Initial medications

• Tranexamic acid 1g IV now

• Metoclopromide 10mg IV now then Q8h PRN for nausea or vomiting
• Omeprazole 80mg IV now then 40mg IV Q12h
• Rebamipide 100mg tab TID
• Sucralfate 1g tab QID
• Propanolol 10mg tab BID
• Lactulose 30 cc TID to attain 2-3 soft stool, discontinue if >4 x a day
• Rifaximin 200mg 2tabs TID
• Vitamin B complex tab BID

S/P EGD
• Propanolol 10mg tab TID
• BCAA sachet, 1 glass OD HS
• Lactulose 30 cc TID to attain 2-3 soft stool, discontinue if >4 a day
• Rifaximin 200mg 2tabs TID
• Vitamin B complex tab BID
• Vitamin K 1 amp Q8h x 3 doses
• Metoclopromide 10mg IV now then Q8h PRN for N/V

Tranexamic - an analog of aminocaproic acid which is a synthetic inhibitor of fibrinolysis and

competitively inhibits plasminogen activation and has the same properties.
Metoclopromide – blocks dopamine receptors & serotonin receptors in CTZ, sensitizes tissues
to ach, inc upper gi motility, inc LES tone
Omeprazole – sustain intragastric pH >6 and enhance clot stability, decreases further bleeding
and mortality in patients with high-risk ulcers when given after endoscopic therapy, 80-mg
bolus and 8-mg/h infusion
Rebamipide – mucosal protective agent and increase gastric blood flow, prostaglandin
biosynthesis
Sucralfate - insoluble in water, a viscous paste within the stomach and duodenum, binding
primarily to sites of active ulceration
Propanolol – moderate effect on reduction of portal & collateral blood flow & smaller effects
on the inc in portal resitance and dec on portal pressure
Lactulose – breakdown of lactulose to organic acids by colonic bacteria acidifies colonic
contents, inhibitinf diffusion of ammonia back to blood
Rifaximin – inhibits growth of enteric ammonia producing bacteria to indirectly reduce serum
ammonia level
Vitamin B complex – there is b deficiency
BCAA sachet – affect gene expression, protein metab, apoptosis & regeneration of hepatocytes
and insulin resistance, inhibit liver cancer, essential for lymphocyte prolif and dendritic cell
maturation, levels are decreased in cirrhosis, prevent negative nitrogen balance
Vitamin K – correct coagulopathy, all clotting factors except 8 are produced in the liver,
promotes synthesis of Factor 2, 7, 9, 10, protein C and S