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PHRM 845 > Liver > Flashcards

Liver Flashcards

1
Q

what is the liver responsible for

A

bile production
drug/food/toxin metabolism
protein synthesis (albumin / coag)
storage viatmins

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2
Q

AST and ALT levels with acute liver injury

A

AST > 50
ALT > 50
alk phos > 120

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3
Q

are LFTs indicators of liver function?

A

no just mark acute injury

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4
Q

what are markers of acute liver injury

A

increased, ALT, AST, alk phos, bilirubin

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5
Q

chronic liver disease labs

A

decreased albumin
increased INR
increased bilirubin

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6
Q

incidence of drug induced liver injury

A

0.02%

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7
Q

classifications of drug induced liver injury

A

direct hepatotoxicity
idiosyncratic hepatotoxicity
indirect hepatotoxicity

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8
Q

direct hepatotoxicity drug causes

A

acetaminophen
IV amio
IV methotrexate

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9
Q

idiosyncratic hepatotoxicity drug causes

A

mycins
penicillins
cephalosporines
floxacins

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10
Q

indirect hepatotoxicity causes

A

metabolic abnormalities causing alcoholic fatty liver disease

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11
Q

which meds cause drug induced liver injury

A

acetaminophen
penicillins
cephalosporins
floxacins
mycins
isoniazid

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12
Q

what to do if we suspect DILI

A

hold agent

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13
Q

acetaminophen toxicity usaully what dose

A

8g at once

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14
Q

toxic metabolite from acetaminophen toxicity

A

NAPQI
direct hepatotox

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15
Q

signs of acetaminophen tox

A

N/V
abdominal pain
jaundice

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16
Q

how do we reverse acetaminophen

A

if within 1-2 hours give activated charcoal
N-acetylcysteine chart after 4 h

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17
Q

how does NAC work

A

binds NAPQI and decreases the toxic effects

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18
Q

N-acetylcystine dosing oral

A

140 mg/kg loading
70 mg/kg q4h x 72 h

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19
Q

N-acetylcysteine dosing IV

A

1st: 150 mg/kg over 1 hr (15g max)
2nd: 50 mg/kg over 4 h (5g max)
3rd: 100 mg/kg over 10 h (10g max)

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20
Q

what to monitor with NAC

A

AST
ALT
q12-24 h
s/sx

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21
Q

what is cirrhosis

A

severe, chronic irrversible fibrosis of liver

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22
Q

causes of cirrhosis

A

alcohol use
viral hepatitis
drugs (amio, methotrexate)

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23
Q

symptoms of cirrhosis

A

jaundice
fatigue
weight loss
ascites
hepatomegaly/splenomegaly
enchephalopathy

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24
Q

how do we confirm diagnosis of cirrhosis

A

liver biopsy

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25
Q

what does MELD predict

A

3 month mortality risk
used in transplant list

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26
Q

ascites symptoms

A

abdominal distension
abdominal pain
SOB
nausea

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27
Q

how do ascites happen

A

increased pressures with portal HTN drive fluid into peritoneal space
compensatory mechanisms result in fluid retention
decrease albumin

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28
Q

ascites non-pharm treatment

A

low sodium diet
assess for liver transplant

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29
Q

ascites first line

A

aldosterone antagonist + loop diuretic

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30
Q

ascites second line

A

paracentesis

31
Q

what class of meds to avoid in pts with cirrhosis

A

NSAIDs

32
Q

diuretic dosing ascites

A

spironolactone 100: furosemise 40
5:2 ratio
max 400/160
titrate every 3-5 days

33
Q

if we have to do monotherapy in ascites what should we do

A

spironolactone

34
Q

side effects from spironolactone

A

hyperkalemia
AKI
gyneco

35
Q

side effects from furosemide

A

AKI
decreased potassium

36
Q

monitroing in spiro/loop treatment

A

SCr, K+

37
Q

paracentisis treatment outline

A

if > 5L fluid lost: 25% albumin IV 6-8g per L removed

38
Q

does albumin for paracentisis help with mortalituy

A

yes

39
Q

what are varices

A

small offshoots in the esphagus
can burst and cause variceal bleeding

40
Q

risk factors for variceal bleeding

A

size of varices
cirrhosis severity
red color
alcohol use

41
Q

what can prevent variceal bleeding first line

A

non selective BBs
EVL (bands)
not for use together

42
Q

does variceal bleeding prophylaxis impact mortality

A

no

43
Q

non selective BB MOA

A

only in moderate disease
beta I and II antagonism
decreased HR and CO
vasoconstriction

44
Q

non selective beta blockers options

A

nadolol
propranolol
carvedilol

45
Q

nadolol dosing

A

20-40 mg PO daily
max: 80 (ascites), 160 (no ascites)

46
Q

propranolol dosing

A

20-40 mg PO BID
max:160 mg (ascites), 320 (no ascites)

47
Q

carvedilol dosing

A

6.25 mg PO daily
max: 12.5 mg PO daily

48
Q

how to titrate BBs

A

to HR < 60
every 3 days till goal
keep SBP > 90

49
Q

what is EVL

A

endoscopic variceal ligation
bands off varices

50
Q

variceal bleeding presentation

A

visualized via endoscopy
hematemeiss
melena
fatigue
dizzy
hypo

51
Q

gold standard for variceal bleeding reatment

A

EVL

52
Q

what do we give at first sign of variceal bleeding

A

blood transfusion
octreotide
antibiotic prophylaxis

53
Q

what is ocreotide

A

vasoconstrictor and decrease blood flow

54
Q

what is ocreotide indicated in

A

variceal bleeds only

55
Q

how long do we use ocreotide

A

2-5 days or 24 h after EVL

56
Q

side effect monitoring of ocreotide

A

BP
HR
BG
N/V

57
Q

goal EVL initation in variceal bleed

A

within 12 hours

58
Q

antibiotic prophylaxis in variceal bleeding

A

ceftriaxone up to 7 days
until hemorrhage gone

59
Q

is ceftriaxone renally cleared

A

no

60
Q

what drug not reccommended in variceal bleed

A

Vit K

61
Q

secondary prophylaxis of variceal bleeding

A

EVL q 1-2 weeks
non selective BBs

62
Q

what is SBP

A

spontaneous bacterial peritonitis
bacterial translocation when bacteria cross intestinal barrier

63
Q

presentation of SBP

A

fever
abdom pain/tender
leukocytosis
encephalopathy
some asymptomatic

64
Q

how do we diagnose SBP

A

positive ascitic fluid culture
> 250 cells/PMN
PMN = WBC x % neutrophils

65
Q

how to treat SBP

A

ceftriaxone
5-7 days
albumin

66
Q

ceftriaxone side effect

A

diarrhea

67
Q

albumin dosing SBP

A

day 1: 1.5 g/kg x 1 (within 6 h)
day 3: 1 g/kg x 1

68
Q

SBP secondary prevention

A

Bactrim or cipro
avoid PPIs

69
Q

bactrim dosing SBP prevention

A

800/160 mg once daily

70
Q

ciprofloxacin SBP prevention dose

A

500 mg once daily

71
Q

monitoring for cipro and bactrim for SBP secondary prophy

A

CBC, SCr, electrolytes

72
Q

how long do we give secondary prophylaxis in SBP

A

indefinite

73
Q

hepatic encephalopathy first line treatment

A

lactulose
target >2 BMs per day

PHRM 845 (38 decks)

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