBP secondary prophylaxis

A

bactrim or cipro and only once a day instead of 2 like normal

75
Q

what to monitor on bactrim (3)

A

SCr, electrolytes, CBC

76
Q

what to monitor on cipro

A

mental status, CBC, renal function

PHRM 864 (28 decks)

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