Week 4 GI

Question 1

MOA

Spironolactone

Clinical Uses

Answer 1

Aldosterone antagonist, increases Na and water excretion, decreases K excretion

Used to treat ascites. Combination with Furosemide improves ascites more rapidly than either alone. Maintaining a 100 mg: 40 mg ratio of spironolactone to furosemide helps maintain normokalemia.

Question 2

adverse affects

Spironolactone

Answer 2

hyperkalemia, gynecomastia, dehydration

Question 3

MOA

Furosimide

clinical use

Answer 3

Loop diuretic, inhibits NKCC2, reducing reabsorption of Na, Cl, K, Mg, and Ca

Used to treat ascites. Combination with Spironolactone improves ascites more rapidly than either alone. Maintaining a 100 mg: 40 mg ratio of spironolactone to furosemide helps maintain normokalemia.

Question 4

Adverse Affects

Furosemide

Answer 4

hypokalemia, hypomagnesemia, hypotension, dehydration

Question 5

MOA

Albumin

Clinical Use

Answer 5

Colloid that increases intravascular oncotic pressure and causes mobilization of fluids from interstitial to intravascular space

Large volume paracentesis > 5 L, hepatorenal syndrome

Question 6

MOA

Midodrine

Clinical Use

Answer 6

Active metabolite is an alpha-1 agonist, which increases arteriolar and venous tone, resulting in increased blood pressure

Refractory ascites, hypotension with diuretic use, hepatorenal syndrome

Question 7

Adverse Affects

Midodrine

Answer 7

Hypertension, bradycardia

Question 8

MOA

Octreotide

Clinical Use GI specific

Answer 8

Inhibits release of vasodilator hormones, leading to splanchnic vasoconstriction, decreased portal vein pressure, and decreased variceal pressure

Treatment of acute variceal bleeding, given for 3-5 days after variceal bleed

Question 9

Adverse Affects

Octreotide

Answer 9

Cholelithiasis, hyperglycemia, pancreatitis, hypothyroidism, bradycardia, abdominal discomfort, dizziness, nausea/vomiting

Question 10

MOA

Nadolol, Propranolol

Clinical Use (GI)

Answer 10

Non selective Beta Antagonists- Decrease cardiac output, which reduces portal pressure; produce splanchnic vasoconstruction, which reduces portal blood flow

Used for primary and secondary prophylaxis of variceal bleeding

Question 11

MOA

Entecavir, Lamivudine, Tenofovir

Clinical Use

Answer 11

Nucleoside Nucleotide Analogs- Competitively inhibit HBV DNA polymerase

Hepatitis B treatment. Adefovir is slower to suppress HBV DNA levels. Entecavir has greater suppreession of HBV DNA leevels than adefovir or lamivudinee and a lower rate of resistance. Lamivudine shows initial rapid and potent HBV suppression, but rseistance develops quicky and at a high rate. Telbivudine has greater suppression of HBV than lamivudine or adefovir but has a high rate of emergence of resistance. Tenofovir has a low rate of emergence of resistanc

Question 12

Adverse Affects

Entecavir, Lamivudine, Tenofovir

Answer 12

Infrequent, depends on agent, greater risk for lactic acidosis with decompensated cirrhosis. Adefovir: AKI, hypophosphatemia, lactic acidosis. Entecavir: lactic acidosis. Lamivudine: pancreatitis, lactic acidosis. Telbivudine: elevated CK, myopathy, preipheral neuropathy, lactic acidosis

Question 13

MOA

Sofosbuvir

Clinical Use

Answer 13

Inhibit the HCV NS5B RNA polymerase, which is essential for viral replication

Hepatitis C treatment

Question 14

Adverse Affects

Sofobuvir

Answer 14

Fatigue, headache

Question 15

Moa- rifaximin
Clinical use

Answer 15

Poorly absorbed antibiotic that destroys ammonia producing bacteria in the gut biome.
Used for hepatic encephalopathy.