Pharm-Cirrhosis Complications

Question 1

esophageal and gastric varices are a serious complication of cirrhosis that result from?

Answer 1

portal hypertension

Question 2

all patients with cirrhosis require a ____ to assess for varices

Answer 2

screening endoscopy

Question 3

primary prophylaxis for variceal bleeding

Answer 3

most recent theory is that non-selective beta blockers are preferable to endoscopic variceal ligation

Question 4

what are the risks of endoscopic variceal ligation?

Answer 4

bleeding, expensive

Question 5

how do beta blockers prevent variceal bleeding?

Answer 5

decrease tone to decrease portal hypertension (ex: propranolol, nadolol, carvedilol)

Question 6

all patients with a large varix receive ____

Answer 6

beta blockers

Question 7

ABCDE treatment of acute variceal bleeding stands for?

Answer 7

ABCDE: airway, breathing, circulation, drugs, endoscopy

Question 8

what drugs should be given during an acute variceal bleed?

Answer 8

octreotide, PPI (hedge against ulcer), and ABX

Question 9

what is octreotide?

Answer 9

synthetic, long-acting analogue of somatostatin; inhibits release of vasodilatory hormones and indirectly causes mesenteric vasoconstriction and decreased portal flow

Question 10

what benefit do ABX have in the tx of acute variceal bleeding?

Answer 10

1. decrease risk of re-bleed, 2. decrease risk of SBP, and 3. decrease risk of encephalopathy

Question 11

research on secondary px of variceal bleeding suggests that _____ therapy decreases risk of rebleed and increases survival

Answer 11

combination (beta blocker + band ligation)

Question 12

the principle therapies for tx of ascites are..

Answer 12

low sodium diet & diuretic combo (furosemide loop diuretic to get rid of volume, spirinolactone for RAS)

Question 13

risks associated with ascites tx

Answer 13

hyponatremia, diuretic-induced volume depletion and renal failure

Question 14

who recieves primary SBP prophylaxis?

Answer 14

anyone with a Child’s Class C, impaired renal function, or sodium less than 131

Question 15

primary SBP prophylaxis is _____, and results in decreased ____ and ____ (with increased survival)

Answer 15

ciprofloxacin, SBP and HRS

Question 16

when should high risk SBP patients be started on antibiotics?

Answer 16

RIGHT AWAY

Question 17

most SBP infections are caused by (2 things)?

Answer 17

E. coli, Klebsiella

Question 18

abx tx for SBP is usually ____, but ___ can be used in certain situations

Answer 18

3rd gen cephalosporin, levoflox/quinolones (IV x5 days)

Question 19

what should be given with SBP tx to prevent renal failure?

Answer 19

IV albumin

Question 20

secondary prophylaxis for SBP includes?

Answer 20

cipro 1d/wk or TMP-SMX 5d/wk if refractory

Question 21

standard of care for HRS

Answer 21

albumin, midodrine, octreomide (AMO) - much better than nothing, but still high mortality from HRS

Question 22

terlipressin shows moderately increased survival, is not yet approved in US, and causes risk of ____

Answer 22

cardiac side effects

Question 23

mainstay of tx for encephalopathy is?

Answer 23

bowel cleansing

Question 24

the best laxative/cathartic for hepatic encephalopathy is?

Answer 24

non-absorbable dissacharide like lactulose (acidification of bowel leads to reduced formation of ammonia)

Question 25

risks of bowel cleansing

Answer 25

hypernatremia, volume contraction

Question 26

in addition to bowel cleansing, ____ can reduce nitrogen load from gut

Answer 26

antibiotics (neomycin, metronidazole)

Question 27

what are the individual side effects of the drugs used to treat hepatic encephalopathy?

Answer 27

neomycin = auditory, renal dysfnc; metronidazole = periph neuropathy

Question 28

what is the downside to the new Rifaximin treatment to reduce nitrogen in gut?

Answer 28

too expensive

Question 29

this is a third line therapy for HE used more frequently in alcoholics

Answer 29

zinc

Question 30

what is an advantage of short-medium branched fatty acids in tx of HE?

Answer 30

less ammoniagenic than other proteins