Test results can be influenced by the type of sample, frequency of nicotine use, individual metabolism, and exposure to secondhand or thirdhand smoke
One When vaporized, these substances may potentially form cancer-causing compounds
Judy Chu, bringing with her a whole table of friends and fellow advocates to the luncheon where they cheered her on
Octreotide is first-line because: Causes splanchnic vasoconstriction Portal venous pressure & blood flow to varices Rapid onset effective hemostasis Safer than vasopressin (fewer systemic side effects) Recommended by Baveno & AASLD guidelines Other options: Omeprazole useful in peptic ulcer bleeding, not varices Sucralfate mucosal protectant, no role in acute bleeding Metoclopramide prokinetic, no hemostatic effect Uses of Octreotide Acute esophageal & gastric variceal bleeding Acromegaly Carcinoid syndrome VIPoma Severe secretory diarrhea Mechanism of Action (MOA) Somatostatin analog Inhibits release of vasodilatory hormones (glucagon) Causes splanchnic vasoconstriction Portal venous inflow variceal pressure bleeding control Minimum & Maximum Dose (Acute Variceal Bleed) #Minimum dose: IV bolus 50 micrograms, followed by 50 micrograms/hour infusion #Maximum dose: Continuous infusion up to 100 micrograms/hour (based on response) (Duration: usually 25 days) Mnemonic OCTREO = OCTREO-tide tightens the PORTAL pipe Tightens splanchnic vessels stops variceal bleed Clinical Pearl Start octreotide immediately in suspected variceal bleeding do not wait for endoscopy
You need to understand how the addiction works so that you can learn how to avoid suffering withdrawal pangs
