3.4:1 Drugs in liver disease Flashcards
How much alcohol can an adult process in an hour ?
1 unit = 10ml
What conditions can patients suffering from alcohol withdrawal develop?
Seizures, delirium, tremens and wernickes encephalopathy.
These can be complicated by mental illnesses , vulnerability, lack of support and other co-morbidities
What is the treatment for acute alcohol withdrawal?
Benzodiazepine (tremens and seizures)
Diazepam (seizures) or Chlordiazepoxide
Lorazepam (seizures) and (delirium- haloperidol or olanzapin)
Carbamazepine or Clomethizole
Why is lorazepam usually used instead of diazepam?
Has a shorter half-life and inactive metabolites
Diazepam is easily abused
What can be used to treat delirium in achohol withdrawal?
Lorazepam, haloperidol or olanzapine
What can be used to treat seizures in alcohol withdrawal ?
lorazepam/diazepam
what are the sumptoms of wernickes encephalopathy?
Acute confiusion, psychosis, ataxia, oculomotor dysfunction
How does wernickes encephalopathy occur?
Lack of thiamine (vit B1) and often associated woth high alcohol intake
How would you treat wernickes encephalopathy?
Administer high doses of thiamine (Vit B1) orally or through IV
Supply on long term basis together with multivitamins and vitamin B complex
Lifestyle advice too
What are the roles of a pharmacist ?
Identification and prompt referal of suspected liver disease
Identifyiing possible drug causes of liver disease
Review LFTs and onter[ret their meaning
Recommend drug/dosage/frequency changes
Guid therapy for paracetamol overdose
Encourage patients to participate in alcohol detoxification, signpost appropriate resources and help to manage withdrawal
Guideline development
Encourage excersice, weigh management and healthy diet
What are all the enzymes in the liver present in LFTs?
ALT-, AST, ALP, GGT
What are the other molecules that need to be reviewed in the LFTs?
Bilirubin
Albumin
INR
Prothrombin time
What are the aminotransferases and what are they used to detect?
Alanine aminotransferase
Aspartate aminotransferase
Detects damage to hepatocytes and liver injury
What is the liver parenchyma ?
Functional component of the liver made up of the hepathocytes that filter blood to remove toxins
Which is more specific, ALT or AST?
ALT
Are levels of aminotransferases (ALT and AST) high in chronic hepatits?
NO, levels are usually not high
What are other causes for aminotransferases (ALT and AST) to be elevated?
Onstruction of bile duct, cirrhosis and tumors in the liver
Levels may be elevated as a result of exposure to drugs, infective agents or other sunbstances that are toxic to the liver
What is alkaline phosphate (ALP) used to detect ?
Cholestasis
What is cholestasis ?
A liver disease where the flow of bile is obstructed or reduced (e.g. in gall stones )
Where is ALP present ?
In bone cells so non-specific
This means it can be found elsewhere therefore it is important that it is liver related.
Where is liver-derviced ALP located?
Outside of the bile membrane reflecting biled duct obstruction.
What should a pharmacist do if ALP results are increased but it is not clear wheather it is due to liver disease or bone marrow disease?
They should look at other LFT results
What is GGT?
An enzyme called gamma glutamyl transferase
Can GGT be used to differentiate liver dysfuctions?
No, it is an enzyme which is released in all types of liver dysfuctions sp cannot be used to differentiate
True/false? 95% of the release of GGT is due to liver isoenzymes and the remaining 5% may be found in iother tissues
True
What can a raised GGT with a raised ALP or bilirubin suggest?
Cholestatic damage
What can reised GGI in isolation occur or with enzyme induceding drugs ?
Alcohol abuse
Hepatic damage
When is bilirubin produced ?
The distruction of red blood cells
Is the reliese of bilirubin specific?
No, it is also relaeased in haemolytic anaemias
What can hepatocytes transform uncnjugated bilirubin into ?
Water-soluble conjugated from whihc is excreted vbia bile into the intestine
When is jaundice prodiced?
When serum bilirubin leves is excess of 50micromol/L
How can cholestasis be identified ?
When bilirubin, ALP and GGT levels have rised
True/false ?Bilirubin is also seen in hepatic damage where decreased metabolism of unconjugated (insoluble) bilirubin to conjugated (water soluble ) bilirubin
True
It is important to determine if haundice is caused by conjugatedor unconjugated hyperbilirubinaemia
True
What is albumin a marker for?
Synthetic function of the liver (helptocellular marker)
Is albumin specific or non specific for liver dysfuction ?
Non-specific as it is low in malnourashed patients and nephrotic syndrome
Why is albumin an indicator of chronic liver disease rather than acute?
It has a half life od about 20 days
What can an increase INR tell us about a patient?
Synthetic function of the liver has decreased or absorption of Vit K is impaired
Is INR peramiters specific or non specific and why?
Non-specific as deranged in patients on vitamine K antagonist or individuals with coagulopathy disorders
What can changed is Prothrombin time tell us ?
Useful in predicting hepatocellular damage ina cute situations
Occurs more rapidly than changes in albumin
What are the types of liver diseases?
- Acute and chronic
- Cirrhosis
Healthy liver -> Fatty liver (steatosis) -> alcoholic hepatitis -> cirrhosis - Cholestasis
- Compensated and decompensated
What is the child pugh score used for?
Assess the severity of chronic liver disease but no indication about metabolic capacity
What are the 5 parameters in child pugh score ?
Ascites, encephalopathy, nutritional status, albumin and bilirbin
