PHTN/Cirrhosis Module (Quiz 4) Flashcards
treatment for variceal hemorrhage
- octreotide
prevention of variceal hemorrhage
- nonselective beta blocker
- propranolol
- nadolol
- carvedilol
treatment/prevention of hepatic encephalopathy
- decrease intestinal nitrogen burden
- lactulose (laxative)
- neomycin (antibiotic)
- rifaximin (antibiotic)
treatment/prevention of ascites
- diuretics
- furosemide
- spironolactone
treatment/prevention of spontaneous bacterial peritonitis
- 3rd gen cephalosporin (cefotaxime)
- fluoroquinolones (cipro)
- albumin to decrease risk for hepatorenal syndrome
treatment of hepatorenal syndrome
- maintain renal perfusion
- midodrine (alpha 1 agonist)
- octreotide
- albumin
MOA of octreotide
- splanchnic vasoconstrictor
- reduce portal inflow
Octreotide is a synthetic octane-tide analog of the hormone _______________
- somatostatin
how Octreotide inhibits portal inflow
- inhibits release of vasodilator hormone glucagon
- splanchnic vasoconstriction
primary prophylaxis for patients against variceal hemorrhage
- band ligation OR
- nonselective beta blocker
secondary prophylaxis for patients against variceal hemorrhage
- band ligation AND
- nonselective beta blocker
how does blocking beta 1 decrease portal flow
- decreases cardiac output
MOA of alpha 1 receptor
- vasoconstriction
MOA of beta 2 receptor
- vasorelaxation
what makes nonselective beta blockers so effective
- block vascular relaxation
- alpha 1 vascular constriction activity is unopposed
principal side effects of beta blockers to keep in mind
- hypotension
- bradycardia
lactulose is composed of
- fructose
- galactose
MOA of lactulose
- in colon cleaved into fructose and galactose
- fermented to generate lactic acid and H+
- protonates NH3 (ammonia) into NH4+
- ammonium won’t get absorbed
side effect of lactulose
how can this make hepatic encephalopathy worse
- diarrhea
- stimulates colonic motility
- can cause dehydration
MOA of neomycin and metronidazole
- reduce number of ammonia producing bacteria in the gut
side effects of neomycin
- nephrotoxicity
- ototoxicity
side effects of metronidazole
- bacterial resistance
- peripheral neuropathy
MOA of rifaximin
- antibacterial against gram +/- aerobes/anaerobes
- works on small intestinal bacteria
treatment for ascites that is difficult to manage with medications
- large volume paracentesis
problems with large volume paracentsis
- can also remove proteins in ascites fluid
how the TIPS procedure works
- forms direct tract between portal vein and hepatic vein
- bypass liver
problems with the TIPs procedure
- bypass detoxification effect of hepatocytes
- can cause hepatic encephalopathy
how to diagnose spontaneous bacterial peritoniitis
- paracentesis
> 250 neutrophils found
