Prescribing Drugs in Liver Disease - Week 8

Question 1

Give 4 factors which may result in abnormal liver function tests.

Answer 1

Obesity/Diabetes, alcohol, HCV/HBV in blood, drugs

Question 2

Grade A disease suggests…

Answer 2

Well compensated disease

Question 3

Grade B disease suggests…

Answer 3

Disease with significant functional compromise

Question 4

Grade C disease suggests…

Answer 4

decompensated liver disease

Question 5

What is meant by First Pass Metabolism?

Answer 5

phenomenon of drug metabolism whereby the concentration of a drug is greatly reduced before it reaches the systemic circulation

Question 6

What is meant by first-order metabolism?

Answer 6

Metabolism increases as plasma concentration increases

Question 7

What is meant by zero order metabolism?

Answer 7

Metabolism remains constant as plasma concentration increases

Question 8

Give examples of drugs which follow zero order metabolism.

Answer 8

Alcohol, Phenytoin

Question 9

Liver disease may affect the circulation to which organs?

Answer 9

Kidneys

Question 10

Which hormones are increased in liver disease?

Answer 10

Endothelin and Oestrogen

Question 11

What are the effects of liver disease on the kidneys?

Answer 11

Water retention, sodium retention, potassium loss, hepatorenal syndrome

Question 12

Give some wider effects of liver disease on the body.

Answer 12

Ascites, gut oedema, liver & kidney congestion, congestive heart failure

Question 13

Explain the use of paracetamol in alcoholics.

Answer 13

Even normal doses may cause poisoning

Question 14

What is the latest drug to cause drug-induced liver injury?

Answer 14

Lumiracoxib

Question 15

Which drugs may be used to treat ascites?

Answer 15

Loop diuretic, thiazide diuretic, spironolactone

Question 16

Give side effects of loop and thiazide diuretics.

Answer 16

Hypokalaemia, hypomagnesaemia

Question 17

Which class of drugs are sometimes needed for sedation?

Answer 17

benzodiazepines

Question 18

Give examples of benzodiazepines.

Answer 18

Lorazepam
Oxazepam
Lormetazepam

Question 19

Which classes of antibiotics may cause problems?

Answer 19

Quinolones, Aminoglycosides, Metronidazole

Question 20

Name the worst hepatic disorders.

Answer 20

Fulminant Hepatic Failure
Decompensated Cirrhosis
Severe acute or chronic hepatitis
Severe Congestive Heart Failure

Question 21

Which type of drugs should be avoided in liver disease?

Answer 21

Pro-drugs

Question 22

Drugs with which type of excretion should be used if possible?

Answer 22

Renal excretion

Question 23

Which groups of drugs should you be wary with in liver disease?

Answer 23

sedatives, CNS drugs, anticoagulants, NSAIDS, theophyllines, aminoglycosides