Prescribing in Liver Disease Flashcards Preview

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Flashcards in Prescribing in Liver Disease Deck (37):
1

Name some causes of abnormal liver tests

Obesity
Alcohol
Drugs
Fatty foods
Fizzy drinks

2

What is cirrhosis?

Cirrhosis is scarring of the liver as a result of continuous, long-term liver damage. Scar tissue replaces healthy tissue in the liver and prevents the liver from working properly.

3

Name 3 major factors contributing to cirrhosis?

Reduced liver blood flow as it is hard for the blood to get through from the portal system
Reduced metabolic function
Reduced plasma proteins

4

Describe a standard case of cirrhosis

Middle aged man, alcoholic, complaining of severe chest pain due to many fractured ribs from falling over drunk

Increased creatinine, decreased Na and K+
Low blood pressure

5

How can we treat cirrhosis?

NSAID
Paracetamol
Opiate

6

What is a clue of first pass metabolism

Oral dose is greater than the IV dose

7

What type of blood does not go through the liver?

Blood that is shunted

8

What is the result of 70-90% metabolism

Increased plasma levels

9

What has to happen to pro drugs to become active? Give an example of a pro drug

They need to be metabolised first
Codeine

10

What happens to the plasma volume if albumin is low

The plasma level is low

11

What is aldosterone?

A steroid with a complex structure
No steroid is well metabolised in the liver

12

What do patients with aldosteronism require and why

IV vitamins all the time to prevent brain damage

13

What happens to the plasma concentration of hormones

It increases as the liver cannot metabolise them very well

14

Why can male alcoholics get female characteristics?

Because they dont metabolise oestrogen so it builds up in their body

15

What happens to a patient with hepato-renal syndrome>

It is very hard to reverse and there is a high mortality rate as the kidney is basically falling apart

16

What type of drugs can induce renal failure?

NSAID as they get rid of protoglandins

17

describe 3 signs of moderate hepatic impairment

Decrease renal clearance
effect on unbound drug masked by decrease protein binding
renal function reduced

18

describe 3 consequences of moderate hepatic impairment

Gut oedema
Liver and kidney congestion
Gross oedema and ascites
CHF

19

Name 8 adverse affects of NSAIDs

UGI ulcer complications
CV toxicity
Hypertension
CHF
Sodium Retention
Asthma
Diarrhoea / Colitis
Renal Failure

20

What should always be co-prescribed with a proton pump inhibitor (PPI)

NSAID or COX2 inhibitor

21

Describe the prescribing cascade

One drug that is prescribed may give unwanted side effects which have to be treated with another drug. This is not cost effective

22

Why might the diaphragm not be able to be pushed down in breathing?

Ascities - fluid blocks it

23

What are the phases of drug metabolism

Phase 1 (early) and phase 2 (late)

24

What drugs are are best for treating early stages of lvier disease?

Phase 2 metabolised drugs so that they will be properly metabolised

25

Name some drugs which have reduced metabolism

Opiates (codeine)
Benzodiazepines
Chlormethiazole
Cyclosporin
Metronidazole
Calcium blockers

26

How long does it take for symptoms of a paracetamol overdose to appear?

Around 4 days

27

What does alcohol do to the receptors

It blocks the receptors if it is on board which is good

28

What happens for chronic alcoholics and paracteramol

It gets metabolised faster which is worse for the patient

29

Name 4 effects of Paracetamol in liver disease

reduced glutathione stores
longer half-life
increased P450 in acloholics
Toxicity with normal doses

30

Name 2 other drugs which cause liver disease

Flucloxiclav and Amoxicillin

31

Is drug induced liver injury more common in men or women

Women

32

What is the best diuretic to give in liver disease?

Spironolactone

33

What are the requirements for patients to be on spironolactone?

Fluid restriction (1L)
Use at high doses
1kg/day weight loss (aim)

34

Are antibiotics safe to give in liver disease?

Yes

35

What are the worst hepatic disorders?

Fulminant hepatic failure
Decompensated cirrhosis
severe acute or chronic hepatitis
severe congestive heart failure

36

What is the main message of drugs and liver disease

Dose reduction regardless of the route of elimination of drug or metabolite

37

Name some general principles in presribing in liver disease

Avoid pro drugs
Use drugs with renal excretion
Be wary of sedatives, CNS drugs, anticoagulants, NSAIDs, theophyllines, aminoglycosides
high inter-inividual variability
Liver tests not predictive
Start low, go slow

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