Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacotherapeutics > Cirrhosis and Liver Disease Part II (exam 3) > Flashcards

Cirrhosis and Liver Disease Part II (exam 3) Flashcards

(91 cards)

Start Studying
1
Q

screening tests for varices

A

transient elastography
EGD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

when liver stiffness is ______________ and platelets are ______________ there is a low risk of varices

A

under 20 pKa

over 150,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

when liver stiffness is ______________ and platelets are ______________, _________ is recommended

A

over 20 kPa

EGD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

EGD

A

invasive
varices can be seen
required for patients with high risk TE
repeat annually for patients who have low risk findings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

indications for primary prophylaxis of variceal bleeding if the patient has compensated cirrhosis

A

clinically significant portal hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

the goal of primary prophylaxis of variceal bleeding if the patient has compensated cirrhosis is

A

prevention of cirrhosis decompensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

indications for primary prophylaxis of variceal bleeding if the patient has decompensated cirrhosis

A

medium/large varices NEED
small varices - Child-Pugh class C, Red Wale Marks (at least one)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

preferred therapy for primary prophylaxis of variceal bleeding

A

nonselective beta blocker (carvedilol, propanolol, nadolol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

__________ is preferred for variceal bleeding in compensated cirrhosis

A

carvedilol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what agent is recommended for primary prophylaxis for variceal bleeding in decompensated cirrhosis?

A

any nonselective beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

alternative method of prophylaxis available for medium/large varices only

A

endoscopic variceal ligation (EVL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

endoscopic variceal ligation

A

placement of rubber bands around varices
q1-2 weeks until obliteration of varices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

consider _______ when beta blockers cannot be used

A

EVL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

when can EVL not be done?

A

in patients with small varices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

nonselective beta blockers decrease portal pressure by

A

reducing portal venous flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

beta blockers contraindications

A

asthma
extreme bradycardia
2nd, 3rd degree AV block w/o implanted pacemaker
insulin dependent DM with hypoglycemic episodes
PAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

beta blockers adverse effects

A

hypotension
bradycardia
CNS effects
worsening of lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

use beta blockers with caution in ________________ because it may worsen outcomes

A

refractory ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

treat acute variceal bleeding as

A

a medical emergency (ICU)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

in a patient with acute variceal bleeding, provide ___________________ to maintain hemodynamic stability

A

intravascular support and blood transfusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

pharmacotherapy for acute variceal bleeding

A

octreotide (most common)
terlipressin
somatostatin
vasopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

start pharmacotherapy for acute variceal bleeding as soon as

A

variceal bleeding is suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

endoscopic therapy for acute variceal bleeding

A

perform EGD within 12 hours
EVL (preferred)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

1st line therapy for acute variceal bleeding

A

octreotide (Sandostatin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
MOA of octreotide
local splanchnic vasoconstriction and decreased portal inflow less systemic side effects than vasopressin
26
while on octreotide, monitor
hyperglycemia bradycardia HTN arrhythmia abdominal pain vomiting
27
start all patients with variceal bleeding on a short course of
antibiotics
28
preferred antibiotic for variceal bleeding
ceftriaxone (1g/day) x 7 days
29
balloon tamponade
temporarily effective in stopping bleeds rebleeding is common
30
TIPS (transjugular intrahepatic portosystemic shunt)
stents placed between the hepatic and portal veins decreased incidence of rebleeding
31
TIPS is indicated in those
with high risk hemorrhage who fail to achieve hemostasis standard treatment
32
who requires secondary prophylaxis for variceal bleeding? what is recommended?
all patients! combination of EVL and nonselective BB
33
exceptions for secondary prophylaxis for variceal bleeding
patients who received TIPs procedure
34
when assessing a patient with ascites, perform a
abdominal paracentesis
35
what is an abdominal paracentesis
needle is inserted into peritoneal cavity and ascitic fluid is removed
36
after abdominal paracentesis is performed __________ is analyzed for
ascitic fluid cell count with differential, total protein and culture of fluid
37
serum-ascites albumin gradient (SAAG)
serum albumin - ascitic fluid albumin
38
if SAAG is greater or equal to 1.1 g/dl
there is portal HTN
39
if SAAG is less than 1.1 g/dl
consider other causes of ascites
40
grade 1 (mild ascites)
only detected on ultrasound
41
grade 2 (moderate ascites)
moderate symmetric dissension of the abdomen
42
grade 3 (large/gross ascites)
marked distention of the abdomen
43
treatment is recommended for what classifications of ascites?
only grades 2 and 3
44
responsive ascites
can be resolved or limited to grade 1 with diuretic therapy with/wo dietary sodium restriction
45
recurrent ascites
recurs on at least 3 occasions within 12 months despite treatment
46
refractory ascites
cannot be mobilized or unpreventable early recurrence
47
treatment recommendations for ascites
NO alcohol sodium restriction (less than 2g/day) if severe hyponatremia - restrict fluids
48
recommended diuretic therapy for ascites
spironolactone with/wo furosemide in 100:40 ratio
49
goal of diuretic therapy for ascites
attain weight loss of 0.5 kg/day
50
in patients with active bleeds, HE, or renal dysfunction, it may be necessary to
withhold diuretics
51
what to monitor when treating ascites with diuretics?
sodium body weight SCr
52
what is the drug of choice for ascites?
spironolactone
53
an ADR of spironolactone is __________ and if this occurs, it should be switched to ___________-
painful gynecomastia amiloride or eplerenone
54
tense ascites
ascites with large volume of fluid limits activities of daily life
55
for large volume paracentesis, administer
albumin 6-8 g/L of fluid removed
56
for tense ascites, after abdominal paracentesis, start
sodium restriction and diuretics
57
medications to avoid in ascites
ACEIs ARBs NSAIDs amino glycoside antibiotics
58
avoid ___________ in refractory ascites
ACEIs and ARBs
59
refractory ascites
unresponsive to Na restriction and high dose diuretics
60
recommendations for refractory ascites
continue dietary sodium restriction restrict fluids if hyponatremia stop ACEIs/ARBs serial therapeutic paracentesis refer for liver transplantation consider TIPS peritoneovenous shunt
61
diagnosis of SBP
ascitic fluid polymorphonuclear leukocyte over 250/mm3 no evidence of alternative source of infection
62
suspect SBP in patients with ascites presenting with
signs and symptoms of infection
63
therapy for community acquired SBP
third generation cephalosporin (cefotaxime, ceftriaxone)
64
therapy for hospital acquired SBP, critically ill/ICU admission
broad spectrum needed based on local resistance patterns
65
what should be done 48 hours after starting an antibiotic for SBP?
repeat diagnostic paracentesis to assess response to antibiotics
66
when on antibiotics for SBP, if PMN decreases over 25%,
patient is responding to antibiotics
67
when on antibiotics for SBP, if PMN decreases under 25%
broaden antibiotics and assess for secondary infection
68
duration of antibiotics for SBP
5-7 days
69
after culture results for SBP,
narrow antibiotic therapy
70
when should albumin be added for SBP management?
patients with PMN over 250 cells/ml plus renal or liver dysfunction
71
who should receive one term prophylaxis for SBP?
all patients with a previous episode of SBP
72
long term prophylaxis for SBP should be considered for patients with ______ protein ascites and at least 1 of the following:
low SCr > 1.2 mg/dl BUN > 25 mg/dl SNa < 130 mEq/L Child-Pugh score > 9 with bilirubin > 3 mg/dl
73
who should receive short term prophylaxis for SBP?
patients with acute variceal bleed for up to 7 days
74
oral agents for long term prophylaxis of SBP
ciprofloxacin bactrim rifaximin
75
Short term prophylaxis for variceal bleeding
IV ceftriaxone
76
______________ levels assist in diagnosis of HE
venous ammonia
77
diagnosis of HE is a diagnosis of
exclusion
78
classifying HE by underlying disease
type A - acute liver disease type B - portosystemic bypass type c - cirrhosis
79
classify HE by time course
episodic HE recurrent HE - multiple HE episodes within 6 months persistent HE - always present
80
classify HE by presence of precipitating factors
nonprecipitated precipitated
81
goal of HE treatment
reduce ammonia levels
82
how to reduce ammonia for HE?
decrease protein intake decrease ammonia/nitrogenous load via gut
83
decrease ammonia/nitrogenous load via gut
lactulose lactulose and PEG3350 Zinc neomycin, metronidazole, rifaximin
84
nonpharmacologic therapy for HE
minimize protein intake when HE episode resolve initiate 1.2-1.5 g/kg/day of protein avoid precipitating factors
85
first line treatment for HE
lactulose
86
when using lactulose, you want to titrate to _________ soft stools per day
2-3
87
side effects of lactulose
flatulence abdominal cramping excessively sweet taste
88
If HE recurs while on lactulose, ______________ to prevent further recurrence
add rifaximin 550 mg PO BID
89
other treatments for HE
PEG3350 Zinc acetate flumazenil bromocriptine metronidazole or neomycin
90
which treatment for HE is only when there is suspected benzodiazepine use?
flumazenil
91
systemic complications of cirrhosis
hepatorenal syndrome hepatopulmonary syndrome coagulation disorders endocrine dysfunction

Pharmacotherapeutics (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions