Cirrhosis Flashcards
Complications of cirrhosis include (6)
- Ascities
- Portal HTN
- Variceal bleeding
- Spontaneous bacterial peritonitis
- Hepatic encephalopathy
- Hepatorenal syndrome
Expected labs in a cirrhosis patient
Jaundice: Bilirubin >1
Chronic liver injury: no change in AST/ALT
Low albumin: Alb<4
Clotting factors decreased: high PT/INR (normal INR~2)
Low platelets
Causes of cirrhosis
- alcohol use
- hepatitis C
- Fatty liver damage (obesity)
MELD Score
Used to determine if a patient should be receiving a transplant sooner (high score = priority)
Based on serum bilirubin, INR, SCr to calculate
Child Pugh Score
Use to determine the need for drug dose adjustments
- class A = ok
- class C = worst condition
Based on bili, albumin, ascites, encephalopathy, PTT
PKPD changes in cirrhosis (5)
Decreased liver blood flow
Loss of hepatocyte function
Decreased albumin production
Decreased renal function w/ high SCr (due to less intravascular volume)
Increased therapeutic response to drugs
Cirrhosis PKPD: liver blood flow
Decreased Q due to portal HTN
Blood gets shunted
Will impact drugs with high first-pass effects
–> no first pass = higher [systemic]
//may req dose decrease to compensate
Cirrhosis PKPD: hepatocyte loss
Decreased metabolic capacity –> fewer phase 1 enzymes (CYPs)
Will see the increased therapeutic effect of drugs
//should switch to a drug without CYP pathway use (Lorazepam»_space; Diazepam)
Cirrhosis PKPD: Albumin
Low albumin production (liver impaired)
Highly protein bound drugs now free conc elevated
//should decrease dose (phenytoin, warfarin )
Cirrhosis PKPD: Renal function
Decreased intravascular volume –> hepatorenal syndrome (elevated SCr)
Cirrhosis PKPD: therapeutic response
Increased therapeutic response
BBB becomes more permeable
//may require a dose decrease of CNS acting drugs (opioids, benzodiazepines) if AMS seen
