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80 Cards in this Set
- Front
- Back
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psyllium
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bulk-forming agent - laxitive
MOA: absorb water and form gels in lrg intestine, distends intestine, stimulates peristalsis I: chronic constipation, also diarrhea C: GI obstruction/perforation, gastric retention, undx abdom pain, vomit, appendicitis, toxic colitis, ileus or megacolon avoid fiber agents in pts w swallowing difficulties, severely slow colon, diverticulitis watch Na, K, aspartme AE: bloating, flatulence, abdom cramps interxns: affect absorption, separate admin by 1 hr |
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carboxymethycellulose
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bulk-forming agent - laxitive
MOA: absorb water and form gels in lrg intestine, distends intestine, stimulates peristalsis I: chronic constipation, also diarrhea C: GI obstruction/perforation, gastric retention, undx abdom pain, vomit, appendicitis, toxic colitis, ileus or megacolon avoid fiber agents in pts w swallowing difficulties, severely slow colon, diverticulitis watch Na, K, aspartme AE: bloating, flatulence, abdom cramps interxns: affect absorption, separate admin by 1 hr |
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magnesium citrate
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osmotic/saline/hyperosmotic laxitive
MOA: nonabsorbable/nondigestible salts/surgars hold water in intesting by osmotic foce, distends colon, stim peristalsis I: constipation, colon prep for HI procedure, remove toxin C: GI obstruction/perforation, gastric retention, undx abdom pain, v, appendicitis, toxic colitis, ileus, megacolon, kidney disease/renal fxn, caustion w diuretics, ACE-I, ARBs, NSAIDs AE: electrolyte abnormalities Interxn: Mb(OH)2 can dec absorption of some antibiotics, drugs given prior to colon prep may be flushed out before absorption DRINK H2O |
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magnesium hydroxide
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osmotic/saline/hyperosmotic laxitive
MOA: nonabsorbable/nondigestible salts/surgars hold water in intesting by osmotic foce, distends colon, stim peristalsis I: constipation, colon prep for HI procedure, remove toxin C: GI obstruction/perforation, gastric retention, undx abdom pain, v, appendicitis, toxic colitis, ileus, megacolon, kidney disease/renal fxn, caustion w diuretics, ACE-I, ARBs, NSAIDs AE: electrolyte abnormalities Interxn: Mb(OH)2 can dec absorption of some antibiotics, drugs given prior to colon prep may be flushed out before absorption DRINK H2O |
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sodium phosphates
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osmotic/saline/hyperosmotic laxitive
MOA: nonabsorbable/nondigestible salts/surgars hold water in intesting by osmotic foce, distends colon, stim peristalsis I: constipation, colon prep for HI procedure, remove toxin C: GI obstruction/perforation, gastric retention, undx abdom pain, v, appendicitis, toxic colitis, ileus, megacolon, kidney disease/renal fxn, caustion w diuretics, ACE-I, ARBs, NSAIDs AE: electrolyte abnormalities Interxn: Mb(OH)2 can dec absorption of some antibiotics, drugs given prior to colon prep may be flushed out before absorption DRINK H2O |
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polyethlene glycol + electrolytes
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osmotic/saline/hyperosmotic laxitive
MOA: nonabsorbable/nondigestible salts/surgars hold water in intesting by osmotic foce, distends colon, stim peristalsis I: constipation, colon prep for HI procedure, remove toxin C: GI obstruction/perforation, gastric retention, undx abdom pain, v, appendicitis, toxic colitis, ileus, megacolon, kidney disease/renal fxn, caustion w diuretics, ACE-I, ARBs, NSAIDs AE: electrolyte abnormalities Interxn: Mb(OH)2 can dec absorption of some antibiotics, drugs given prior to colon prep may be flushed out before absorption DRINK H2O |
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lactulose
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osmotic/saline/hyperosmotic laxitive
MOA: nonabsorbable/nondigestible salts/surgars hold water in intesting by osmotic foce, distends colon, stim peristalsis I: constipation, colon prep for HI procedure, remove toxin C: GI obstruction/perforation, gastric retention, undx abdom pain, v, appendicitis, toxic colitis, ileus, megacolon, kidney disease/renal fxn, caustion w diuretics, ACE-I, ARBs, NSAIDs AE: electrolyte abnormalities Interxn: Mb(OH)2 can dec absorption of some antibiotics, drugs given prior to colon prep may be flushed out before absorption DRINK H2O |
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sorbitol
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osmotic/saline/hyperosmotic laxitive
MOA: nonabsorbable/nondigestible salts/surgars hold water in intesting by osmotic foce, distends colon, stim peristalsis I: constipation, colon prep for HI procedure, remove toxin C: GI obstruction/perforation, gastric retention, undx abdom pain, v, appendicitis, toxic colitis, ileus, megacolon, kidney disease/renal fxn, caustion w diuretics, ACE-I, ARBs, NSAIDs AE: electrolyte abnormalities Interxn: Mb(OH)2 can dec absorption of some antibiotics, drugs given prior to colon prep may be flushed out before absorption DRINK H2O |
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glycerin suppositions
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osmotic/saline/hyperosmotic laxitive
MOA: nonabsorbable/nondigestible salts/surgars hold water in intesting by osmotic foce, distends colon, stim peristalsis I: constipation, colon prep for HI procedure, remove toxin C: GI obstruction/perforation, gastric retention, undx abdom pain, v, appendicitis, toxic colitis, ileus, megacolon, kidney disease/renal fxn, caustion w diuretics, ACE-I, ARBs, NSAIDs AE: electrolyte abnormalities Interxn: Mb(OH)2 can dec absorption of some antibiotics, drugs given prior to colon prep may be flushed out before absorption DRINK H2O |
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docusate dioctyl sodium sulfosuccinate (Na+, Ca2+, K+)
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surfactant laxitive
MOA: anionic detergents, emulsify w stool, softens, easier passage I: stool softened C: GI obstruction or perforation; gastric retention, undx abdom pain, v, appendicitis, toxic colitis, ileus, megacolon, fecal impaction/obstruction, acute surg abdomen, NOT w/ mineral oil AE: mild cramping Interxn: surfactant + mineral oil --> inc min oil abdorption and toxicity NB: not useful once constipation occurred |
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mineral oil
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lubricant laxitive
MOA: penetrates and lubricates feces for easier passage, prevents water reabsorption I: fecal impaction, postMI/surg/partum to avoid strain C: risk of aspiration, appendicitis, diverticulitis, ulc colitis, colostromy, ileostomy AE: risk of asp, incontinence/anal leakage, w/ chr use: malabsorption of fat soluble mineral, chr inestinal hypomotility Interxn: docusate, fat soluble vits, surfactants |
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anthraquinones: Cascara sagrada, Senna/sennosides, Cassia plant, Aloe, castor oil
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irritant/stimulant/contact
MOA: contact irritant effects on enterocytes, enteric neurons, muscle, cause accumulation of water and electrolytes and stimulate intestinal motiltiy via several different pathways (PG; NO; Na, K, ATPase) PK: all prodrugs I: constipation, prep fo rdelivery, surgery, GI CI: acute abdomen, bowel obstruction, appendicitis, gastroenteritis, not for chronic use AE: melanosis coli, cathartic colon, cramps, severe diarrhea, depndency, castor oil, diphenylmethanes cna cause mucosal damage I: antacids, milk |
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diphenylmethan derivs: bisacodyl
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irritant/stimulant/contact
MOA: contact irritant effects on enterocytes, enteric neurons, muscle, cause accumulation of water and electrolytes and stimulate intestinal motiltiy via several different pathways (PG; NO; Na, K, ATPase) PK: all prodrugs I: constipation, prep fo rdelivery, surgery, GI CI: acute abdomen, bowel obstruction, appendicitis, gastroenteritis, not for chronic use AE: melanosis coli, cathartic colon, cramps, severe diarrhea, depndency, castor oil, diphenylmethanes cna cause mucosal damage I: antacids, milk |
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methylnaltrexone
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laxitive
subcut inj MOA: periph mu opiod receptor antag cannot X BBB, no CNS effect PK: 85% elim, unchnged drug I: opiod induced constipation, post op ileus, preg cat B CI: known or suspected mech GI obstruction AE: diarrhea, abdominal pain, n, d |
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Lubiprostone
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oral laxitive
MOA: agonist at GI CLC-2 chloride ch, activates ch in apical membrane of intestine --> inc production of chloride rich intestinal fluids wo affecting serum Na or K levels like a PG in structure PK: very poor systemic absorption (plasma serum levels not detectable with therapeutic doses) I: chr idiopathic constipation; IBS w constipation (f >=18), no restriction on length use CI: known or suspected mech GI obstruction AE: n, d, abdom pain no evidence of tolerance, dependence or rebound effects (a prob w other laxatives) |
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psyllium
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MAO: absorb water and form gels in lrg intestine. this slows passage through the intestine in the setting of d
I: chr d, d with incontinence, diarrhea w irribale bowel AE: avoid if difficulty swallowing, slow GI, diverticulitis Interxn: may absorb other drugs caution: new ingredients of combination drugs/familiar trade names |
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carboxymethylcellulose
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MAO: absorb water and form gels in lrg intestine. this slows passage through the intestine in the setting of d
I: chr d, d with incontinence, diarrhea w irribale bowel AE: avoid if difficulty swallowing, slow GI, diverticulitis Interxn: may absorb other drugs caution: new ingredients of combination drugs/familiar trade names |
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methylcellulose
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MAO: absorb water and form gels in lrg intestine. this slows passage through the intestine in the setting of d
I: chr d, d with incontinence, diarrhea w irribale bowel AE: avoid if difficulty swallowing, slow GI, diverticulitis Interxn: may absorb other drugs caution: new ingredients of combination drugs/familiar trade names |
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kaolinpectin
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MAO: absorb water and form gels in lrg intestine. this slows passage through the intestine in the setting of d
I: chr d, d with incontinence, diarrhea w irribale bowel AE: avoid if difficulty swallowing, slow GI, diverticulitis Interxn: may absorb other drugs caution: new ingredients of combination drugs/familiar trade names |
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phenylpiperidine analgesic analog
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MOA: stimulates opiate receptor in myenteric plexis, with the result of delayed intestinal transit and dec secretions
I: acute, nonspecific d CI: not for infectious d, toxigenic E. coli, Salmonella, Shigella AE: constipation, toxic megacolon Interxn: other anticholinergic drugs - atropine, other drugs causing sedation, MAO inhibitions |
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loperamide
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MOA: stimulates opiate receptor in myenteric plexis, with the result of delayed intestinal transit and dec secretions
I: acute, nonspecific d CI: not for infectious d, toxigenic E. coli, Salmonella, Shigella AE: constipation, toxic megacolon Interxn: other anticholinergic drugs - atropine, other drugs causing sedation, MAO inhibitions |
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diphenoxylate + atropine
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MOA: stimulates opiate receptor in myenteric plexis, with the result of delayed intestinal transit and dec secretions
I: acute, nonspecific d CI: not for infectious d, toxigenic E. coli, Salmonella, Shigella AE: constipation, toxic megacolon Interxn: other anticholinergic drugs - atropine, other drugs causing sedation, MAO inhibitions |
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diphenoxin + atropine
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MOA: stimulates opiate receptor in myenteric plexis, with the result of delayed intestinal transit and dec secretions
I: acute, nonspecific d CI: not for infectious d, toxigenic E. coli, Salmonella, Shigella AE: constipation, toxic megacolon Interxn: other anticholinergic drugs - atropine, other drugs causing sedation, MAO inhibitions |
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bismuth subsalicylate
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anti-diarrheal, mucoasal protective agent
MOA: may bind bacterial toxins, anti-secretory effects (NSAID effect)? also neutralizes gastric acids? r/t formation of glycoprotein-bismuth complex over ulcer crater preventing further ulceration and promoting healing I: d CI: hypersensitivity to ASA, not for kids w viral inf, chr use in renal failure pts AE: temp black tongue and stools, hi doses can cause salicylte toxicity Interxns: tetracyclines, salicylates chew the tablets |
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cholestyramine
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bile-acid binder, anti-diarrhetic
MOA: anion exchange resin; binds bile acids I: secretory d, post-op CI: pts sensitive to constipation AE: bloating, constipation Interxn: can bind other drugs (separate admin times) & interfere w some diagnostic tests |
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colestipol
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bile-acid binder, anti-diarrhetic
MOA: anion exchange resin; binds bile acids I: secretory d, post-op CI: pts sensitive to constipation AE: bloating, constipation Interxn: can bind other drugs (separate admin times) & interfere w some diagnostic tests |
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octreotide (analog of somatostatin)
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anti-secretory, anti-diarrhetic
MOA: somatostatin receptors, hyperpolarizes gut neurons, dec ACh, slows peristalsis PK: longer 1/2 life, more potent than somatostatin at inhib gastric and pancreatic secretions I:Zollinger-Ellison syndrome, AIDS diarrhea, refractory, endocrine tumor-related d CI: hypersenstivity to drug or components AE: GB stasis, inhib pancreatic secretions Interxn: cyclosporine other: must be given subcutaneously |
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sucralfate
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mucosal protective agent
MOA: salt sucrose complexes w protein exudates at ulcer sites and acts as protective barrier, promotes mucous/bicarb lyr and the mucoid cap promoting epi regen PK: min absorption I: duodenal/gastric ulcers CI: renal failure Interxn: req acidic pH for activation |
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misoprostol
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mucosal protective agent
MOA: PGE1 analogue, inhib gastric acid secretion and promotes mucosal protective properties PK: 1st pass, shrt 1/2 life I: prevent NSAID-induced gastric ulcers, induces labor and for incomplete and therapeutic abortions CI: pregnancy! allergy to PG, IBD AE: minor diarrhea, miscarriage, Preg Cat X Interxn: does NOT affect P450 system, NO effect on aspiring or NSAID |
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antacids
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MOA: neutralize acid
I: relief GI sx CI: dec renal function AE: minimal (constip, diarrhea) Interxns: MANY!!! self-tx replaced by H2 receptor blockers and PPIs components: hydroxides of Al (slow) and Mg (med); Na and Ca bicarb - fast non-acid neutralizing components: simethicone, alginic acid tablets neutralize less acid than liquid, but last longer |
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cimetidine
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H2 receptors on parietal cell membrane
reveribly s w histamine for binding PK: rapid absorb, little hep metab, excret kidney, cimitidine inhib P450 slow metab of other drugs (warfarin, phenytoin) I: promotes gastric and duodenal ulcer healing, prevents ulcer recurrence, suppress of nocturnal acid secretion maximizes efficacy AE: confusional state in elderly, gynecomastia |
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ranitidine
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H2 receptors on parietal cell membrane
reveribly s w histamine for binding PK: rapid absorb, little hep metab, excret kidney, cimitidine inhib P450 slow metab of other drugs (warfarin, phenytoin) I: promotes gastric and duodenal ulcer healing, prevents ulcer recurrence, suppress of nocturnal acid secretion maximizes efficacy AE: HA |
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famotidine
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H2 receptors on parietal cell membrane
reveribly s w histamine for binding PK: rapid absorb, little hep metab, excret kidney, cimitidine inhib P450 slow metab of other drugs (warfarin, phenytoin) I: promotes gastric and duodenal ulcer healing, prevents ulcer recurrence, suppress of nocturnal acid secretion maximizes efficacy AE: HA |
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nizatidine
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H2 receptors on parietal cell membrane
reveribly s w histamine for binding PK: rapid absorb, little hep metab, excret kidney, cimitidine inhib P450 slow metab of other drugs (warfarin, phenytoin) I: promotes gastric and duodenal ulcer healing, prevents ulcer recurrence, suppress of nocturnal acid secretion maximizes efficacy |
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Proton Pump Inhibitor
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Gastric antisecretory drugs
MOA: inactivates H/K/ATPase as the end common pathway of acid production rapidly absorbed highly protein bound excreted by kidney metab by inhib P450 prodrugs that req activation in an acid mileu Clin: short term tx GU and DU TOC: Zollinger-Ellison used w antibiotics for H pylori GERD AE: inhib P450 lead dec benzos, warfarin, phenytoin, n, abdom pain, change bowel habits, elevated gastrin, lack of acid-feedback inhib |
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GERD
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PPI more effective than H2
empirical trial of PPI is appropriate in absence of alarm sx (wt loss, dysphagia) |
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PUD
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PPI promote more rapid healing than H2
IV PPI have role in acute bleed |
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carbechol
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cholinergic agents
activation of muscarinic receptors on sm muscle cells inc intracell Ca++ |
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bethanecol
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cholinergic agents
activation of muscarinic receptors on sm muscle cells inc intracell Ca++ |
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metoclopromide (domperidone)
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dopamine receptor antagonists
dopaminergic receptors on motor neuron activation inhib motility: DA effect, dec ACh from ENS blockade (antagonism) has anti-DA effect --> protects GI motiltiy |
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metoclopromide (reglan)
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serotonin receptor modulators
antagonist: 5HT3r on ECL cells and ENS modulate inhib responses, antagonism promotes motiltiy agonist: 5HT4r modulates excitatory resp, agonism shld enhance motiltiy I: gastroparesis, anti-emesis, heartburn in GERD PK: rapid absorb, 1/2 life = 2-4hr AE: somnolence, nervouseness, dystonia/dyskinesia in elderly |
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tegeserod maleate (zelnorm)
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serotonin receptor modulator
target: 5HT4 agonist, modulate excitatory resp, agonism promotes motility for constipation predom IBS |
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erythromycin
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motilin agonists
target: motilin receptors on sm muscle cells stim enhances MMC |
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Botulinum toxin
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inhib Ach release
intrapyloric injection inhib pylorospasm, which has been described in diabetic gastroparesis enhances solid, not liquid, emptying improves postprandial fullness and bloating |
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pancreatin
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extract of hog pancreas
dose with meals titrated to effect higher gastric pH enhances activity I: fatty diarrhea, pancreatic insufficiency |
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pancrelipase
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enriched with lipase
dose with meals titrated to effect higher gastric pH enhances activity I: fatty diarrhea, pancreatic insufficiency |
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metronidazole
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mild to moderate Crohn's disease
induce remission antibiotic |
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ciprofloxacin
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mild to moderate Crohn's disease
induce remission antibiotic |
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5-Aminosalicylates (5-ASA)
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MOA: inhib cyclooxygenase, lipoxygenase, B cells, inflam ctk, activates PPARy, inhib of lkt most imp
I: IBD, most efficacious in UC, CD maintencance, chemoprophylax (colon CA) Safety: hypersensitivity, nephrotox, rev oligospermia sulfasalazine: folate depletion anemia, oligospermia (PO, rectal) |
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sulfasalzine
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combines sulfapyridine with 5-ASA linked by azo bond
(azo bond is broken by bacteria in distal bowel) used in mild/moderate ulcerative colitis (esp in maintaining remission) dose: 3-4g/day AE: dose related malaise, nausea, abdom pain, impaired folic acid absorption, rev dec in sperm count, severe skin rxns (Stevens-Johnson syndrome), bone marrow suppression |
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mesalamine
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coated 5-ASA
lacks sulfa component I: IBD asacol: coating dissolves in alkaline milieu, allowing slow release through the bowel (mostly in terminal ileum and colon) pentasa: semi-permeable membrane, drug released from jejunum thru colon enema: allow local delivery for tx of distal colotos and rectal disease |
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olsalazine
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I: IBD
2 5-ASA molecules linked by diazo bond bond cleaved y bacterial flora |
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glucocorticoids
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immunosuppressive agents for IBD - abdom pain, fever, leukocytosis, rectal bleed
results in remission in 90% oral |
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azathioprine, 6-mercaptopurine (PO)
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purine analog
cytotoxic agents suppress lymphocyte prolif second line tx for severe IBD AZA --> 6MP --> 6TG--> dec prolif activated lymphocytes, apop CD/UC: steroid w.drawl, maintenance max clin benefit: 3-4mo early rxns: fever, pancreatitis AE: leukopenia, hepatotoxicity, infection (viral), lymphoma, non-melanoma skin CA |
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cyclosporine (IV --> PO)
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I: IBD, UC - severe refractory dz
immunosuppressive agent calcineurin inhibitor that suppresses proinflam factors for severe UC not responding to steroids lipophilic peptide: down reg IL-2 --> inhib Th cells use lmtd by toxicity: renal insuff, HTN, neurotox, nephrotox, infection |
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infliximab (IV)
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TNFa inhibitors
CD/UC: induction and maintenance TNF is a product of mononuclear cells and thought to be a critical ctk in pathogen of inflamm TNFa is known to be inc in mucosa of Crohn's pts single infusion of infliximab 5mg/kg is effective in inducing remission in Crohn's lasting 2-6wks, leads to significant reduction in fistualizing disease AE: n, low risk inf and malig I: inducing and maintaining remission |
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adalimumab (SQ)
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TNFa inhibitors
CD: induction/maintenance TNF is a product of mononuclear cells and thought to be a critical ctk in pathogen of inflamm TNFa is known to be inc in mucosa of Crohn's pts single infusion of infliximab 5mg/kg is effective in inducing remission in Crohn's lasting 2-6wks, leads to significant reduction in fistualizing disease AE: n, low risk inf and malig, CHF, infusion rxn, lymphoma, demyleination I: inducing and maintaining remission |
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chenodiol
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bile salt tx
used for oral tx to dissolve gallstones lmted by diarrhea |
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ursodiol
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bile salt tx
epimer of chenodiol few toxicity used in gallstone dissolution and primary biliary cirrhosis |
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Tx for Achalasia
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meds to relax lower eso muscles
BoTox at GEJ to relax lower eso sphincter dilation of eso surgical myotomy |
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Tx for Esophageal spasm
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long and short acting nitrate preps
CCBs BoTox inj in cases where lower eso sphincter pressure is hi |
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Tx for Delayed gastric emptying
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prokinetic agents
BoTox inj at pyloric sphincter gastric pacemakers (esp in pts w neuropathic gastroparesis, is DM) |
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Tx for gastric outlet obstruction
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correct obstruction problem (pyloric stenosis due to chronic scarring from PUD, compression from pancreatic cancer)
use of prokinetic agensts can worsen sx |
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Tx for gastroparesis
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prokinetic agents
BoTox at pyloric sphincter gastric pacemakers, most useful in neuropathic gastroparesis, DM |
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H. pylor tx
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2 general therapeutic regimens:
PPI w 2 antibiotics (amoxicillin, clarithromycin) PPI w 3 antibiotics PPI or H2RA, bismuth, metronidazole, tetracylcine (BMT) eradication rates gen 85-90% metronidizole and clarithromycin resistance is inc common amoxicillin resistance much less prevalent |
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H2RAs
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acid suppression
unless dosed at hi dose with continue IV infusion, shldnot be considered 1st line for acid suppression AE: tachyphylaxis occurs over days |
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budesonide
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Tx: IBD
hi 1st pass metab few systemic side effects time dependent release in SB efficacy: CD - ileal/R colonic induction ulcerative proctitis - enema formulation induces remision in ileal and rt colonic CD AE: < 10% of systemic side effects |
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glucocorticosteroid
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IBD
binds GC receptors --> inhib inflamm mediators, WBC migration/funciton, dec ctk, lkt, PG I: + induction, NOT maintenance of UC and CD no benifit > 40-60mg prednison IV, oral, rectal 5-10d AE: short-term: moon-face, acne, stria, hirsutism, infection, ecchymoses, petechia, HTN, osteonecrosis, other: insomnia, mood, truncal obsety, hyperglycemia, hypokalemia, leukocytosis long-term: HTN, DM, inf, osteoporosis, cataracts/glaucoma, myopathy/muscle atrophy, psychosis, growth retard, atherosclerosis, adrenal insuff |
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methotrexate (IM, PO)
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MOA: folate anolog, rever comp inhib DHFR; interfers w DNA syn, multi anti-inflamm effects
I: CD + induction and maintenance, UC? Safety: pneumonitis, hepatotox, BM suppression, teratogen/abortifacient |
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natalizumab
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IBD, anti-TNF Ab
MOA: inhib interxn bt WBCa4 integrins and adhesion molecules on vascular endo cells in GI tract --> dec WBC trafficking to sites of inflamm efficacy: CD - induciton/maintenance Safety: progresive multifocal leukoencephalopathy (PML) |
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Antibiotics for IBD (PO, IV)
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Cipro (quinolone; g neg)
metronidazole (anaerobes) rifaximin (min absorp) CD: colonic, perianal (cipro/metronidazole) ileocolonic (hi dose rifaxamin) safety: C - tendon rupture, M - metallic taste, R - periph neuropathy |
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Cerolizumab (SQ)
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anti-TNFa
CD: induciton/maintenance AE: inf (opportunistic/TB), demyleination, SLE-like, CHF, infusion rxn, lymphoma |
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IFN-g
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HBV
HCV SA: flu-like sx, bone marrow suppression, irritability, thyroiditis, depression |
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lamivudine
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nucleoside analogs - HBV
rapid inhib of HBV replication seroconversion rates sim to IFN safe in decompensated cirrhosis viral mutaiton a prob w lamivudine |
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adefovir
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nucleoside analogs - HBV
rapid inhib of HBV replication seroconversion rates sim to IFN safe in decompensated cirrhosis viral mutaiton a prob w lamivudine |
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entecavir, tenofovir
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nucleoside analogs - HBV
rapid inhib of HBV replication seroconversion rates sim to IFN safe in decompensated cirrhosis viral mutaiton a prob w lamivudine |
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talbivudine
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nucleoside analogs - HBV
rapid inhib of HBV replication seroconversion rates sim to IFN safe in decompensated cirrhosis viral mutaiton a prob w lamivudine |
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peg IFN + ribavirin
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HCV
6-12 mo sustained viro resp serum HCV RNA undetectable for 6mo after tx = 50% IFN not for decompensated liver disease |
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ursodeoxycholic acid (ursodiol)
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tx for primary biliary cirrhosis
replace endogenous hepatotoxic bile acids, provides symptomatic and biochem improvement transplant-free |
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cholestyramine
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tx for primary biliary cirrhosis
binds bile acids reliees pruritis no effect on natural hx of disease AE: bile acid binding can worsen fat-souble vit malabsorption |
