Drugs used for treatment of acute variceal bleeding are all EXCEPT:
Ans. c (Desmopressin), (Ref. KD Tripathi , 5th/540 & Harrison 16th/l 864,1865)Terlipressin due to VI action can be used. [Desmopressin-only V2)Drugs used for treatment of acute variceal bleeding are:# Vasopressin (Terlipressin)# Somatostatin (acts via VI receptors)# Octreotide# b-blockers are used for prophylactic treatment of large varices; reduce risk by 40-50%.VARICEAL HEMORRHAGE: TREATMENTTreatment for variceal hemorrhage as a complication of portal hypertension is divided into two main categories:# primary prophylaxis and# prevention of re-bleeding once there has been an initial variceal hemorrhage.# Primary prophylaxis requires routine screening by endoscopy of all patients with cirrhosis. Once varices that are at increased risk for bleeding are identified, then primary prophylaxis can be achieved either through nonselective beta blockade or by variceal band ligation. Several studies have also evaluated variceal band ligation and variceal sclera- therapy as methods for providing primary prophylaxis.# Endoscopic variceal ligation (EVL) has achieved a level of success and comfort with most gastroenterologists who see patients with these complications of portal hypertension. Thus, in patients with cirrhosis who are screened for portal hypertension and are found to have large varices, it is recommended that they receive either beta blockade or primary prophylaxis with EVL.# The approach to patients once they have had a variceal bleed is first to treat the acute bleed, which can be life- threatening, and then to prevent further bleeding. Prevention of further bleeding is usually accomplished with repeated variceal band ligation until varices are obliterated.# The medical management of acute variceal hemorrhage includes the use of vasoconstricting agents, usually somatostatin or Octreotide. Vasopressin was used in the past but is no longer commonly used.# Balloon tamponade (Sengstaken-Blakemore tube or Minnesota tube) can be used in patients who cannot get endoscopic therapy immediately or who need stabilization prior to endoscopic therapy. Control of bleeding can be achieved in the vast majority of cases; however, bleeding recurs in the majority of patients if definitive endoscopic therapy has not been instituted. Octreotide, a direct splanchnic vasoconstrictor, is given at dosages of 50-100 g/h by continuous infusion. Endoscopic intervention is employed as first-line treatment to control bleeding acutely.# When esophageal varices extend into the proximal stomach, band ligation is less successful. In these situations, when bleeding continues from gastric varices, consideration for transjugular intrahepatic portosystemic shunt (TIPS) should be made.# Surgical esophageal transection is rarely used and generally is associated with a poor outcome.
Octreotide
Somatostatin
Desmopressin
Terlipressin
G.I.T