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PHRM 864 > Hepatology > Flashcards

Hepatology Flashcards

1
Q

functions of the liver

A

bile production, drug/food/toxin metabolism, protein synthesis (albumin and coag factors), storage and adjustment of vitamins and gluconeogenesis.

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2
Q

Lab markers

A

AST (0-50 IU/L) >50 with acute liver injury
ALT (0-50 IU/L) >50 with acute liver injury
ALK Phos (30-120 IU/L) >120 with biliary tract injury from liver injury (ex:gallstones)

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3
Q

what does elevated bilirubin indicate?

A

sign of acute or chronic liver issues

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4
Q

chronic liver disease impact on proteins

A

decreased albumin, increased INR, and increased bilirubin

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5
Q

DILI incidence?

A

14 to 19 cases per 100,000

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6
Q

medications that cause idiosyncratic DILI

A

augmentin, isoniazid, macrobid, bactrim, minocycline, cefazolin, z-pack, cipro, tylenol, niacin, glucocortocoids, antineoplastic agents

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7
Q

what causes acetaminophen DILI

A

> 8g acetaminophen = toxic levels of N-acetyl-p-benzoquinone imine (NAPQI)

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8
Q

signs and symptoms of DILI

A

abd pain, jaundice, n/v/d

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9
Q

Treatment for acetaminophen DILI

A

N-acetylcysteine (NAC) and activated charcoal

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10
Q

NAC MOA

A

Binds to NAPQI

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11
Q

NAC dosing

A

oral: 140mg/kg, then 70mg/kg q4h x72H
IV: 150 mg/kg x1 hours, then 50 mg/kg x4h, then 100mg/kg x10 hours

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12
Q

cirrhosis causes

A

alcohol, hepatitis, metabolic liver disease, cholestatic liver disease, drugs (amiodarone, methotrexate)

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13
Q

cirrhosis s/sx

A

fatigue, weight loss, ascites, jaundice, hepatomegaly, encephalopathy

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14
Q

cirrhosis complications

A

ascites, esophageal varices, encephalopathy, spontaneous bacterial peritonitis, thrombocytopenia, hyponatremia, hepatorenal syndrome

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15
Q

child-pugh assessment

A

bilirubin <2 (1pt), 2-3 (2 pts), >3 (3pts)
albumin g/dL >3.5 (1 pt), 2.8-3.5 (2 pts), <2.8 (3 points)
ascites: none (1 pt), mild (2 pts), mod-severe (diuretic refractory) (3 pts)
prothrombin time: 1-3 (1 pt), 4-6 (2 pts), >6 (3 pts)

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16
Q

Child-pugh classifications

A

A = score <7 = mild
B = score 7-9 = moderate
C = score 10-15 = severe

17
Q

Model for end stage liver disease (MELD)

A

score <9 = 1.9% 3 month mortality
10-19 = 6%
20-29 = 20%
30-39 = 53%
>40 = 71%

18
Q

ascites s/sx

A

abdominal distention, abd pain, SOB, nausea

19
Q

ascites pathophys

A

portal HTN drives fluid into peritoneal space, hypoalbuminemia

20
Q

ascites management

A

sodium restriction <2g/day
aldosterone antagonist (spironolactone + furosemide)
second line: paracentesis, TIPS

21
Q

Meds to avoid

22
Q

Diuretics for Ascites

A

Initiate at ratio of Spironolactone 100mg to furosemide 40mg
(max 400/160). monitor Scr, K+

23
Q

paracentesis

A

if removing >5L, then give albumin
25% albumin IV, then 6-8g albumin per liter removed

24
Q

variceal bleeding prophylaxis

A

non-selective beta blocker (moderate disease only) or endoscopic variceal ligation monotherapy

25
Q

beta blocker and dosing

A

Nadalol (20-40mg PO daily) (max doses 80 ascites, 160 no ascites)
Propranolol (20-40mg PO BID) max doses (160,320mg)
Carvedilol 6.25mg daily to bid (max dose 12.5 mg PO daily)

26
Q

Beta blocker for prophylaxis monitoring

A

HR Goal: 55-60 BPM
BP: SBP >90 mmHg

27
Q

variceal bleeding treatment

A
  • blood transfusion
  • Octreotide (somatostatin (vasoconstrictor))
  • antibiotics
    _ NO PPIs
28
Q

Octreotide MOA

A
  • inhibits release of vasodilatory peptides (glucagon)
  • Splanchnic vasoconstriction and decreased blood flow.
29
Q

Octreotide SE

A

N/V, HTN, bradycardia, hyperglycemia

30
Q

EVL (endoscopic variceal ligation)

A
  • gold standard for variceal bleeding cessation
  • within 12 hours of presentation
31
Q

Other variceal bleeding treatment

A
  • ceftriaxone x7 days or until hemorrhage resolution (SE = diarrhea)
  • NOT vitamin K (INR will be elevated)
32
Q

Secondary prophylaxis for varices

A
  • endoscopic variceal ligation every 1-4 weeks
  • NS BB:
  • Nadolol 20-40mg PO daily (max 80/160)
    Propranolol 20-40mg PO BID (max 160/0mg)
33
Q

SBP risk

A

10-30% due to bacterial translocation

34
Q

SBP clinical presentation

A

fever abd pain, leukocytosis, encephalopathy, asyptomatic

35
Q

diagnosed through paracentesis

A

ascitic fluid with >250 cells/mm3 polymorphonuclear leukocytes (PMN)

36
Q

SBP treatment

A
  • ceftriaxone (SE = diarrhea) x5-7 days
  • albumin 1.5g/kg x1 (within 6 hours
  • day 3 1g/kg x1
37
Q

SBP secondary prophylaxis

A
  • avoid PPIs
  • BActrim DS 800/160mg daily
  • Cipro 500mg daily
  • indefinite duration
38
Q

dosing in liver insufficiency

A
  • highly bound protein drugs increase free drug concentration but not total drug concentration
39
Q

when can activated charcoal be used for tylenol overdose

A

within an hour

PHRM 864 (13 decks)

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