6: Prescribing for liver disease Flashcards Preview

Gastrointestinal Week 6 2016/17 > 6: Prescribing for liver disease > Flashcards

Flashcards in 6: Prescribing for liver disease Deck (43)
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1

What is a common sign of liver disease?

Jaundice

2

What liver disease is associated with obesity?

NAFLD

non-alcoholic fatty liver disease, or hepatic steatosis

3

What are some causes of liver disease?

Obesity

Alcohol

Viruses

Drugs

Autoimmune

 

4

What is cirrhosis?

Small shrunken liver which cannot regenerate

5

What are three major factors of cirrhosis?

Reduced liver blood flow

Reduced metabolic function

Reduced plasma proteins

6

If an alcoholic patient presents with lots of fractured ribs, what could have caused this?

Alcoholism - lots of falling over, bumps and bruises

7

What is portal hypertension?

High blood pressure in the portal venous system, caused by cirrhosis

8

Where do varices appear in cirrhosis?

What is a major complication of these varices?

Oesophagus

Umbilicus

Rectum

Haemorrhage

9

What is a sign of liver disease in which a patient becomes confused and disorientated?

Encephalopathy

10

What is a sign of portal hypertension seen at the umbilicus?

Caput medusae

11

What happens to some of the blood in cirrhosis?

Portal system bypassed

"shunting" of blood past the liver, metabolism doesn't occur so more of a drug needs to be administered to see the same effect

12

In cirrhosis, the liver has (increased/reduced) metabolic capacity.

reduced

13

High portal pressure and low albumin causes ___ in the abdomen.

ascites

14

If the oral dose of a drug is greater than the IV dose, what organ is important in its metabolism?

Liver

15

Which drug is administered sublingually to treat angina?

Why is it administered this way?

GTN

Sublingual administration bypasses the liver

16

The liver has a limit of metabolism - small doses of a drug can be metabolised but increasing the rate of administration may suddenly cause the plasma concentration to increase. What drug is this prominently seen in?

Alcohol

17

Which plasma protein is lowered in liver disease?

Albumin

marker of liver disease

can carry less protein in blood, leading to ascites

18

Low albumin levels causes a low ___ volume.

plasma

19

Why may plasma volume decrease, prompting the kidneys to secrete renin?

Low albumin in liver disease

20

Which system produces aldosterone as a response to low albumin (low plasma volume)?

RAAS

21

Which product of the RAAS system cannot be metabolised by diseased livers?

Aldosterone

22

What name is given to accumulation of aldosterone in patients with liver disease?

Secondary hyperaldosteronism

23

Why do people with liver disease develop gynaecomastia?

Liver cannot metabolise hormones like oestrogen and endothelin

24

In liver disease, hormones aren't metabolised and go on to act on the kidneys. What are some consequences of this?

Potassium loss - HYPOKALAEMIA

Sodium retention - HYPERNATREMIA & WATER RETENTION

25

Aldosterone also causes ___ in the kidney.

What condition does this cause?

Vasoconstriction

Hepato-renal syndrome

26

The failure of the liver to metabolise drugs, which then travel to the kidneys, leads to what?

Reduced renal clearance

Reduced renal function

27

What signs are seen in patients with reduced hepatic and renal function?

Oedema

Ascites

Spider naevi, gynaecomastia (lots of oestrogen)

Congestive heart failure

28

Which class of drug would further impair renal function by inhibiting prostaglandin production?

NSAIDs

29

What is a major GI side-effect of NSAIDs?

Peptic ulcers

30

Would you give an NSAID as analgesia to someone suffering liver disease?

No