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Therapeutics IV > Hepatology > Flashcards

Hepatology Flashcards

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1
Q

AST levels are ___ in ___ liver dysfunction.

A

increased; acute

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2
Q

ALT levels are ___ in ___ liver dysfunction.

A

increased; acute

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3
Q

Alk phos levels are ___ in ___ liver dysfunction.

A

increased; acute

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4
Q

Bilirubin levels are ___ in ___ liver dysfunction.

A

increased; acute and chronic

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5
Q

Albumin levels are ___ in ___ liver dysfunction.

A

decreased; chronic

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6
Q

INR levels are ___ in ___ liver dysfunction.

A

increased; chronic

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7
Q

Platelet levels are ___ in ___ liver dysfunction.

A

decreased; chronic

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8
Q

Why does INR increase in chronic liver disease?

A

clotting factors are produced in the liver - therefore liver dysfunction leads to decreased clotting factors and increased INR

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9
Q

Why is thrombocytopenia associated with chronic liver disease?

A

Platelets are produced in the liver

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10
Q

What dose of acetaminophen can lead to DILI?

A

> /= 8 g

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11
Q

What molecule leads to DILI in those taking acetaminophen?

A

NAPQI

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12
Q

What are the signs/symptoms of acetaminophen DILI? (4)

A

abdominal pain; jaundice; N/V; diarrhea

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13
Q

What is used to treat acetaminophen DILI?

A

N-acetylcysteine (NAC)

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14
Q

How does NAC work?

A

provides cysteine for glutathione synthesis - glutathione breaks down NAPQI into inactive metabolites

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15
Q

How do you determine if NAC is indicated?

A

concentration of acetaminophen > 4 hours after ingestion

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16
Q

Dosing for NAC

A

140mg/kg loading dose followed by 70mg/kg Q4H for 17 doses

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17
Q

NAC monitoring parameters

A

liver enzymes; s/sx acute liver injury

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18
Q

What is cirrhosis?

A

irreversible fibrosis of the liver

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19
Q

What are the two main causes of cirrhosis?

A

EtOH abuse; Hepatitis

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20
Q

What are the signs/symptoms of cirrhosis?

A

fatigue; weight loss; itchy; jaundice; confusion; enlarged spleen and/or liver

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21
Q

Why does cirrhosis cause jaundice?

A

increased bilirubin

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22
Q

What is portal hypertension?

A

hepatic portal vein gradient > 5mmHg

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23
Q

What are the 2 complications of portal hypertension?

A

ascites; esophogeal varices

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24
Q

How does portal hypertension lead to ascites?

A

compensatory mechanisms lead to activation of RAAS which has stimulates several mechanisms that lead to ascites

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25
Characteristics of decompensated cirrhosis (3)
variceal hemmorhage; ascites; hepatic encephalopathy
26
Surgical management of portal hypertension
TIPS
27
What is ascites?
fluid accumulation in the peritoneal space
28
Signs/Symptoms of ascites (4)
abdominal distention; abdominal pain; SOB; nausea
29
How does portal hypertension lead to ascites?
increased pressures drive fluid into peritoneal space
30
How does hyperalbuminurea lead to ascites?
increases risk of fluid going outside the vascular space
31
Non-pharmacologic ascites treatment
restrict sodium to < 2g daily
32
First-line treatment for ascites
100mg spironolactone + 40mg furosemide
33
Spironolactone ADRs (3)
AKI; increased potassium; gynecomastia
34
Furosemide ADRs (2)
AKI; decreased potassium
35
What do you switch a patient to if they experience gynecomastia with spironolactone?
eplerenone
36
Second-line treatment for ascites
paracentesis
37
What do you need to administer if you remove > 5L via paracentesis?
25% albumin
38
What is the dose of albumin after paracentesis?
6-8g per liter removed
39
Risk factors for variceal bleeding
larger varices; more severe cirrhosis; red wale signs; active alcohol use
40
Criteria for primary prohylaxis of variceal bleeding
varices > 5mm; red wale signs; decompensated cirrhosis
41
Treatment options for primary prophylaxis
non-selective beta blocker; EVL
42
Nadalol dosing for variceal bleeding prophylaxis
Initial: 20-40mg PO daily Max: 80mg if ascites; 160mg if no ascites
43
Propranolol dosing for variceal bleeding prophylaxis
Initial: 20-40mg PO BID Max: 160mg if ascites; 320mg if no ascites
44
Carvedilol dosing for variceal bleeding prophylaxis
Initial: 6.25mg PO daily Max: 6.25mg PO BID
45
Non-selective beta blocker ADRs (4)
drowsiness; insomnia; bradycardia; hypotension
46
Non-selective beta blocker monitoring (3)
HR 55-60 bpm; SPB > 90 mmHg; s/sx of variceal hemorrhage
47
What should a patient receive immediately upon presentation of variceal bleeding?
blood transfusions; octreotide; antibiotic prophylaxis
48
What is the goal Hgb during a variceal bleed?
7-9 mg/dL
49
What is the octreotide dose for variceal bleeding?
50mcg IV bolus followed by 50mcg/hr for 2-5 days
50
Octreotide ADRs (4)
N/V; HTN; bradycardia; hyperglycemia
51
Antibiotic recommendation for variceal bleeding (with dosing)
Ceftriaxone 1g IV Q24H
52
When do you discontinue ceftriaxone?
7 days or after discontinuing octreotide
53
What is the goal time of EVL administration?
within 12 hours of presentation
54
What is a long-term solution for portal HTN and variceal bleeding?
TIPS procedure
55
What causes spontaneous bacterial peritonitis (SBP)?
bacterial translocation
56
Clinical presentation of SBP (4)
fever; abdominal pain/tenderness; leukocytosis; encephalopathy
57
How do you diagnose SBP? (2)
PNM leukocyte count > 250; positive ascitic fluid
58
How do you calculate the PNM leukocyte count?
WBC x Neutrophils
59
SBP treatment
Ceftriaxone 1g IV Q24H for 5 days
60
What are the two options for SBP prophylaxis?
Bactrim & ciprofloxacin
61
Non-pharm treatment for NAFLD/NASH
7-10% weight loss
62
Treatment for a diabetic patient with NASH
Pioglitazone 45mg PO daily
63
Treatment for a non-diabetic patient with NASH
Vitamin E 800 IU PO daily

Therapeutics IV (21 decks)

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