Drugs And Treatment In Heaptic Disorders Flashcards
Why does ascites occur in patients with liver cirrhosis?
Hypoalbuminemia is present and increased portal HTN is also present
Treatment fo ascites
Low sodium diet
Diuretics
Paracentesis
- go in and drain the blood from the veins
Surgical shunts
How does potassium sparing and loop diuretics differ with MOA?
Potassium sparing (spironolactone):
- antagonizes aldosterone
- targets distal renal tubules
Loop (furosemide):
- antagonizes the Na/K/2Cl co-transporter
- targets ascending loop of Henle
What is spontaneous bacterial peritonitis?
Occurs when ascites is present secondary to bacterial infections
- ascites varices rupture and poor bacteria into peritoneum
Most common pathogens:
- E. Coli
- klebsella
- pneumococci
Treatment =
- cefotaxime (1st line)
- fluroquinolones (ciprofloxacin/ofloxacin) (2nd line)
What does ascites in liver cirrhosis generally imply?
If its moderate-large volume = end stage organ failure
What are common prophylaxis treatment for esophageal varices?
Beta blockers
- Nadolol (tends to be #1), propranolol, carvedilol
Sclerotherpy
- injection of sodium tetradecyl sulfate and polidocanol
Endoscopic variceal ligation (EVL)
- uses rubber bands
EVL is safer than sclerotherpy
What is the regiment for active esophageal varices ruptures?
Octrotide or vasopressin and Omeprazole
What is the underlying mechanism behind hepatic encephalopathy?
Overwhelming buildup of ammonia (NH3) in the blood
- liver fails to metabolize enough or any of it depending on how much liver failure is present
Ammonia reaches brain which is toxic
Treatment = Lactulose and antibiotics
What are the 3 antibiotics used for hepatic encephalopathy?
Rifaximin, neomycin, metronidazole
amoung other functions, all three work to decrease growth of urease producing bacteria
Urease = CO2 + ammonia (need to kill these bacteria in hepatic encephalopathy)
Hep A vaccines
HAVRIX and VAQTA
ADRs:
- pain at injection site/nausea/fatigue/fever
Hep B vaccines
Adults only:
- Recombivax HB
- Engerix B
- TWINRIX (combo A/B vaccine)
Children only:
- Comvax
- Pediarix
ADRs:
- pain at injection site
- nausea
- fatigue
- fever
What is the difference interferon-alpha and pegylated interferon-alpha
Pegylated = wayyy higher half life (3-days)
- better for patients since they dont have to take it twice a day, only once a day
What are the three steps in viral Hep C replication that direct-acting antivirals can target to kill the virus?
Translation/processing
- NS3/4A protease inhibitors
- includes paritaprevir
Replication
- NS5B polymerase inhibitors
- includes Dasaburvir and sofosbuvir
Morphogenesis
- NS5A inhibitors (unknown MOA though)
- includes Ombitasvir and ledipasvir
What does the 4 drug regiment for hep C infection include?
Ombitasvir/paritaprevir/ritovair/dasaburvir
What is the 3 drug regiment for hep C infections?
Ombitasivr/paritaprevir/ritovair
same as 4 regiment except substract dasaburvir
