PHTN/Cirrhosis Module (Quiz 4)

Question 1

treatment for variceal hemorrhage

Answer 1

• octreotide

Question 2

prevention of variceal hemorrhage

Answer 2

• nonselective beta blocker
• propranolol
• nadolol
• carvedilol

Question 3

treatment/prevention of hepatic encephalopathy

Answer 3

• decrease intestinal nitrogen burden
• lactulose (laxative)
• neomycin (antibiotic)
• rifaximin (antibiotic)

Question 4

treatment/prevention of ascites

Answer 4

• diuretics
• furosemide
• spironolactone

Question 5

treatment/prevention of spontaneous bacterial peritonitis

Answer 5

• 3rd gen cephalosporin (cefotaxime)
• fluoroquinolones (cipro)
• albumin to decrease risk for hepatorenal syndrome

Question 6

treatment of hepatorenal syndrome

Answer 6

• maintain renal perfusion
• midodrine (alpha 1 agonist)
• octreotide
• albumin

Question 7

MOA of octreotide

Answer 7

• splanchnic vasoconstrictor

- reduce portal inflow

Question 8

Octreotide is a synthetic octane-tide analog of the hormone _______________

Answer 8

• somatostatin

Question 9

how Octreotide inhibits portal inflow

Answer 9

• inhibits release of vasodilator hormone glucagon

- splanchnic vasoconstriction

Question 10

primary prophylaxis for patients against variceal hemorrhage

Answer 10

• band ligation OR

- nonselective beta blocker

Question 11

secondary prophylaxis for patients against variceal hemorrhage

Answer 11

• band ligation AND

- nonselective beta blocker

Question 12

how does blocking beta 1 decrease portal flow

Answer 12

• decreases cardiac output

Question 13

MOA of alpha 1 receptor

Answer 13

• vasoconstriction

Question 14

MOA of beta 2 receptor

Answer 14

• vasorelaxation

Question 15

what makes nonselective beta blockers so effective

Answer 15

• block vascular relaxation

- alpha 1 vascular constriction activity is unopposed

Question 16

principal side effects of beta blockers to keep in mind

Answer 16

• hypotension

- bradycardia

Question 17

lactulose is composed of

Answer 17

• fructose

- galactose

Question 18

MOA of lactulose

Answer 18

• in colon cleaved into fructose and galactose
• fermented to generate lactic acid and H+
• protonates NH3 (ammonia) into NH4+
• ammonium won’t get absorbed

Question 19

side effect of lactulose

how can this make hepatic encephalopathy worse

Answer 19

• diarrhea
• stimulates colonic motility
• can cause dehydration

Question 20

MOA of neomycin and metronidazole

Answer 20

• reduce number of ammonia producing bacteria in the gut

Question 21

side effects of neomycin

Answer 21

• nephrotoxicity

- ototoxicity

Question 22

side effects of metronidazole

Answer 22

• bacterial resistance

- peripheral neuropathy

Question 23

MOA of rifaximin

Answer 23

• antibacterial against gram +/- aerobes/anaerobes

- works on small intestinal bacteria

Question 24

treatment for ascites that is difficult to manage with medications

Answer 24

• large volume paracentesis

Question 25

problems with large volume paracentsis

Answer 25

• can also remove proteins in ascites fluid

Question 26

how the TIPS procedure works

Answer 26

• forms direct tract between portal vein and hepatic vein

- bypass liver

Question 27

problems with the TIPs procedure

Answer 27

• bypass detoxification effect of hepatocytes

- can cause hepatic encephalopathy

Question 28

how to diagnose spontaneous bacterial peritoniitis

Answer 28

• paracentesis

> 250 neutrophils found