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Acute Esophageal Varices: Pharmacologic Agents - #MEDSHED

Updated: Nov 14, 2023

Welcome to the #MEDSHED! Needing a brief, concise review of clinical pharmacotherapy and disease management? Direct links of reference to content discussed? Look no further than the #MEDSHED series based on infographics and carousel presentations!



🆎 Acute Esophageal Varices: Pharmacologic Agents - #MEDSHED ✨ Goals of therapy include optimizing resuscitation, pre- & post-endoscopic management, and timely endoscopic intervention. Considerations of optimizing resuscitation are securing ABCs, transfusion blood over crystalloids in hemorrhagic shock, maintaining calcium replacement during MTP, and reversal anticoagulant agents, as appropriate. 👹 Theres only two outlets for GI bleeds to go out of, your mouth and rectum. Esophageal varices develops from structural changes to the liver from cirrhosis. Intrahepatic vascsular resistance to portal flow and splanchnic vasodilation cause portal hypertension. Overtime, varices develop and rupture from an overpressure. 💔 Volume resuscitation should be initiated, but limit crystalloid fluids and replace blood with blood. Infections from bacterial translocation increases incidence of rebleeding and hospital mortality. Meta-analysis indicate prophylactic antibiotics reduces this risk. 🤢 Acid suppression with pantoprazole should be initiated, 80 mg IV followed by a continuous infusion or 40 mg q12 hours. PPI reduce incidence of rebleeding and transfusion requirements by promoting hemostasis via increased gastric pH. 🌊 Vasoactive medications target portal hypertension by inducing splanchnic vasoconstriction indirectly from glucagon secretion inhibition. Octreotide is utilized as a 50 mcg bolus, then 50 mcg/hr. There are indications for 100 mcg subcutaneously three times daily as well. 🤖 I'd appreciate if you share the #MEDSHED and #PHARMFAX with a friend, become a subscribed member of my website or join the broadcast channel, and as always, I hope you learn something new today. Check out all links, bringing the pharmacotherapy to you. @pharmwyze @pharmwyzepharmfax #emergencymedicine #criticalcare #medtwitter #pharmacy #nursing #medicine #studentpharmacist #foamed #emrx #studentpharmacist #pharmacy #nursingstudent #medicalschool #pharmacyschool #medicalstudent #meded #levels #medigram #pharmfax #pharmwyze #medshed #thelab #qlab

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