Hepatic C7

Question 1

what is pabrinex and what is it used for

Answer 1

combination product containing thiamine and ascorbic acid

used as treatment of Wernicke’s encephalopathy or in severe vit B deficiency

alcohol related liver disease

Question 2

how is pabrinex administered

Answer 2

slow IV/IM- slow to reduce risk of anaphylaxis and hypersensitivity

30 mins

often followed by oral B1 (thiamine) supplementation - NOT given together to prevent thiamine overdose

ampoules given - in pairs

Question 3

what is chlordiazepoxide hydrochloride and what is it used for - relate to hepatic indication

Answer 3

long acting benzodiazepine

anxiety & treatment of alcohol withdrawal

Question 4

MOA chlordiazepoxide

Answer 4

binds to GABA receptors to form a complex

within CNS

= increased binding of the inhibitory NT

enhances activity here

POSITIVE ALLOSTERIC MODULATOR

• increases chloride influx = neuronal hyperpolarisation = CNS depression

Question 5

how does chlordiazepoxide achieve its effect in treating alcohol withdrawal

Answer 5

in chronic alcohol use there is enhancer GABAergic activity = surpression of glutamate pathways
over time there is downregulation if GABA receptors and upregualtion of glutamate receptors
in alcohol withdrawal, sudden loss of inhibitory GABA effects and high excitatory glutamate activity = CNS hyperexcitability

chlordiazepoxide replaces missing GABA effect = reduces withdrawal symptoms created by glutamate excitability (tremor, delirium, anxiety)

Question 6

how does lactulose have its effect when used to treat hepatic encephalopathy

Answer 6

• traps ammonia in the gut - in HE there is an accumulation of neurotoxins, mainly ammonia
• laxative: eliminate ammonia and other toxins
• changes to gut flora - reduces amount of ammonia producing bacteria