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Therapeutics IV > Hepatology > Flashcards

Hepatology Flashcards

1
Q

AST levels are ___ in ___ liver dysfunction.

A

increased; acute

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2
Q

ALT levels are ___ in ___ liver dysfunction.

A

increased; acute

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3
Q

Alk phos levels are ___ in ___ liver dysfunction.

A

increased; acute

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4
Q

Bilirubin levels are ___ in ___ liver dysfunction.

A

increased; acute and chronic

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5
Q

Albumin levels are ___ in ___ liver dysfunction.

A

decreased; chronic

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6
Q

INR levels are ___ in ___ liver dysfunction.

A

increased; chronic

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7
Q

Platelet levels are ___ in ___ liver dysfunction.

A

decreased; chronic

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8
Q

Why does INR increase in chronic liver disease?

A

clotting factors are produced in the liver - therefore liver dysfunction leads to decreased clotting factors and increased INR

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9
Q

Why is thrombocytopenia associated with chronic liver disease?

A

Platelets are produced in the liver

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10
Q

What dose of acetaminophen can lead to DILI?

A

> /= 8 g

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11
Q

What molecule leads to DILI in those taking acetaminophen?

A

NAPQI

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12
Q

What are the signs/symptoms of acetaminophen DILI? (4)

A

abdominal pain; jaundice; N/V; diarrhea

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13
Q

What is used to treat acetaminophen DILI?

A

N-acetylcysteine (NAC)

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14
Q

How does NAC work?

A

provides cysteine for glutathione synthesis - glutathione breaks down NAPQI into inactive metabolites

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15
Q

How do you determine if NAC is indicated?

A

concentration of acetaminophen > 4 hours after ingestion

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16
Q

Dosing for NAC

A

140mg/kg loading dose followed by 70mg/kg Q4H for 17 doses

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17
Q

NAC monitoring parameters

A

liver enzymes; s/sx acute liver injury

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18
Q

What is cirrhosis?

A

irreversible fibrosis of the liver

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19
Q

What are the two main causes of cirrhosis?

A

EtOH abuse; Hepatitis

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20
Q

What are the signs/symptoms of cirrhosis?

A

fatigue; weight loss; itchy; jaundice; confusion; enlarged spleen and/or liver

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21
Q

Why does cirrhosis cause jaundice?

A

increased bilirubin

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22
Q

What is portal hypertension?

A

hepatic portal vein gradient > 5mmHg

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23
Q

What are the 2 complications of portal hypertension?

A

ascites; esophogeal varices

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24
Q

How does portal hypertension lead to ascites?

A

compensatory mechanisms lead to activation of RAAS which has stimulates several mechanisms that lead to ascites

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25
Q

Characteristics of decompensated cirrhosis (3)

A

variceal hemmorhage; ascites; hepatic encephalopathy

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26
Q

Surgical management of portal hypertension

A

TIPS

27
Q

What is ascites?

A

fluid accumulation in the peritoneal space

28
Q

Signs/Symptoms of ascites (4)

A

abdominal distention; abdominal pain; SOB; nausea

29
Q

How does portal hypertension lead to ascites?

A

increased pressures drive fluid into peritoneal space

30
Q

How does hyperalbuminurea lead to ascites?

A

increases risk of fluid going outside the vascular space

31
Q

Non-pharmacologic ascites treatment

A

restrict sodium to < 2g daily

32
Q

First-line treatment for ascites

A

100mg spironolactone + 40mg furosemide

33
Q

Spironolactone ADRs (3)

A

AKI; increased potassium; gynecomastia

34
Q

Furosemide ADRs (2)

A

AKI; decreased potassium

35
Q

What do you switch a patient to if they experience gynecomastia with spironolactone?

A

eplerenone

36
Q

Second-line treatment for ascites

A

paracentesis

37
Q

What do you need to administer if you remove > 5L via paracentesis?

A

25% albumin

38
Q

What is the dose of albumin after paracentesis?

A

6-8g per liter removed

39
Q

Risk factors for variceal bleeding

A

larger varices; more severe cirrhosis; red wale signs; active alcohol use

40
Q

Criteria for primary prohylaxis of variceal bleeding

A

varices > 5mm; red wale signs; decompensated cirrhosis

41
Q

Treatment options for primary prophylaxis

A

non-selective beta blocker; EVL

42
Q

Nadalol dosing for variceal bleeding prophylaxis

A

Initial: 20-40mg PO daily
Max: 80mg if ascites; 160mg if no ascites

43
Q

Propranolol dosing for variceal bleeding prophylaxis

A

Initial: 20-40mg PO BID
Max: 160mg if ascites; 320mg if no ascites

44
Q

Carvedilol dosing for variceal bleeding prophylaxis

A

Initial: 6.25mg PO daily
Max: 6.25mg PO BID

45
Q

Non-selective beta blocker ADRs (4)

A

drowsiness; insomnia; bradycardia; hypotension

46
Q

Non-selective beta blocker monitoring (3)

A

HR 55-60 bpm; SPB > 90 mmHg; s/sx of variceal hemorrhage

47
Q

What should a patient receive immediately upon presentation of variceal bleeding?

A

blood transfusions; octreotide; antibiotic prophylaxis

48
Q

What is the goal Hgb during a variceal bleed?

A

7-9 mg/dL

49
Q

What is the octreotide dose for variceal bleeding?

A

50mcg IV bolus followed by 50mcg/hr for 2-5 days

50
Q

Octreotide ADRs (4)

A

N/V; HTN; bradycardia; hyperglycemia

51
Q

Antibiotic recommendation for variceal bleeding (with dosing)

A

Ceftriaxone 1g IV Q24H

52
Q

When do you discontinue ceftriaxone?

A

7 days or after discontinuing octreotide

53
Q

What is the goal time of EVL administration?

A

within 12 hours of presentation

54
Q

What is a long-term solution for portal HTN and variceal bleeding?

A

TIPS procedure

55
Q

What causes spontaneous bacterial peritonitis (SBP)?

A

bacterial translocation

56
Q

Clinical presentation of SBP (4)

A

fever; abdominal pain/tenderness; leukocytosis; encephalopathy

57
Q

How do you diagnose SBP? (2)

A

PNM leukocyte count > 250; positive ascitic fluid

58
Q

How do you calculate the PNM leukocyte count?

A

WBC x Neutrophils

59
Q

SBP treatment

A

Ceftriaxone 1g IV Q24H for 5 days

60
Q

What are the two options for SBP prophylaxis?

A

Bactrim & ciprofloxacin

61
Q

Non-pharm treatment for NAFLD/NASH

A

7-10% weight loss

62
Q

Treatment for a diabetic patient with NASH

A

Pioglitazone 45mg PO daily

63
Q

Treatment for a non-diabetic patient with NASH

A

Vitamin E 800 IU PO daily

Therapeutics IV (21 decks)

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