NURM-103 Liver Pancreas Pharmacology + Extras Exam Review

H2 Antagonist examples

• Famotidine

• Cimetidine

H2 antagonist primary usage + indications

Reduces stomach acid but less potent than PPIs

• GI bleeds + ulcer prevention

H2 antagonist primary SE

Headache

Gallstone solubilizing agents examples

• Ursodiol

• Chenodeoxycholic acid

What diseases do alpha interferons treat?

Chronic hepatitis B and C

Major SE/consideration of alpha interferon

Flu-like symptoms

• Fever

• Chills

• Fatigue

What is another rare use of flumazenil, the benzo antidote?

For hepatic encephalopathy

• Rare + experimental

Critical consideration for benzo antagonists (like flumazenil)

Can cause seizures

• MUST be taken in monitored setting

Spironolactone is potassium-_______ (wasting/sparing).

wasting

What should be monitored in pt taking diuretics?

• Electrolytes (K⁺!!!)

• BP

• Daily wt + I&Os

Vasoactive drug examples

• Ocreotide

• Vasopressin

What are vasoactive drugs used for?

Managing acute variceal bleeds

• Vasoconstriction of gut → Less blood in portal system

What should be monitored in pt taking vasoactive drugs?

• CHEST PAIN

• BP + Fluids

In an emergency, vasoactive drugs are given…

IV

Beta blocker examples

• Propranolol

• Nadolol

• Carvedilol

What are beta blockers used for?

PREVENTING a variceal bleed

• Lowering portal pressure

Are beta blockers used for prevention or treating an active bleed?

Prevention

What should pts taking beta blockers be monitored for?

Hypotension + bradycardia

• Uncompensated symptoms

Nitrate example

Isosorbide

Isosorbide is a…

Nitrate medication

What are nitrates used with?

Beta blockers

What is the purpose of nitrates?

Relax blood vessels → Reduce portal pressure

What should be monitored in pt taking nitrates?

Hypotension + headache

What are PPIs used for in the event of a variceal bleed?

Protecting the esophagus after variceal banding

When are PPIs given?

30 min before first meal

What can long term PPI usage cause?

• Osteoporosis risk

• Abnormal magnesium levels

What is the first-line emergency medication for an esophageal varices bleed?

Ocreotide

What should be monitored in pt taking ocreotide specifically?

Blood glucose

What medications are used for acute bleeds?

Vasoactive drugs!

• Ocreotide + vasopressin

What medications are used for prevention?

Beta blockers + Nitrates!

• -lol medications

• Isosorbide

What does vasopressin do?

Powerfully reduces ALL blood flow

What is the pt at risk for taking vasopressin?

Ischemia of the heart and limbs

Beta-blocker contraindication

Asthma

What are beta blockers titrated to achieve?

HR of 55-60 bpm

Which beta blocker carries a higher risk of hypotension? Why?

Carvedilol → More potent portal pressure reducer

Rifaximin

Abx that kills ammonia-producing bacteria in gut

What is rifaximin used with?

Lactulose

What is the big issue with Rifaximin

EXPENSIVE AF!!!!

• Affects adherence

How may pt receive lactulose if they are comatose or cannot swallow?

Via NG tube

• Retention enema

How is lactulose dose adjusted?

Based on # + consistency of BMs/day

What is the main question a pt may have for why they’re taking lactulose?

“Why am I getting a laxative for liver issues?”

Which hepatitis’ are acute?

• A

• E

Which Hepatitis’ are chronic?

BCD

Ursodiol indications

• Treating primary biliary cholangitis (PBC)

• Dissolving gallstones for poor surgical candidates

• Preventing gallstones in obese pts losing lots of wt

Ursodiol CONTRAindications

• Complete biliary obstruction

• Calcified gallstones

• Allergy to bile acids

Ursodiol considerations

• Baseline LFTs + Bilirubin → Monitor

• Confirm gallbladder function

Should ursodiol be given with or without food?

with

What should ursodiol not be given with?

Antacids

Bile acid sequestrates (cholestyramine)

Ursodiol SE

• Diarrhea

• Headache

• Dizziness

• Nausea

• Back pain

Contraindications for chenodeoxycholic acid (Chenodiol)

• Liver disease (cirrhosis)

• Bile duct obstruction

• Pancreatitis RT gallstones

What is a higher risk with chenodiol than ursodiol? What should therefore be monitored?

Hepatotoxicity

• Monitor LFTs

Mild acute pancreatitis timeline + treatment

Resolves in 3-7 days

• NPO + IV fluids

• Pain control + antiemetics

Severe acute pancreatitis

Systemic inflammatory response syndrome (SIRS) → Bloodstream

• Massive inflammatory cascade → Organ failure

What differentiates severe acute pancreatitis from mild?

• SHOCK S/S that doesn’t respond to fluids

• Tachycardia + Resp failure (ARDs)

• Renal failure

Renal failure signs

Oliguria + Rising Cre

What are the 2 classic signs that acute pancreatitis is SEVERE?

Cullen’s + Grey Turner’s Sign

Severe acute pancreatitis treatment

• Massive IV fluid resuscitation + vasopressors if needed

• Mechanical ventilation

• Dialysis

• Enteral feedings

Blumberg’s sign

Pain upon removal of pressure to abdomen

What can Blumberg sign indicate?

• Peritonitis

• Appendicitis