Liver cirrhosis (Vivien)

Question 1

Class of anti-virals for hep. B

Answer 1

nucleoside

Question 2

role of anti-viral

Answer 2

reduce viral DNA synthesis

Question 3

dose and route of anti-viral for Hep. B

Answer 3

orally 0.5-1mg once daily

Question 4

When is anti-viral for hep B administered?

Answer 4

on an empty stomach

eg. 2hrs before or aft meal

Question 5

Management of ascites due to cirrhosis
1.
2.

Answer 5

1. Spironolactone + furosemide

2. Sodium restriction (max. 2000mg/day)

Question 6

The purpose of the ratio of 100mg spironolactone : 40mg furosemide is to _________

Answer 6

maintain normokalemia (normal potassium lvl)

Question 7

Frequency administered:

1. Loop diuretics (Eg. furosemide)
2. K sparing diuretics (Eg. spironolactone)

Answer 7

1. in divided doses daily

2. once daily

Question 8

What do we have to monitor after administering diuretics?

Answer 8

• renal function (esp. K level)
• urine output
• weight
• BP
• abdominal girth
• gynaecomastia (tenderness of breasts)

Question 9

1st line treatment for hepatic encephalopathy

Answer 9

lactulose

Question 10

Effective add-on therapy for prevention of hepatic encephalopathy

Answer 10

rifaximin

Question 11

Frequency administered:

1. lactulose
2. rifaximin

Answer 11

1. 3-6x/day; ensure bowel output of at least 2-3 times/day

2. 2x daily

Question 12

Role of lactulose

Answer 12

• reduce ammonia concentration (converts NH3 to NH4+)

- prebiotic effect that promotes growth of beneficial microorganism

Question 13

Role of rifaximin

Answer 13

antibiotic that stops the growth of bacteria that produce toxins

Question 14

What do we have to monitor after administering lactulose/rifaximin?

Answer 14

frequency of bowel movement

Question 15

Alternative laxative

Answer 15

polyethene glycol (PEG)