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NAPLEX!!!!! > Hepatitis and Liver Disease > Flashcards

Hepatitis and Liver Disease Flashcards

1
Q

Hepatitis A transmission

A

fecal-oral route

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2
Q

Treatment of Hepatitis A

A

supportive

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3
Q

Treatment of Hepatitis B

A

interferons, select NRTIs

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4
Q

most common indication for liver transplant

A

hepatitis C

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5
Q

of hepatitis C genotypes

A

6

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6
Q

treatment options for hepatitis C

A

peginterferons, ribaviron, direct acting antivirals (protease inhibitors, NS5B polymerase inhibitors, NS5A replication complex inhibitors)

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7
Q

Interferon alfa indicated for treatment of which hepatitis

A

HBV and HCV

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8
Q

Interferon alfa 2b brand name

A

intron A

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9
Q

interferon alfa 2b indications

A

hbc, hcv, many cancers

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10
Q

Pegylated interferon alfa 2a brand name

A

pegasys

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11
Q

pegylated interferon alfa 2a indications

A

HBV, HCV

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12
Q

Pegylated interferon alfa 2b brand name

A

peg-intron

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13
Q

pegylated interferon alfa 2b indications

A

HCV

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14
Q

Which dose reductions are required when treating with interferon alfa

A

thrombocytopenia, neutropenia, renal dysfunction

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15
Q

When in neutropenia should be interferon alfa be held

A

ANC

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16
Q

when in thrombocytopenia should interferon alfa be held

A

platelets

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17
Q

boxed warnings for interferon alfa

A

cause or exacerbate neuropsychiatric, autoimmune, ischemic, or infectious disorders. combination with ribavirin can cause birth defects, fetal mortality, or hemolytic anemia

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18
Q

contraindications to interferon alfa

A

autoimmune hepatitis, decompensated liver disease in cirrhotic patients, infant and neonates (Pegasys)

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19
Q

warning for interferon alfa

A

neuropsychiatric events, cardiovascular events, endocrine disorders (aggravates hypo/hyperthroidism, hypo/hyperglycemia), ophthalmologic disorders (retiniopathy, decrease in vision), pancreatitis, myelosuppression and serious skin reactions

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20
Q

interferon alfa side effects

A

CNS effects (fatigue, anxiety, depression, weakness), GI upset (N/V, anorexia, weight loss), increased LFTs (5-10x ULN), myelosuppression, mild alopecia, Flu-like syndrome (fever, chills, HA, malaise, arthralgia, myalgia, diaphoresis)

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21
Q

pretreatment required for interferon alfa

A

acetaminophen and antihistamine

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22
Q

Interferon alfa monitoring

A

CBC with differential and platelets, LFTs, urice acid, SCr, electrolytes, TGs, thyroid function tests, serum HBV DNA or HCV RNA levels

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23
Q

NRTIs MOA

A

inhibit HBV replication by inhibiting HBV polymerase resulting in DNA chain termination

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24
Q

Dose adjustment required for all NRTIs (HBV)

A

CrCl

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25
Q

Boxed warnings for ALL NRTIs (HBV)

A

Lactic acidosis and severe hepatomegaly with steatosis (may be fatal). Exacerbations of HBV upon discontinuation,

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26
Q

Lamuvidine brand name (HBV)

A

Epivir HBV

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27
Q

Lamuvidine dose for HBV only

A

100 mg daily

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28
Q

Lamuvidine dose for HBV with HIV coinfection

A

150 mg BID or 300 mg daily

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29
Q

Lamuvidine dose adjustment

A

decrease dose CrCL

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30
Q

Lamuvidine boxed warning

A

Do not use Epivir HBV for treatment of HIV (HIV resistance due to lower dose)

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31
Q

Lamuvidine side effects

A

HA, N/V/d, fatigue, insomnia, myalgias, increased LFTs, rare risk of pancreatitis

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32
Q

Adefovir brand name (HBV)

A

Hepsera

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33
Q

Adefovir dosing (HBV)

A

10 mg daily

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34
Q

Adefovir dose adjustment (HBV)

A

CrCl

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35
Q

Adefovir boxed warning

A

May cause HIV resistance in untreated/unrecognized HIV, caution in renal impairment or those at risk of renal toxicity (NSAIDs, nephrotoxic agents)

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36
Q

Adefovir side effects

A

HA, weakness, abdominal pain, hematuria, rash, nephrotoxicity

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37
Q

Tenofovir brand name (HBV)

A

Viread

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38
Q

1st line NRTIs (HBV)

A

Tenofovir, Entecavir

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39
Q

Tenofovir dose (HBV)

A

300 mg daily

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40
Q

tenofovir dose adjustment (HBV)

A

CrCl

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41
Q

tenofovir warnings

A

renal toxicity including acute renal failure and/or Fanconi’s syndrome, osteomalacia, and decreased bone mineral density

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42
Q

tenofovir side effects

A

N/V/d, HA, depression, renal impairment, decreased bone mineral density, increased LFTs, increased CPK

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43
Q

Entecavir brand name (HBV)

A

Baraclude

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44
Q

Entecavir dosing (HBV)

A

NRTI niave: 0.5 mg daily, Lamivudine resistant: 1 mg daily TAKE ON AN EMPTY STOMACH (food reduces AUC, 2 hours before or after a meal)

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45
Q

Entecavir dose adjustment (HBV)

A

CrCl

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46
Q

Entecavir boxed warning

A

HIV resistance in untreated or unrecognized HIV infection

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47
Q

Entecavir side effects

A

peripheral edema, pyrexia, ascites, increased LFTs, nephrotoxcity, increased SCr

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48
Q

Telbivudine brand name (HBV)

A

Tyzeka

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49
Q

Telbivudine dosing (HBV)

A

600 mg daily

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50
Q

Telbivudine dose adjustment (HBV)

A

CrCl

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51
Q

telbivudine side effects

A

increased CPK, fatigue, HA, increased LFTs

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52
Q

Ribavirin drug interaction with all NRTIs

A

increase hepatotoxic effects -> lactic acidosis can occur

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53
Q

Lamuvidine drug interaction with SMZ/TMP

A

increase lamivudine levels due to decreased excetion

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54
Q

Tenofovir drug interaction with didanosine or adefovir

A

Avoid concomitant use due to increased risk of virologic failure and increase side effects

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55
Q

Telbivudine drug interaction with interferon alfa

A

Avoid concomitant use due to increased risk of peripheral neuropathy

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56
Q

Ribavirin MOA

A

inhibits replication of RNA and DNA viruses

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57
Q

Ribavirin indications

A

HCV in combination with other agents (NEVER MONOTHERAPY); aerosolized ribavirin used for RSV infection

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58
Q

Ribavirin brand name (HCV)

A

Copegus, Moderiba, Rebetol, Ribasphere, Ribasphere RibaPak

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59
Q

Ribavirin brand name (RSV)

A

Virazole

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60
Q

Ribavirin dosing (HCV)

A

400-600 mg BID with food (increased tolerability) SWALLOW WHOLE

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61
Q

Ribavirin dose adjustments

A

Hgb

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62
Q

Ribavirin boxed warnings

A

significant teratogenic effects, monotherapy not effect, hemolytic anemia (first 4 weeks)

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63
Q

Ribavirin contrindications

A

pregnancy, those wishing to become pregnant, male partners of pregnant women, hemoglobinopathies, CrCl

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64
Q

ribavirin side effects

A

hemolytic anemia (can worsen cardiac disease and lead to MIs, do not use in unstable cardiac disease), fatigue, HA, insomnia, N/V/d, anorexia, myalgias, hyperuricemia

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65
Q

ribavirin monitoring

A

CBC with differential and PLTs, electrolytes, uric acid, bilirubin, LFTs, HCV-RNA levels, TSH, monthly pregnancy tests

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66
Q

How long after ribavirin to avoid pregnancy

A

6 months after completing therapy

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67
Q

Ribavirin drug interaction with didanosine

A

do not use together due to hepatic failure, peripheral neuropathy, and pancreatitis

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68
Q

ribavirin drug interaction with NRTIs

A

can increased hepatotoxic effects of NRTIs causing lactic acidosis

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69
Q

ribavirin drug interaction with zidovudine

A

increase risk and severity of anemia from ribavirin

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70
Q

direct acting antivirals indication

A

treatment of chronic HCV infection in adult patients

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71
Q

direct acting antivirals include

A

NS3/4A protease inhibitors (simeprevir, paritaprevir), NS5B polymerase inhibitors (sofosbuvir, dasabuvir), NS5a replication complex inhibitors (daclastasvir, ledipasvir, ombitasvir)

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72
Q

medications in Technivie

A

Ombitasvir, ritonavir boosted paritaprevir

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73
Q

Viekira Pak medications

A

Ombitasvir, ritonavir boosted partiaprevir, and dasabuvir

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74
Q

Medications in Harvoni

A

Sofosbuvir and ledipasvir

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75
Q

Simeprevir brand name

A

Olysio

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76
Q

Simeprevir dosing (HCV)

A

150 mg daily with food

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77
Q

Simeprevir genetic screening

A

NS3 Q80K polymorphism screening recommended for HCV genotype 1a being treated with simprevir + ribavirin and Peg-INF-alfa. if positive consider alternate therapy

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78
Q

Simeprevir warnings

A

serious symptomatic bradycardia (sofosbuvir + amiodarone + another DAA [especially with beta blockers, cardiac conditions, advanced liver disease]), hepatic decompensation and hepatic failure (in advanced / decompensated cirrhosis), photosensitivity, rash

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79
Q

Simeprevir side effects

A

Rash (photosensitivity), pruritis, myalgia, dyspnea, increased serum bilirubin, nausea, fatigue

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80
Q

Simeprevir monitoring

A

CBC with differential (anemia and neutropenia), electrolytes, LFTs, HCV-RNA levels

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81
Q

When to discontinue treatment with simeprevir/ribavirin/peg INF alfa combination

A

HCV-RNA > 25 units/ml at treatment weeks 4 or 12.

82
Q

Simeprevir drug interaction with moderate or strong 3A4 inducers or inhibitors

A

Simeprevir 3A4 substrate - do not administer with inhibitors or inducers

83
Q

Simprevir effects on CYP enzymes

A

3A4 substrate, 1A2 inhibitor, inhibits intestinal 3A4

84
Q

Simeprevir effect on P-gp

A

Inhibits P-gp. decrease concentrations of P-gp substrates

85
Q

Simeprevir drug interaction with amiodarone

A

increase bradycardia

86
Q

Sofosbuvir indication

A

HCV

87
Q

Sofosbuvir brand name

A

Sovaldi

88
Q

Sofosbuvir/ledipasvir brand name

A

Harvoni

89
Q

Sofosbuvir dosing

A

400 mg daily with or without food

90
Q

sofosbuvir warnings

A

symptomatic bradycardia when taken with amiodarone and another DAA (especially with beta blockers, and underlying cardiac conditions, advanced liver disease)

91
Q

sofosbuvir side effects

A

fatigue, HA, nausea, insomnia, anemia, chills, irritability, pruritus, skin rash, weakness, myalgia

92
Q

sofosbuvir monitoring

A

LFTs, bilirubin, CBC, HCV-RNA levels

93
Q

Harvoni dosing

A

1 tablet (sofosbuvir 400 mg/ ledipasvir 90 mg) daily with or without food

94
Q

Harvoni drug interactions

A

acid suppression therapy should be avoided due to decreased absorption of ledipasvir

95
Q

Daclatasvir brand name

A

Daklinza

96
Q

Daclatasvir dosing

A

60 mg daily with or without food in combination with sofosbuvir

97
Q

Daclatasvir dose adjustments

A

30 mg daily with strong 3A4 inhibitors, 90 mg daily with moderate 3A4 inducers

98
Q

Daclatasvir contraindications

A

use with strong 3A4 inducers

99
Q

Daclatasvir warnings

A

serious symptomatic bradycardia with sofosbuvir + amiodarone + DAA (esp. with beta blockers, cardiac conditions, advanced liver disease)

100
Q

Daclatasvir side effects

A

Fatigue, HA, N/d

101
Q

Daclatasvir monitoring

A

LFTs, SCr, cardiac monitoring (with amiodarone), HCV RNA

102
Q

Paritaprevir/ritonavir/ombitasvir brand name

A

Technivie

103
Q

Technivie dosing

A

2 tablets once daily in the morning with a meal

104
Q

Technivie contraindications

A

Moderate/severe hepatic impairment, concomitant use with drugs highly dependent on 3A4 for elimination, moderate/strong inducers of 3A4,

105
Q

technivie warnings

A

hepatic decopensation and hepatic failure in patient with cirrhosis (not indicated in cirrhosis), risk of increase LFTs (>5 x ULN) within 4 weeks (females taking ethinyl estradiol are at increased risk, significant drug interaction potential, risk of HIV protease inhibitor resistance

106
Q

Technivie side effects

A

Asthenia, fatigue, nausea, insomnia, pruritis, skin reactions

107
Q

Technivie monitoring

A

CBC, LFTs, bilirubin, HCV-RNA levels

108
Q

Paritaprevir/ritonavir/ombitasvir + dasabuvir brand name

A

Viekira Pak

109
Q

Viekira Pak dosing

A

2 Paritaprevir/ritonavir/ombitasvir combo tablets once daily in the morning and 1 dasabuvir tablet twice daily with meals

110
Q

Viekira Pak contraindications

A

Moderate/severe hepatic impairment, concomitant use with drugs highly dependent on 3A4 for elimination, moderate/strong inducers of 3A4, and strong inducers/inhibitors of 2C8

111
Q

Viekira Pak warnings

A

Hepatic decompensation and hepatic failure in patients with cirrhosis, risk of increase LFTs (>5xULN) within 4 weeks (females taking ethyinl estradiol at increased risk), significant drug interaction potential, risk of HIV protease inhibitor resistance

112
Q

Viekira Pak side effects

A

Fatigue, HA, pruritus, skin reactions, insomnia, nausea

113
Q

Viekira Pak monitoring

A

CBC, LFTs, bilirubin, HCV RNA, SCr

114
Q

Sofosbuvir drug interaction with Pgp

A

Sofosbuvir is a Pgp substrate. avoid with potent inducers (St. John’s wort, rifampin)

115
Q

Avoid co-administration of Sofosbuvir with which medications

A

carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifapentine, rifabutin, and tipranavir/ritonavir

116
Q

Harvoni drug interactions with antacids

A

seperate by 4 hours

117
Q

Harvoni drug interaction with H2RAs

A

take at the same time or seperate by 12 hours. famotidine max 40 BID or equivalent

118
Q

Harvoni drug interaction with PPIs

A

Max 20 mg omeprazole or equivalent/day and avoid use with food. take at same time as harvoni

119
Q

Harvoni drug interaction with rosuvastatin

A

avoid co-administration

120
Q

Daclastavir drug interactions

A

Avoid strong 3A4 inducers

121
Q

Technivie drug interactions with ethinyl estradiol

A

ethinyl estradiol must be stopped before starting and 2 weeks after stopping

122
Q

Viekira Pak drug interactions with ethinyl estradiol

A

ethinyl estradiol must be stopped before starting and 2 weeks after stopping

123
Q

Duration of treatment for HCV for treatment naive patients without cirrhosis

A

12 weeks

124
Q

duration of treatment for HCV for treatment naive patients with cirrhosis

A

16 or 24 weeks

125
Q

Recommended treatment for treatment naive HCV patients with genotype 1a

A

Sofosbuvir/Daclatasvir x 12 weeks, Sofosbuvir/Daclatasvir +/- Ribavirin x 24 weeks, Sofosbuvir/ledipasvir x 12 weeks, Sofosbuvir/Simeprevir x 12 weeks, sofosbuvir/simprevir +/- ribavirin x 24 weeks, Viekira Pak + ribavirin x 12/24 weeks

126
Q

Recommened treatment for treatment naive HCV patients with genotype 1b

A

Sofosbuvir/Daclatasvir x 12 weeks, Sofosbuvir/Daclatasvir +/- Ribavirin x 24 weeks, Sofosbuvir/ledipasvir x 12 weeks, Sofosbuvir/Simeprevir x 12 weeks, sofosbuvir/simprevir +/- ribavirin x 24 weeks, Viekira Pak x 12 weeks

127
Q

Recommended treatment for treatment naive HCV patients with genotye 2

A

Sofosbuvir/daclatasvir x 12 weeks, Sofosbuvir/ribavirin x 12/16 weeks

128
Q

Recommended treatment for treatment naive HCV patients with genotype 3

A

Sofobuvir/daclatsvir x 12 weeks, Sofosbuvir/daclatasvir +/-ribavirin x 24 weeks,

129
Q

Recommended treatment for treatment naive HCV patients with genotype 4

A

Sofosbuvir/Ledipasvir x 12 weeks, Technivie/ribavirin x 12 weeks, sofosbuvir/ribavirin x 24 weeks

130
Q

Recommended treatment for treatment naive HCV patients with genotype 5-6

A

Sofosbuvir/ledipasvir x 12 weeks

131
Q

most common causes of cirrhosis in the US

A

hepatitis C, alcohol consumption

132
Q

symptoms of liver disease/ cirrhosis

A

nausea, loss of appetite, vomiting, diarrhea, malaise, pain in the upper right quadrant of the abdomen, jaundice, darkened urine, light colored (white/clay) stool

133
Q

normal range for ALT and AST

A

10-40 units/L

134
Q

clinical signs of liver disease

A

increased ALT/AST, decreased albumin, increase alkaline phosphatase, increased total bilirubin, increased lactate dehydrogenase, increase prothrombin time

135
Q

clinical signs of hepatocellular liver disease

A

increase ALT/AST

136
Q

clinical sign of cholestatic liver disease

A

increase Alk Phos and increase Tbili

137
Q

Clinical sign of mixed liver disease

A

increased AST/ALT, Alk phos and Tbili

138
Q

Child Pugh class A (mild disease) score range

A
139
Q

Child Pugh class B (moderate disease) score range

A

7-9

140
Q

Child Pugh class C (severe disease) score range

A

10-15

141
Q

milk thistle side effects

A

diarrhea

142
Q

milk thistle possible drug interactoins

A

antiviral HCV medications

143
Q

Natural products that are hepatotoxic

A

KAva, comfrey, flavocoxid, Limbrel

144
Q

When to stop hepatotoxic drugs due to liver injury

A

LFTs 3x ULN

145
Q

Which OTC pain relief products should be avoided in patients with cirrhosis

A

NSAIDs due to decompensation and risk of bleeding

146
Q

Drugs with boxed warning against liver disease (underlined)

A

acetaminophen, isoniazid, NNRTIs, NRTIs, PIs, Valproic acid

147
Q

Drugs with boxed warning against liver disease

A

acetaminophen, amiodarone, bosentan, felbamate, flutamide, isoniazid, ketoconazole, leflunomide and teriflunomide, lomitapide, maraviroc, methotrexate, mipomersen, nefazodone, NNRTIs (nevirapine), NRTIs (didanosine, stavudine, zidovudine) PIs (tipranavir), Propylthopuracil, Tolcapone, Valproic acid

148
Q

medications used for alcohol withdrawal

A

Benzos (inpatient), anticonvulsants (outpatient), Naltrexone (revia) acamprosate (campral), disulfiram (antabuse) to prevent relapse

149
Q

Vitamins and trace minerals important to reverse malnutrition in alcoholism

A

vitamin A, D, thiamine (B1), folate, pyridoxine (B6), zinc

150
Q

Thiamine use in alcoholism

A

prevent Wernicke-Korsakoff syndrome

151
Q

treatment of acute variceal bleeding

A

supportive care (volume resuscitation, blood products, mechanical ventilation, correction of coagulopathy, stop bleeding, prevent rebleeding), band ligation, sclerotherapy, vasoactive therapy (octreotide, vasopressin), surgery (balloon tamponade, transjugular intrahepatic portosystemic shunt), short term antibiotics

152
Q

Antibiotics used to prevent infection in acute variceal bleeds

A

ceftriaxone or quinolone x 7 days

153
Q

what is used for secondary prevention of variceal bleeds

A

non-selective beta blockers

154
Q

Octreotide brand name

A

SandoStatin

155
Q

Octreotide dosing

A

Bolus: 25-100 mcg IV, repeat in 1 hour followed by infusion (25-50mcg/hr x 2-5 days)

156
Q

Octreotide side effects

A

bradycardia, chest pain, fatigue, HA, pruritus, hyper/hypoglycemia, N/V/d, hypothyroidism, abdominal pain, malaise, fever, dizziness, flatulence, cholelithiasis, biliary sludge, constipation, injection site pain, arthropathy, myalgias, URTIs

157
Q

Octreotide monitoring

A

Blood glucose, HR, ECG

158
Q

Vasopressin brand name

A

Pitressin, Vasostrict

159
Q

What is normally given with vasopressin for variceal bleeds and why

A

nitroglycerin IV to prevent myocardial ischemia

160
Q

Vassopressin dose for variceal bleeds

A

0.2-0.4 units/min IV (max 0.8 units/min). max duration 24 hours

161
Q

Vasopressin side effects

A

arrhythmias, chest pain, MI, decreased cardiac output, increase BP, nausea, vomiting

162
Q

Vasopressin monitoring

A

BP, HR, ECG, fluid balance

163
Q

What is used as primary prevention of variceal bleedings

A

nonselective beta blockers (nadolol, propranolol), endoscopic varcieal ligation

164
Q

How do beta blockers lower portal pressure

A

decrease cardiac output, decreased splanchnic blood flow

165
Q

Target HR for beta blocker therapy for prevention of variceal bleeding

A

55-60 BPM

166
Q

Nadolol brand name

A

Corgard

167
Q

Nadolol dosing for prevention of variceal bleeding

A

20-40 mg daily

168
Q

Propranolol brand name

A

Inderal LA, Inderal XL, InnoPran XL

169
Q

Propranolol dosing for prevention of variceal bleeding

A

20 mg PO BID

170
Q

boxed warning for beta blockers

A

do not withdraw beta blockers abruptly to avoid tachycardia, HTN, and ischemia

171
Q

Contraindications to beta blockers

A

sinus bardycardia, 2nd or 3rd degree heart block, sick sinus syndrome, cardiogenic shock, active asthma exacerbation. Non-selective agents: caution in asthma/COPD, peripheral vascular disease, Raynaud’s disease. may mask signs of hyperthyroidism, aggrevate psychiatric conditions, caution in recurrent hypoglycemia

172
Q

symptoms of hepatic encephalopathy

A

musty odor of the breath and/or urine, changes in thinking, confusion, forgetfulness, mood changes, poor concentration, drowsiness, disorientation, worsening handwriting and hand tremor (asterixis), sluggish movements

173
Q

What causes symptoms of hepatic encephalopathy

A

accumulation of gut derived nitrogenous substances (ammonia, glutamate, others)

174
Q

daily protein intake for hepatic encephalopathy patients

A

1-1.5g/kg vegetable and diary preferred over animal

175
Q

treatment for hepatic encephalopathy

A

lactulose followed by rifaximin

176
Q

Lactulose MOA in hepatic encephalopathy

A

converts gut ammonia to ammonium which cannot diffuse into the blood

177
Q

Lactulose brand name

A

constulose, enulose, generlac, kristalose

178
Q

lactulose dosing for treatment of hepatic encephalopathy

A

30-45 ml (20-30 grams) every hour until evacuation, then repeat 3-4 times daily titrated to produce 2-3 bowel movements daily

179
Q

lactulose dosing for prevention of hepatic encephalopathy

A

30-45 ml (20-30 grams) 3-4 times daily titrated to produce 2-3 bowel movements daily

180
Q

lactulose side effects

A

flatulence, diarrhea, dyspepsia, abdominal discomfort, dehydration, hypernatremia, hypokalemia

181
Q

lactulose monitoring

A

mental status, bowel movements, ammonia, fluid status, electrolytes

182
Q

rifaxamin brand name

A

Xifaxin

183
Q

rifaxamin dosing for treatment of hepatic encephalopathy

A

400 mg Q8H x 5-10 d

184
Q

rifaxamin dosing for prevention of hepatic encephalopathy

A

550 mg BID

185
Q

rifaxamin side effects

A

peripheral edema, dizziness, fatigue, nausea, ascites, flatulence, HA

186
Q

Rifaxamin monitoring

A

mental status, ammonia

187
Q

Neomycin brand name

A

Neo-fradin

188
Q

Neomycin dosing for hepatic encephalopathy

A

500-2000 mg Q6-8H x 5-6 days

189
Q

Neomycin boxed warnings

A

Neurotoxicity (hearing loss, vertigo, ataxia), nephrotoxicity, neuromuscular blockade and respiratory paralysis (after anesthesia or with muscle relaxants)

190
Q

Neomycin side effects

A

GI upset, ototoxicity, nephrotoxicity, irritation/soreness of mouth or rectal area

191
Q

Neomycin monitoring

A

Mental status, renal function, hearing, ammonia

192
Q

Metronidazole brand names

A

Flagyl, Flagyl ER, Metro

193
Q

Metronidazole should not be used long term why

A

peripheral neuropathies

194
Q

Treatment approaches for ascites

A

restrict dietary sodium (

195
Q

diuretic options for ascites

A

spironolactone monotherapy or spironolactone and furosemide

196
Q

spironolactone dosing in ascites (monotherapy)

A

50-100 mg daily max 400 mg/day

197
Q

dosing and ratio of furosemide:spironolactone in treatment of ascites

A

max weight loss of 0.5kg/day 40 furosemide: 100mg spironolactone

198
Q

When is the addition of albumin recommended to prevent paracentesis induced circulatory dysfunction

A

removal > 5 L add 6-8 grams of albumin per liter of fluid removed

199
Q

Treatment of spontaneous bacterial peritonitis

A

Ceftriaxone (or equivalent against streptococci and enteric gram negative pathogens) x 5-7 days, albumin (1.5 g/kg on day 1 and 1 g/kg on day 3)

200
Q

Medications used for primary and secondary prevention of spontaneous bacterial peritonitis

A

norfloxacin (not readily available substitute cipro) or SMZ/TMP

201
Q

Treatment for hepatorenal syndrome

A

albumin, octreotide, and midodrine

202
Q

Prevention for hepatorenal syndrome

A

treat cirrhosis, avoid nephrotoxins, and renal hypoperfusion

NAPLEX!!!!! (8 decks)

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