S2E5: Liver Dz

Question 1

Drug groups used

Answer 1

beta blockers
octreotide
spironolactone
furosemide
abx
lactulose

Question 2

nonselective beta blocker use

Answer 2

Prevention of esophageal variceal bleeding (doesn’t prevent variceal formation).

Question 3

octreotide use

Answer 3

treatment of active bleeding of esophageal varicies

Question 4

Tx of ascites

Answer 4

Na restriction and/or diuretics

Question 5

Abx for SBP (prophylaxis and tx)

Answer 5

Prophylaxis (only if hx of SBP): TMP/SMZ or norfloxacin

Tx: 3rd gen cephalosporin (cefotaxime, ceftriaxone), quinolones, albumin.

Question 6

Abx for encephalopathy

Answer 6

1st line: neomycin, metronidazole, or vancomycin

2nd: rifaximin (may be better tolerated)

Question 7

Encephalopathy 1st line

Answer 7

lactulose (targets NH3). Lactulose is solution, Kristalose is powder solution

Question 8

Hep B tx classes

Answer 8

interferon alpha (drug); nucleoside analogue (class); nucleotide analogue (class)

Question 9

nucleoside analogue

Answer 9

entacavir (1st line), telbivudine (increased resistance), lamuvudine (only if other antivirals contraindicated and not in combo with interferon alpha)

Question 10

nucleotide analogue

Answer 10

tenofovir (1st line), adefovir (good if lamivudine resistance)

Question 11

Hep C tx

Answer 11

interferon alpha; ribavirin; sofosbuvir/ledipasivir (Harvoni)

Question 12

Types of drug induce liver dz

Answer 12

Hepatocellular necrosis; cholestatic injury

Question 13

Clinical presentation of liver dz

Answer 13

idiosyncratic rxn (rare, unpredictable); allerigic hepatitis (immune based); toxic hepatitis (most common rxn); chronic active hepatitis (Hep B/C + hepatotoxic rx)