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281 Cards in this Set

  • Front
  • Back
define nausea
inclination to vomit
define retching
rhythmic contractions
T or False

Regurgitation does not equal vomiting
True
what are the 4 indications for TPN
complete intestinal obstruction
ileus
severe intractable diarrhea
Initial SBS
what are the other 5 indications
radiation enteritis
acute GI bleeding
high output fistula
acute pancreatitis
hemodynamic instability
what 2 things complicate a central line in TPN?
pneumothorax
infection
Esophagus is what kind of tissue
stratified squamous
what is critical for development of esophageal mucosal injury?
gastric juices
GERD causes....
Erosion, ulceration, bad taste, pneumonitis

**Barretts esophagitis
**Adenocarcinoma
define Barretts disease
distal squamous mucosa replaced by metaplastic columnar epithelium
why is squamous tissue replaced by columnar epithelium
because it is more resistant to gastric acid
how do you diagnosis Barretts
endoscopic evid. of column. epithelium ABOVE the gastroesphageal junction

must be histologic evidence of intestinal metaplasia
what are the 2 criteria for Barretts?
columnar epithelium
intestinal metaplasia
Barretts is a precursor for what?
adenocarcinoma
(which is preventable)
define acute gastritis
inflam. of gastric mucosa
-predominantly neutrophilic infiltrate(PMNs)
define chronic gastritis
same as acute but minaly MONOnuclear
primary causes of acute gastritis
heavy NSAID use
Increase in EtoH use
primary causes in chronic gastritis
H. Pylori
Gastric hyperacidity
describe H. pylori
causes chronic gastritis

Gram neg rod, motile
produces Urease-protects bug from acid
Does not invade-it superfical colonizes by adhesion
define ulcer
break in mucosa(anywhere)

extends thru muscularis mucosa into submucosa or DEEPER
put in order from inner to outer

submucosa
muscularis mucosa
mucosa
mucosa

Muscularis mucosa

submucosa(where blood vessels are)
what is the most important factor in Peptic Ulcer Disease
H. Pylori
how does H. pylori cause damage?
produces proteases and phospholipases-break down epithelial cells-->ulcer
what are main characteristics of Peptic Ulcers?
Duodenum
lesser curvature
body/antrum
main characteristics of Duodenal ulcers?
acid hyposecretion
rapid gastric emptying
what are the complications seen in peptic/duodenal ulcerS?
obstruction(most common)
malignant change
hemorrhage
perforation
malignant change mostly seen in which type of ulcer?
rare in DU
mainly GU
Crohns is mainly seen where?
anywhere in GI
Ulcerative Colitis seen where?
ONLY large intestine
Crohns and colitis common symptoms
infection
abnormal host immunoreactivity
inflamm.
Crohns symptoms
relapsing, inflam., GRANULOMAS
often small intestine + colon-but can be ANYWHERE
describe Crohns type of inflam?
transmural inflam->entire wall
-noncaseating granulomas
-mononuclear(macroFAGS)
desribe what Crohns looks like
skiplessions
cobblestone
linear ulcers
clinical signs of crohns
stricture formation
intestinal obstruction
fistula
prenicou anemia
steatorrhea
what is steatorrhea?
can't absorb fats->go thru large colon
desribe ulcerative colitis
relapsing, inflam
NON-granulomatus
limited to the colon
ulcerative colitis characteristics
continuous extension from rectum
retrograde progession
psudeopolyps, crypt abcesses, submucosal fibrosis

**serosa NOT involved**
what is seen in colorectal carcinoma
polyps
what are the 2 type of polyps
hyperplastic-no malignant potential

adenomatous-exhibit dysplasia, precursors for carcinoma
where does adenomatous grow?
on stocks(pedunuclated)

on mucosa(sessile)
molecular pathogeneis of adenomatus polyps
abnormal tumor suppressor genes
genes resp. for repairing DNA
most cancers are in which part of intestine
sigmoidal>ascending> other
proximal tumors
polypoid
exophytic
no obstruction, easily bleed
anemia
positive fecal occult blood test results in what color?
blue=iron in blood
distal tumor characteristics
annular, encircling
Napkin ring constriction
change in bowel habits
hematochezia
desmoplastic
dfine hematochezia
bright red blood in stool->more bright means closer to rectum
define demoplastic
firm outside of tumor
Best ways to diagnosis colon tumors
colonoscopy-->Fe deficency-->CEA(carcinoembryonic antigen)
characteristics of cirrhosis of liver
YES U R FUCKED CRAIG
bridging fibrous septa
parenchymal nodules
what caues the fibrous tissue in cirrhosis
EtoH
chronic viral Hepatitis
what is the central pathogenic process in cirrhosis?
progessive fibrosis
what cell produced the fibrous tissue
Hepatic Stellate cell
what activates the Stellate cell?
toxins
cytokines
disruption of extracellular matrix
describe hepatic steatosis
fatty liver
can be reversible
describe alcoholic hepatitis
inflam.
describe alcoholic cirrhosis
deposition of fibrous tissue that does NOT go away
PERMANENT-like Craigs AIDS
3 features of cirrhosis
hypoalbuminemia
gynecomastia
spider angiomata
define acute pancreatitis
acute onset of abdominal pain from enzymatic necrosis + inflam.

releasing enzymes into extracell. space
clinical signs of pancreatitis
increases in lipases and amylases
severe signs of pancreatitis
DIC-blood clots everywhere
shock
acute renal tubular necrosis
2 signs of pancreatic cancer
couvosier sign
trousseau sign
define couvosier sign
paliable destended gallbladder
define troussea sign
migratory thromboplebitis
tumor markers
c19-9->specific for pancreas
what are the symptoms of chronic dyspepsia
epigastric pain
N/V
2 common causes of PUD
H. pylori
NSAIDS
H. pylori is listed as a?
carcinogen
H. pylori secretes catalase, which does what
inactivates our neutrophils
H. pylor vs NSAID
ulcer depth
HP-superfical
NSAID-DEEP
HP vs NSAID
-histology
-pain
HP-chronic inflam.
NSAID-no inflam

HP-pain
NSAID-pain, but can be asymptomatic
GI bleeding is more severe in which cause of ulcer ?
NSAID induced-life threatening
what are the alarm symptoms for PUD
Weight LOSS
bleeding
dysphagia
chest pain
Endoscopy does what?
visualizes ulcer and can biopsy to detect for HPI
fecal antigen test
noninvasive
tests for HP antibodies
used for verification of eradication of HP
Urea Breath Test
noninvasive
HP secretes urease which hydrolyzes a labeled C->>pt exhales the labeled CO2
-if labeled co2 is exhaled-HP is present
CLO test
detects HP-urease causes medium to turn red
campylobacter means?
curved bacteria
helicobacter means?
spiral or helical bacteria
first line Tx of HPI eradication
PPI + clarithromycin +amoxil/metro/tetra for 2 weeks
which PPI is not approved for HP tx
pantoprazole or desomeprazole
why are antibiotics comboed with PPIs for HP eradication?
PPI dec. gastric acid volume, which increased antibiotic
which antibiotic should be used once in HP eradication>?
clarithromycin-bugs become resistant to drug quickly
Drug resist. is rare in which antibtiotics for HP tx?
amoxicillin
tetracycline

(metro needs to be increased if used more than once)
Risk factors for NSAID-ulcers
prior ulcer
age >65
high NSAID use (duh)
ASA at same time-doesnt matter form
SSRI, bisphosphates, plavix
1-2 RF for NSAIDs whats tx?
Moderate GI
low cardiac
NSAID + PPI or misoprostil
>3RF for NSAID whats tx?
high GI
low cardiac
tramadol, opoids
celebrex +PPI/misoprostil
moderate GI, high CV risk tx?
Naproxen +PPI/ misoprostil
NSAID ulcer tx for
High GI/High CV risk
avoid NSAIDS
Need PPI
which drug is safest for cardio problems in ulcers
Naproxen
whats in vimovo
naproxen and esomeprazole
tx for NSAID ulcer
DU vs GU
DU-4 weeks of PPI
GU-8weeks of PPI
which drug keeps the pH higher longer?
PPI>H2
PPI facts
inhibits H+/K+ atpase
-NO dosage adj. for renal

Preg Cat. B except Omeprazole
omeprazole is what category
C-so use with caution during lactation
all PPI's provide same...
healing rates
maintenance of healing
relief of symptoms
PPIs do what to clarithromycin
reduces the degradation of the acid-liable drug

-keeps drug around longer
NSAID ulcers
if pt is bleeding on aspirin what should be given?
use aspirin + PPI

DO NOT switch to plavix
S.E. of PPIs
infectious diarrhea ->C. diff ->if so, stop use and give antibiotic

Hip fractures
H.A.
H2 antag facts
inhibit acid secretion by histamine

ALL req. dose adjus. for renal imp.

Preg. B-watch in lactation
what is H2 antag. not used for
not used for preventing a GU due to NSAIDS
H2 antag use
DU-standard dose
GU-double dose needed
relieves dyspepsia
Misoprostil
MOA
Cautions
moa-prostaglandin analog
-protects mucosa

Cautions-Preg Cat. X
Misoprostil efficacy?
reduces riask of increasing complications + ulcers

causes diarrhea(start low then incr.)
sucralfate
better for?
when to use?
best for DU
lastline
define GERD
reflux of stomach contents back into esophagus

-pt does NOT make extra acid
defineNERD
Neg. Endo. reflux disease
-usually dont respond to PPIs
define EE
erosive esophagitis
inflam. with visable damage on endoscopy
pathophysio in GERD
decrease in LESP allows contents to move up

pressure ABOVE les usually higher then stomach to prevent upflow
what can weaken the LES?
estrogens, CCB + BB, and fatties/pregnant women increase pressure behind the stomach
clinical presentation of GERD
heartburn
regurg.
N/v
belching/hiccups
lifestyle mods for GERD
3 small meals
eat slow
lots of water
dont lay down after meals
DON'T USE PILLOWS(just elevate head 6 inches)
Tx:
if GERD symptoms <2days/week
ig >2 days/week
<2days/week- OTC antacids, H2B, Prilosec

>2days- Rx dose of H2B,OTC prilosec
-LIFESTYLE MOD. ALWAYS
severe GERD sympt. Tx with?
PPI
LIFESTYLE MOD. ALWAYS
Antacid disadv.
no esophageal healing
doesnt neutralize at night
alginic acid
helps with nighttime heartburn
causes refluxing of viscous sodium alginate
H2Bs
adv.
disadv.
adv-last for 6-10hours

dis-no increase in LES tone or decrease in freq. of GERD
develop tol. in 5 days
indication for PPI tx
heartburn >2 days/week
use for 8-16 weeks(usually lifelong)

try for 6 months before considered failure
metoclopramide adv
prokinetic agent

increases LES pressur
increases esophageal peristalsis
metoclopramide disadv.
minimal healing
altered mental status(CNS changes)
what is the DOC for pt with GERD and healed esophagitis
PPI
CTZ senses?
responds via?
senses toxins

reports via 5-ht3, D, Neurokinin-1
enterocromaffin cells sense?
responds via?
sesnse damage

respond directly->serotonin
indirectly-> vagal afferent stim
vestib. system sesnse?
responds?
senses balance and propioception

responds by Ach and histam.
Know the Path slide in N/V**
**
simple vs complex vomiting
simple-symptomatic Tx only
-Labs:none

complex-fluid/elect. imbalance
-psychogenic causes
Antacids use?
ADE?
simple NV-from heartburn, overeating Q2-4 hours

ADE-diarrhea(Mg) or constip.
H2 Antag.
BID
simple N/V from heartburn/GERD
causes for motion sicknes?
infection, injury, malignancy
scopolamine is ______ antihistamines
> or =
S.E. for Scopolamine
dry mouth, drowsiness, blurred vision
what are medications used for motion sickness?
anticholinergics and antihistamines
Phenothiazines
why arn't claritin or zyrtec used in motion sickness?
no drowsiness activity
Phenothiazines
actions?
used for?
ADE?
actions-D2 antag., anticholinergic

used for breakthrough

ADE-more risk than other therapies-excessive sedation
PONV RIsk factors?
**NONsmoking**
Female
history of motion sickness/PONV
anesthetics-opoids/N02
long surgery (>60mins)
how many drugs per risk factors
0-1; no meds
2+; prophylaxis 1-2 meds
(4-5)high risk pts will recieve 3 drugs
when should 5-HT3s be given?
at END of surgery
5HT3 -which is longest acting?
ADE?
palonisteron

H.A., constip.->no bad CNS ones
Droperidol
actions?
ADE.?
blocks dopiminergic CTZ stim.

QT prolongation and torsades de pointes
Corticosteroids for N/V
which drugs?
when to give?
mech?
dexamethasone, methypred.

**give at anesthetic introduction**

unkown mech
aprepitant
when to give?
how does it work?
interactions?
3 hours before induction
NK1 antag, inhib GI + CTZ mess.

3A4 inhibitor 2CP inducer
what should be done to dexamethasone if takenwith aprepitant?
decrease dexam. dose by half if co-admin.
Metoclopramide
actions?
ADE?
anti-D2 in CTZ
prokinetic agent: inc. motility

ADE-acute dystonic reactions(25%), tardive dyskinesia, psuedoparkinsonism
when should dose be adjusted with metoclopramide
when pt has kidney problems
-renal adjustment needed**
when does acute N/V take place in CINV pts?

delayed?
acute-within 24 hours

delayed-onset after 24 hours
peaks in 2-3days
breakthrough meds?
what if they didnt work for prophylaxis?
metoclopramide, phenothiazines, FHT3

use meds with diff MOA
CINV drugs rated by?
pts recived what regimen?
rated by emetogenic risk

get prophylaxis + breakthrough
RINV risk varies by?
area of radiation
high risk of 90%
radiation area?
recc?
total body

prophylaxis with 5-HT3A + dexamethasone
low risk of <30%
radiation area?
recc?
head, neck, breast

5HT3 antag
what is hyperemesis gravidarum?
hyper emesis while pregnant.
guidelines for emesis in pregnancy from?
ACOG-college of obstericians + gynecologists
N/V in preg.
start with?
1st line?
2nd?
3rd?
take multivitamin
1st-Vit B6 pyridoxine +/- doxylamine

2nd-diphenhydramine
3rd-phenothiazines, metoclopramide
severe N/V in preg tx?
hyperemesis gravidarium
tx-IV hydration
corticosteroids for REFRACTORY only

supp nutrition-enteral
What is the caloric requirement for dextrose?
20-30 cal/kg
what are caloric requirements for proteins in normal renal function?
renal/hepatic insuff?
1-2g/kg

0.6-0.8 g/kg
glucose caloric values?
protein?
4cal/g
4cal/g
what is the optimal hangtime for TPN in immune compromised?
normal?
immune comp-24H
reg.-12H

shorter times mess with mactophages
what is kwashiorkor?
marasmus?
2 types of malnutrition
k-albumin is depleated-more visceral

m-decrease in skel. muscle
what values do you look for in kwashikor/marasmus
albumin-19 day t1/2
prealbumin-3 day(nutriton indicator)
Enteral feeding-gen info
better for gut
cheaper
gastric or jejunal
gastric vs jejunal
pros/cons
gastric-have to check residuals q 6-8H(whats left instomach)

jejunal-no residual checking, no aspiration prob. but check for diarrhea
problems with parenteral
pneumothorax
gut doesnt get nourishment
central vs peripheral
mOsm?
SE?
central->1000-2000 mOsm
more calories

peripheral-only 1000 mOsm
Phlebitis risk
what is a PICC line?
central line via peripheral route
refeeding syndrome
check *Mg*, K, *Phosphate*
check d for first 4 days

Mg levels need to be corrected first
in pulmonary dysfun. what is the dextrose limit?
do not exceed 5-7 mg/kg/min

if its more it causes a greater increase in CO2
what is preferred route of TPN in pulm dysfun?
enteral
which two drugs have calories and whats the percent?
profolol and ampoterrible
10%
preferred feeding route in pancreas dysfun?
enteral-jejunal-bypasses stomach
give elemental formulas
how are lipids given in pancreas dysfunction?
how often
parenteral
3 times a week
what is the preferred feeding route in renal dysf?

considerations to watch?
enteral

insulin resistance, use carbs in caution mots pts are diabetic
protein values for renal
non-dialyzed
dialyzed
nond-0.6-0.8 g/kg

****d-1-1.5 g/kg***
what is the caloric content of dextrose in renal

lipids need dosage adjust?
20-25 cal/kg

No adjust needed
SBS preferred route?

protein values
enteral

1.5-2g/kg
calories for SBS

fluids?
20-30 cal/kg

1cc/cal
what are 2 requirements to not be on TPN for rest of life?
>100 cm and the ileocecal valve
trauma info
calories
chunkies-wait up to 7 days before feeding
matties-enteral feeding STAT
20-25 cal/kg
what is K electrolyte requirements?
1-2 mEq/kg
what is Na electrolyte requirements?
1-2 mEq/kg
what is Ca electrolyte requirements?
10-15 mEq/DAY

NOT weight based
what is Mg electrolyte requirements?
8-20 mEq/DAY

NOT weight based
what is phosphate electrolyte requirements?
20-40 mmol/DAY

NOT weight based
hyperglycemia in TPN
hypoglycemia
add 2/3 of insulin units given previous day to present TPN

give ampule of D50
Hang bag of D10
stop TPN bag
Na range
hypoNa tx

hperNa tx
135-145
hypo-fluid restrict, give 3%NaCl
vasoprosol

hyper-add free water to TPN
remove Na
K range
hypoK tx

hyper K tx
3.5-5
hypo-Add K(bolus)

hyperK-remove K
kayexalate
dialysis
Phosphate range
hypo tx
hyper tx
(dumb card)
2.5-4.5
hypo-add PO4(bolus)

hyper-remove PO4
dialysis
Ca range
what form?
hypo tx
hyper tx?
1.12-1.23
ionized
hypo-add Ca(bolus)
hyper-remove Ca from TPN
dialysis
Mg range?
1.6-2.3 mg/dl
hypo-Mg bolus

hyper-dialysis 2.7mg/dl
Vitamin A is for?
def?
vision
get this wrong=kicked outta pharm
-night blindness
Vit B1 aka
def?
thiamine
coenzyme in the pentose pathway

def-Beriberi->causes wenickes encephalopathy
Vit B2 aka
def?
riboflavin
dermatitis and stomatitis
vit B3 aka
def?
niacin
def-pellagra(black tongue)
Vit B6 aka
def?
pyridoxine

depression, dermatitis
vit B12 aka
def?
cyanocobalamin
def-megaloblasic anemia, leukopenia, thrombocytopenia
Vit C aka
def?
does what?
ascorbic acid
def-scurvy
antioxidant
what is good for wound healing?
Vit C + Zinc
what is Vit C required for?
for reductive protection of folic acid and Vit E
Vit E use
def?
antioxidant by trapping peroxyl free radicals in cell membranes

def-inc. platelet agg./anemia
folic acid
def?
water soluble
megaloblastic/macrocystic anemia
Iron
def?
trace element
anemias
Zinc def
growth retardation
bad night vision
alt. in taste/smell
Chromium
trace element
potentiates the action of insulin
acetate vs chloride
acetate-converted to bicarb to increase pH-for acidonic pt

chloride-converted to acid to decrease pH for alkalosis
liver recieve blood from
2 systems
hepatic artery
portal vein
whats in the splanchnic blood
oxygen poor
nutrient rich blood
function of liver?
synthesis of albumin, coag factors

detox of ammonia, billirubin
regulation of horomones
diseases of liver
immune/autoimmune
alcholic liver disease
cholestatic syndromes
3 mech that damage the liver
hepatocellular necrosis
cholestatic injury
vascular damage
define cirrhosis
presence of fibrosis tissue replacement
clinical presentation of liver disease
jaundice
N/V
abdominal distentioon
gynecomastia
spider angiomas
Risk factors for liver disease
female>male
>6drinks/day
highly sexual
2 drug-induced liver diseases
methyldopa
amiodarone
LFT's
ALT, AST

it reflects the health of the liver NOT the FUNCTION
ALT
what happens in liver disease?
normal value?
rises dramatically in acute

5-40
AST
what happens in liver damage
normal value?
rises
10-40
TBIL
normal value
breakdown product of heme
0.1-1
measures conjug. vs unconjug
GGTP
normal value
function
0-51
specific to the liver
marker for cholestatic damage
ALP
normal value?
function
24-110
ezymes in the cells lining the biliary ducts(in cholestatic)

drawn with GGTP
LDH
200-300
rises in tissue breakdown
NOT an indicator of liver disease
Child-Pugh score
determines the functionality of the liver
elevated AST/ALT usually means?
hepatocellular
elevated ALP, GGTP, TBIL usually?
suuspect cholestatic
pathogenesis in alcholics
deficiency of protein calories, def of vit B1->wernickes encephalopathy
patho in biliary cirrhosis
lipid malabsorption(ADEK)
Tx in alcoholic liver disease
folate 1mg IV/ daily
thiamine 100 mg daily

given as IV-rally pack(banna bag)
Portal HTN tx
reduce pressure
propranolol 20 mg bid
nadolol 40 mg daily
(non selective B blockers)
Ascities path flow chart
ascities->decrease in arterial blood volume->hyyperdynamic circ.->increase in extracellular fluid
Ascities 1st line TX
Na restriction(<2g/day)
restrict water if hypoNa

diuretic therapy-spironolactone with furosemide
2nd line Tx for Ascites
paracentesis
plasma expander
TIPS-its a shunt(last line)
spironolactone
ascites tx
aldosterone antag
100-300 mg PO/day
caution in renal
furosemide
ascities tx
40-80 mg/day
max 160 mg /day
albumin
ascities tx
1g/kg/day
max 100g/day
tolvaptan use
tx hyponatremia secondary to cirrhosis
tolvaptan contraindic?
dose?
diminished sense of thirst

15mg daily-Check Na in 8 hours
when do you use tolvaptan
Na <125

Na>125 + symptomatic and unresp. to fluid restriction
SBP
Spontaneous Bacterial Peritonitis
failure of the immune system

diagnosis by PMN >250 or positive bacterial culture
SBP tx
paracentesis
C&S of ascitic fluid
empiric antibiotics-cefotaxime/ceftriaxone
cipro(2nd line)
cefotaxime
dose?
SBP tx
2g IV q 8 h
caution in renal dysfun.
ceftriaxone
SBP tx
1g q 24H
no adjust.
cipro
400 mg IV q 12 H
tendon rupture
caution in renal
Varices Tx
Acute bleeding?
No(endoscopy)->use BB

Yes->Octreotide->still yes generally go to TIPS
Octreotide dose?
varices Tx
bolus 100 mcg
infusion 25 mcg/hr (18h-5 days)
prophylatic antibiotic choice for varices
ceftazidime, ceftriaxone, or fluroquin

serious bleeding->fresh frozen plasma
Somatostatin
Varices Tx
growth horomone-inhib. horomone

suppresses Vasoactive intestinal peptide(VIP)
Hepatic Enceph. patho
abnormal ammonia metab
HE severity grading
stage 0-best
stage 4-worst(coma)
HE tx
restrict dietary protein
NPO for 24-48H

clearance of ammonia with lactulose, neomycin, rifaximin
flumazenil
GABA antag
Not really recc for HE
LACTULOSE
HE tx-most used
30-45ml PO q 1-2 H until BM

osmotic laxative
Neomycin
500mg to 2 g PO q 4-6H
Metronidazole
250mg po BID
disulfuram reaction
rifaximin
2nd/3rd gen
400 mg po TID
Liver coag problems
effect PT time
thrombocytopenia

predisposed to disseminated intravascular coagulation(DIC)
Coag Tx
only for active bleeding
give platelet transfusion
fresh frozen plasma
Vit K(only if Liver is working)
Vit K MOA
cofactor for hepatic synthesis
Hepatorenal syndrome(HRS)
kidneys get fucked with no prior evidence its gonna be
-liver fucks up kidneys day job
severe HRS

Extreme HRS
ascities

hepatorenal syndrome
HRS Tx
liver transplant(if not ,death
stop diuretics
octreotide
midodrine
Fulminant Hepatic Failure
onset of HE within 8 weeks
tx-support/transplant
HBV post-exposure prophylaxis
requires 2 forms
1-passive immunity of the Hep B immune globuline
2-active immun-HBV vaccination
Definition of chronic HBV
Definition of chronic HBV: HBsAg+ for ≥ 6
months
when to tx HBV
E antigen(+)->20,000 or >10^5 copies
E antigen(-)->2,000 or >10^4 copies
AND
elevated ALT >2xNormal
or liver disease biopsy
• First line antiviral agents for HBV
• First line antiviral agents:
– Peginterferon alfa‐2a (Pegasys®) 180 mcg SQ qweek
– Tenofovir (Viread®) 300mg PO daily
– Entecavir (Baraclude®) 0.5mg PO daily
second line tx of HBV
Lamivudine (Epivir‐HBV®) 100mg PO daily
– Telbivudine (Tyzeka®) 600mg PO daily
– Adefovir (Hepsera®) 10mg PO daily
primary goal in HCV
– Undetectable HCV RNA, 6 months post‐treatment
(sustained virologic response, SVR)
HCV type 1 tx
• Peginterferon alfa‐2a (Pegasys®) 180 mcg SQ qweek
OR
• Peginterferon alfa‐2b (Peg‐Intron®) 1.5 mcg/kg SQ qweek
AND
• Ribavirin 800‐1400 mg/day based on weight, in 2 divided doses
• <65kg: Ribavirin 800 mg/day
• 65‐85kg: Ribavirin 1,000 mg/day
• 86‐105kg: Ribavirin 1,200 mg/day
• >105kg: Ribavirin 1,400 mg/day
HCV tx duration
tx for 48weeks if RNA is undect. by week 12(Early)

if RNA still detectable at 24 weeks-stop tx

extended tx in slow responders
define slow responder
≥ 2 log decline in baseline HCV
RNA but HCV RNA positive at week 12, then
HCV RNA negative by week 24
HCV type 2 +3 tx
Peginterferon alfa‐2a (Pegasys®) 180 mcg SQ qweek
OR
• Peginterferon alfa‐2b (Peg‐Intron®) 1.5 mcg/kg SQ qweek
AND
• Ribavirin 800 mg/day, in 2 divided doses
Ribavirin
synthetic guanosine analog
not for mono therapy
type 1 is weight based
type 2 is fixed dose
ribavirin AE
Anemia, teratogenic(double prevention)
Ribavirin C/I
renal dystfunction, preg, cardiac prob
Interferon info
C/I
(a) dose is not weight based
must refrigerate

depression, drug abuse
Interferon AE
Flu, fatigue, bone marrow suppresion, depression, tx pre-exsiting before starting
what factors cause nausea in stomach/small intestine area?
chemo
surgery
radiation
what factors cause nausea in the CTZ?
chemo
anesthetics
opoids
what factor causes nausea in the labrynth
surgery
what could be used for stomach/small intestine nausea?
5-HT3 antag

(thru CTZ)
anti-dopinaminergic
anti-muscarinic
anti-histaminic
what drugs can be used for the CTZ nausea
anti-dopinaminergic
anti-muscarinic
anti-histaminic
cannabinoids
what drugs can be used labyrinths nausea?
anti-muscarinic
anti-histaminic
biggest S.E. of phenothiazines
dyskinesias