Renal & Liver Disease Part 2

Question 1

Model for End Stage Liver Disease (MELD)

Answer 1

0-40 w/ higher numbers signifying greater risk of dying w/in 3 months

More for Liver Transplant

Question 2

JH has cirrhosis and comes to the pharmacy to ask about pain medication for his headache. Which of the following should be avoided due to the risk of decompensation?

A. Acetaminophen

B. Motrin

C. Tramadol

D. Excedrin Tension Headache

E. Aspercreme

Answer 2

Motrin

NSAIDs, including aspirin, can precipitate GI bleeding, blunt the diuretic response and exacerbate renal dysfunction in patients with cirrhosis.

Despite being a known hepatotoxin in high doses, acetaminophen is safer than NSAIDs in patients with liver disease if used at a reduced dose and used sparingly.

Acetaminophen is recommended as the first-line choice.

Question 3

JK has been an alcoholic for the past 17 years. Today, he presents to the hospital with variceal bleeding due to portal hypertension. Which of the following medications causes selective vasoconstriction of the splanchnic vessels to help reduce the bleeding?

A. Lopressor

B. Ribavirin

C. Sandostatin

D. Xifaxan

E. Acamprosate

Answer 3

Sandostatin

Octreotide (Sandostatin) offers selective vasoconstriction in the GI circulation versus vasopressin that is non-selective.

Theoretically, this should reduce the incidence of systemic vasoconstrictive side effects (e.g., CV side effects), but these are still a concern with either drug.

Question 4

Portal HTN & Variceal Bleeding

Acute Tx

Answer 4

octreotide (Sandostatin) or vasopressin

Question 5

Portal HTN & Variceal Bleeding

Prevention (primary & secondary)

Answer 5

Non-selective BB:
Nadolol (Corgard)
Propranolol (Inderal)

Use after Acute Tx

Target HR: 55-60

Question 6

Whichof the following is a complication of chronic renal failure?

A. Respiratory acidosis

B. Metabolic acidosis

C. Hypokalemia

D. Hyperthyroidism

E. Hypophosphatemia

Answer 6

Metabolic acidosis

The ability of the kidney to reabsorb bicarbonate decreases as chronic renal disease progresses.

This can cause a metabolic acidosis.

Question 7

Metabolic Acidosis

Treat when

Answer 7

Serum HCO3 < 22

Question 8

Metabolic Acidosis

Treatment

Answer 8

Sodium bicarbonate

Sodium citrat/citric acid solution

Monitor Sodium

Question 9

Which of YB’s lab abnormalities indicate chronic liver disease and reduced synthetic function of the liver?

A. Leukocytosis and anemia

B. Hyponatremia and leukocytosis

C. Thrombocytopenia and increased creatinine

D. Hypoalbuminemia and increased INR

E. Thrombocytopenia and hyperglycemia

Answer 9

Hypoalbuminemia and increased INR

Albumin and clotting factors are produced by the liver, thus low albumin and increased PT/INR are indicators of the reduced synthetic ability of the liver.

This is often seen in chronic liver disease that has progressed to cirrhosis.

Question 10

Objective Criteria

Increase Labs

Answer 10

AST
ALT
Alk Phos
TBili
LDH
PT/INR

Question 11

Objective Criteria

Decrease Labs

Answer 11

Albumin

Platelets

Question 12

Sensipar is used for what purpose in TH?

A. Sensipar is an ESA used to treat anemia of CKD.

B. Sensipar is a calcimimetic used to treat hyperparathyroidism.

C. Sensipar is a phosphate binder used for hyperphosphatemia.

D. Sensipar is used with ACE inhibitors to reduce hyperkalemia.

E. Sensipar is a vitamin D analogue used to decrease PTH release.

Answer 12

Sensipar is a calcimimetic used to treat hyperparathyroidism.

Cinacalcet (Sensipar) is a calcimimetic that works to decrease PTH release from the parathyroid gland.