Pharm-Cirrhosis Complications Flashcards
(30 cards)
esophageal and gastric varices are a serious complication of cirrhosis that result from?
portal hypertension
all patients with cirrhosis require a ____ to assess for varices
screening endoscopy
primary prophylaxis for variceal bleeding
most recent theory is that non-selective beta blockers are preferable to endoscopic variceal ligation
what are the risks of endoscopic variceal ligation?
bleeding, expensive
how do beta blockers prevent variceal bleeding?
decrease tone to decrease portal hypertension (ex: propranolol, nadolol, carvedilol)
all patients with a large varix receive ____
beta blockers
ABCDE treatment of acute variceal bleeding stands for?
ABCDE: airway, breathing, circulation, drugs, endoscopy
what drugs should be given during an acute variceal bleed?
octreotide, PPI (hedge against ulcer), and ABX
what is octreotide?
synthetic, long-acting analogue of somatostatin; inhibits release of vasodilatory hormones and indirectly causes mesenteric vasoconstriction and decreased portal flow
what benefit do ABX have in the tx of acute variceal bleeding?
- decrease risk of re-bleed, 2. decrease risk of SBP, and 3. decrease risk of encephalopathy
research on secondary px of variceal bleeding suggests that _____ therapy decreases risk of rebleed and increases survival
combination (beta blocker + band ligation)
the principle therapies for tx of ascites are..
low sodium diet & diuretic combo (furosemide loop diuretic to get rid of volume, spirinolactone for RAS)
risks associated with ascites tx
hyponatremia, diuretic-induced volume depletion and renal failure
who recieves primary SBP prophylaxis?
anyone with a Child’s Class C, impaired renal function, or sodium less than 131
primary SBP prophylaxis is _____, and results in decreased ____ and ____ (with increased survival)
ciprofloxacin, SBP and HRS
when should high risk SBP patients be started on antibiotics?
RIGHT AWAY
most SBP infections are caused by (2 things)?
E. coli, Klebsiella
abx tx for SBP is usually ____, but ___ can be used in certain situations
3rd gen cephalosporin, levoflox/quinolones (IV x5 days)
what should be given with SBP tx to prevent renal failure?
IV albumin
secondary prophylaxis for SBP includes?
cipro 1d/wk or TMP-SMX 5d/wk if refractory
standard of care for HRS
albumin, midodrine, octreomide (AMO) - much better than nothing, but still high mortality from HRS
terlipressin shows moderately increased survival, is not yet approved in US, and causes risk of ____
cardiac side effects
mainstay of tx for encephalopathy is?
bowel cleansing
the best laxative/cathartic for hepatic encephalopathy is?
non-absorbable dissacharide like lactulose (acidification of bowel leads to reduced formation of ammonia)
