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32 Cards in this Set
- Front
- Back
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Drugs to Prevent Variceal Bleed
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Nadalol (20-40mg po daily)
Propranolol (20mg po daily) Treat to HR 55-60 |
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Drugs to Treat Variceal Bleeding
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Octreotide (Sandostatin 20-50mcg IV bolus followed by 25-50mcg/hr CIV for 5 days)
Vasopressin (Pitressin 0.2-0.4u/min IV for 24h given with noitroglycerine IV) |
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Octreotide
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Octreotide (Sandostatin 20-50mcg IV bolus followed by 25-50mcg/hr CIV for 5 days)
Vasopressin (Pitressin 0.2-0.4u/min IV for 24h given with noitroglycerine IV) MOA-splanchnic vasoconstriction, decreasing portal blood flow SE-Bradycardia, CP, Itching, hyper/hypoglycemia, diarrhea/constipation, hypothyroid |
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Vasopressin
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Vasopressin (Pitressin 0.2-0.4u/min IV for 24h given with noitroglycerine IV)
MOA- nonselective vasoconstriction SE-Arrhythmia, CP, MI, dec. CO, inc BP, NV |
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WHat is Hepatic Encephalopothy
What are S&S |
-Caused by gut-derived nitrogenous substances urea-->ammonia, glutamate etc)
- confusion, forgetfulness, mood change, drowsiness, disorentiation, loss of small hand movement, coma |
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Treatment
Nonpharm |
Limit daily protein to 1-1.5g/kg
-use vegetable and dairy sources(branched chain amion acids BCAAS) vs animal soruces (aromatic amino acids) |
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Treatment
Pharm |
Enulose or Generiac-1st line-leaches ammonia into colon and prevents gut bacteria from creating ammonia
Rifaximin-inhiits urease producing activity of bacteria, dec. ammonia production Other antibiotics-neomycin not commonly used to ototoxicity and nephron toxicity; metronidazole (250mg po q 6-12h) not commonly used to to increased risk for neurotoxicity with long term use |
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Lactulose
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Enulose or Generiac-1st line-leaches ammonia into colon and prevents gut bacteria from creating ammonia
TX: 30-45ml po q hr until evacuation, then 15-40ml po q 6-12 h titrated to 2-3 soft bowel movements a day PX: 15-45ml po q 6-12 h titrated to 2-4 soft bowel movements a day SE: flatulence, diarrhea, dyspnea, abd. discomfort |
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Rifaximan
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Xifaxan-
Rifaximin-inhibits urease producing activity of bacteria, dec. ammonia production TX- 400mg po TID PX- 550 mg po BID SE: peripheral edema, dizziness, fatigue, flatulence, HA |
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Ascites TX Nonpharm
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Restrict NA intake <2g/d
Avoid drugs that cause NA retention (NSAIDS) Restrict fluid only if symptomatic hypernatremia (serum NA<120mEq/L)--- |
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Ascites TX
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Furosemide and spironolactone (40mg/100mg_
Titrate to max weight loss of 0.5kg/day |
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Hepatitis A
-Transmission -duration -prevention |
Self-limiting
Fecal Oral transmission |
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Hepatitis B
-transmission -prevention |
-IVDA most common
-chronic disease -vaccination |
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Hepatitis C
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- mainly silent-->chronic disease emerges
-IVDA -Vo vaccine -Types- genotype 1== most common and difficult to treat; 48weeks genotype 2 and 3==24 week treatment |
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Interferon
BBW |
- MY cause/aggravate fatal or life-threatening autoimmune , neuropsychiatric, ischemic, or Infectious disease
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Interferon
SE |
***high increase in liver enzymes are expected
***withhold tx when ANC<500 or plt <25000 -flu like symptoms--pre treat with APAP or IBU - Bone marrow suppression -CNS--psychosis, depression , insomnia -Pulmonary -infiltrates, dyspnea -Endocrine- hypothyroidism -CA- CP arrhythmia, HTN, syncope, palpitations -Eye- decreased vision, optic neuritis, retinal hemorrhages -GI- Dry mouth, Nausea, cough -Derm- alopecia, rash skin lesions |
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Ribavirin
Side effects and warnings |
RIBA
R- renal (CI when CrCl <50ml/min) I- Interferon-->combo as Ribavirin not effective alone B- Birth Defects (BBW)--> catagory x; men/women must stop 6mo befor trying to get pregnant A-anemia---> hemolytic anemia occurs in 1st 1-2 weeks Also- don't use in unstable cardiac disease (MI can occur); hyperuricemia, hyperbilirubinemia, Monitor: CBC, electrolytes, uric acid, LFT at base and q2 weeks for 2mo, then qmonth |
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Ribavirin DDI
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- USe with didanosine is CI-- liver failure, Pneuropathy, and pancreatitis
- ribavirin may increase levels of neucleoside reverse transcriptase inhibitors |
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Ribavirin
-Brand |
Rebetol
Ribasphere, RibaPack Copegus Virazole Dosing varies based on genotype; stop if EVR hasn't occurred by 12 weeks |
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Protease inhibitor for Hep C
MOA |
- NS3/4A protease inhibition indicated for treatment of genotype 1 infection that must be used with ribavirin
- Boceprevir (Victrelis) -Telaprevir (Incivek) |
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Interferon alpha 2b
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-Intron A
HCV, HBV, cancer - 2million units SC 3 times a week |
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Pegylated Interferon alpha 2b
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- PegIntron
-HCV only - dosed SC weekly |
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Pegylated Interferon alpha 2a-
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Pegasys
-HCV and HBV |
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Interferon Alfacon 1
use |
Infergen
HCV only |
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Other Interferons for MS but not for HEP C or HEP B
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Interferon B 1b (betaseron), Interferon B1a (Rebif and Avone)
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Boceprevir
-dose |
Victrelis
HBV -800mg TID every 7-9 hours with food starting on week 5 of interferon+ribavirin for 24-44 weeks -never reduce dose or interrupt therapy (failure) |
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Boceprevir
CI |
FOR hep B
CI to peg interferon and ribavirin apply due to co administration - on 3A4 inhibitors (high levels/toxcicity) or inducers (low levels and tx failure) |
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Boceprevir
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FOR hep B
SE - fativue, anemia (requiring ESA use) , neutropenia, taste distortion |
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Telaprevir
dose |
FOR hep B
Inceivec 750mg TId (every 7-9) hours with meals started with interferon+ribavirin for 12 weeks Never reduce dos or interrupt therapy |
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Telaprevir
SE |
FOR hep B
SEVERE SKIN RASH, fatigue, itching, tast distortion, anemia, and anorectal disorders (itching/hemorrhoids) Monitor: CBC at base and q4 weeks, HCV RNA, electrolytes, bilirubin, uric acid |
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Telaprevir
CI |
FOR hep B
CI to peg interferon and ribavirin apply due to co administration - on 3A4 inhibitors (high levels/toxcicity) or inducers (low levels and tx failure) |
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Telaprevir and Boceprevir DDI
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FOR hep B
both are Major/strong 3A4 inhibitors and PGP inhibitors |
