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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

Contrary to popular belief, cigarettes butts or filters are not biodegradable

Australia is also working to end vape sales in convenience stores, which its current law does not permit

By acting on nicotinic receptors in brain areas related to healthy cognitive function, chronic nicotine administration reversed the cognitive impairment

Cette prise de poids est de 10 kilos pour les ex-gros fumeurs et de 7 kilos pour les ex-fumeurs obses