second day of not smoking cigarettes Quit Tobacco Calendar: It Only Takes 31 Days To Quit 🌎 No Smoking Day (Second

You could not only light up in restaurants, chain-smoke at work, and stub out in malls, sports arenas and movie theaters, but you could blow smoke rings while hurtling through the sky (on flights over two hours at least)

This bill had 154 cosponsors in the House and 84 cosponsors in the Senate, and President Trump has even truthed favorable things about this bill

That's what I said

After all, the tax rate isn't much of a disincentive if someone finds a way not to pay it at all

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