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PHRM 864 > 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
what does MELD predict
3 month mortality risk used in transplant list
26
ascites symptoms
abdominal distension abdominal pain SOB nausea
27
how do ascites happen
increased pressures with portal HTN drive fluid into peritoneal space compensatory mechanisms result in fluid retention decrease albumin
28
ascites non-pharm treatment
low sodium diet assess for liver transplant
29
ascites first line
aldosterone antagonist + loop diuretic
30
ascites second line
paracentesis
31
what class of meds to avoid in pts with cirrhosis
NSAIDs
32
diuretic dosing ascites
spironolactone 100: furosemise 40 5:2 ratio max 400/160 titrate every 3-5 days
33
if we have to do monotherapy in ascites what should we do
spironolactone
34
side effects from spironolactone
hyperkalemia AKI gyneco
35
side effects from furosemide
AKI decreased potassium
36
monitroing in spiro/loop treatment
SCr, K+
37
paracentisis treatment outline
if > 5L fluid lost: 25% albumin IV 6-8g per L removed
38
does albumin for paracentisis help with mortalituy
yes
39
what are varices
small offshoots in the esphagus can burst and cause variceal bleeding
40
risk factors for variceal bleeding
size of varices cirrhosis severity red color alcohol use
41
what can prevent variceal bleeding first line
non selective BBs EVL (bands) not for use together
42
does variceal bleeding prophylaxis impact mortality
no
43
non selective BB MOA
only in moderate disease beta I and II antagonism decreased HR and CO vasoconstriction
44
non selective beta blockers options
nadolol propranolol carvedilol
45
nadolol dosing
20-40 mg PO daily max: 80 (ascites), 160 (no ascites)
46
propranolol dosing
20-40 mg PO BID max:160 mg (ascites), 320 (no ascites)
47
carvedilol dosing
6.25 mg PO daily max: 12.5 mg PO daily
48
how to titrate BBs
to HR < 60 every 3 days till goal keep SBP > 90
49
what is EVL
endoscopic variceal ligation bands off varices
50
variceal bleeding presentation
visualized via endoscopy hematemeiss melena fatigue dizzy hypo
51
gold standard for variceal bleeding reatment
EVL
52
what do we give at first sign of variceal bleeding
blood transfusion octreotide antibiotic prophylaxis
53
what is ocreotide
vasoconstrictor and decrease blood flow
54
what is ocreotide indicated in
variceal bleeds only
55
how long do we use ocreotide
2-5 days or 24 h after EVL
56
side effect monitoring of ocreotide
BP HR BG N/V
57
goal EVL initation in variceal bleed
within 12 hours
58
antibiotic prophylaxis in variceal bleeding
ceftriaxone up to 7 days until hemorrhage gone
59
is ceftriaxone renally cleared
no
60
what drug not reccommended in variceal bleed
Vit K
61
secondary prophylaxis of variceal bleeding
EVL q 1-2 weeks non selective BBs
62
what is SBP
spontaneous bacterial peritonitis bacterial translocation when bacteria cross intestinal barrier
63
presentation of SBP
fever abdom pain/tender leukocytosis encephalopathy some asymptomatic
64
how do we diagnose SBP
positive ascitic fluid culture > 250 cells/PMN PMN = WBC x % neutrophils
65
how to treat SBP
ceftriaxone 5-7 days albumin
66
ceftriaxone side effect
diarrhea
67
albumin dosing SBP
day 1: 1.5 g/kg x 1 (within 6 h) day 3: 1 g/kg x 1
68
SBP secondary prevention
Bactrim or cipro avoid PPIs
69
bactrim dosing SBP prevention
800/160 mg once daily
70
ciprofloxacin SBP prevention dose
500 mg once daily
71
monitoring for cipro and bactrim for SBP secondary prophy
CBC, SCr, electrolytes
72
how long do we give secondary prophylaxis in SBP
indefinite
73
hepatic encephalopathy first line treatment
lactulose target >2 BMs per day

PHRM 864 (28 decks)

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