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Gastrointestinal and Liver Disorders (GIL) > 3.4:1 Drugs in liver disease > Flashcards

3.4:1 Drugs in liver disease Flashcards

1
Q

How much alcohol can an adult process in an hour ?

A

1 unit = 10ml

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2
Q

What conditions can patients suffering from alcohol withdrawal develop?

A

Seizures, delirium, tremens and wernickes encephalopathy.

These can be complicated by mental illnesses , vulnerability, lack of support and other co-morbidities

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3
Q

What is the treatment for acute alcohol withdrawal?

A

Benzodiazepine (tremens and seizures)

Diazepam (seizures) or Chlordiazepoxide
Lorazepam (seizures) and (delirium- haloperidol or olanzapin)
Carbamazepine or Clomethizole

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4
Q

Why is lorazepam usually used instead of diazepam?

A

Has a shorter half-life and inactive metabolites

Diazepam is easily abused

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5
Q

What can be used to treat delirium in achohol withdrawal?

A

Lorazepam, haloperidol or olanzapine

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6
Q

What can be used to treat seizures in alcohol withdrawal ?

A

lorazepam/diazepam

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7
Q

what are the sumptoms of wernickes encephalopathy?

A

Acute confiusion, psychosis, ataxia, oculomotor dysfunction

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8
Q

How does wernickes encephalopathy occur?

A

Lack of thiamine (vit B1) and often associated woth high alcohol intake

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9
Q

How would you treat wernickes encephalopathy?

A

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

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10
Q

What are the roles of a pharmacist ?

A

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

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11
Q

What are all the enzymes in the liver present in LFTs?

A

ALT-, AST, ALP, GGT

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12
Q

What are the other molecules that need to be reviewed in the LFTs?

A

Bilirubin
Albumin
INR
Prothrombin time

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13
Q

What are the aminotransferases and what are they used to detect?

A

Alanine aminotransferase
Aspartate aminotransferase

Detects damage to hepatocytes and liver injury

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14
Q

What is the liver parenchyma ?

A

Functional component of the liver made up of the hepathocytes that filter blood to remove toxins

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15
Q

Which is more specific, ALT or AST?

A

ALT

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16
Q

Are levels of aminotransferases (ALT and AST) high in chronic hepatits?

A

NO, levels are usually not high

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17
Q

What are other causes for aminotransferases (ALT and AST) to be elevated?

A

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

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18
Q

What is alkaline phosphate (ALP) used to detect ?

A

Cholestasis

19
Q

What is cholestasis ?

A

A liver disease where the flow of bile is obstructed or reduced (e.g. in gall stones )

20
Q

Where is ALP present ?

A

In bone cells so non-specific

This means it can be found elsewhere therefore it is important that it is liver related.

21
Q

Where is liver-derviced ALP located?

A

Outside of the bile membrane reflecting biled duct obstruction.

22
Q

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?

A

They should look at other LFT results

23
Q

What is GGT?

A

An enzyme called gamma glutamyl transferase

24
Q

Can GGT be used to differentiate liver dysfuctions?

A

No, it is an enzyme which is released in all types of liver dysfuctions sp cannot be used to differentiate

25
Q

True/false? 95% of the release of GGT is due to liver isoenzymes and the remaining 5% may be found in iother tissues

A

True

26
Q

What can a raised GGT with a raised ALP or bilirubin suggest?

A

Cholestatic damage

27
Q

What can reised GGI in isolation occur or with enzyme induceding drugs ?

A

Alcohol abuse

Hepatic damage

28
Q

When is bilirubin produced ?

A

The distruction of red blood cells

29
Q

Is the reliese of bilirubin specific?

A

No, it is also relaeased in haemolytic anaemias

30
Q

What can hepatocytes transform uncnjugated bilirubin into ?

A

Water-soluble conjugated from whihc is excreted vbia bile into the intestine

31
Q

When is jaundice prodiced?

A

When serum bilirubin leves is excess of 50micromol/L

32
Q

How can cholestasis be identified ?

A

When bilirubin, ALP and GGT levels have rised

33
Q

True/false ?Bilirubin is also seen in hepatic damage where decreased metabolism of unconjugated (insoluble) bilirubin to conjugated (water soluble ) bilirubin

A

True

34
Q

It is important to determine if haundice is caused by conjugatedor unconjugated hyperbilirubinaemia

A

True

35
Q

What is albumin a marker for?

A

Synthetic function of the liver (helptocellular marker)

36
Q

Is albumin specific or non specific for liver dysfuction ?

A

Non-specific as it is low in malnourashed patients and nephrotic syndrome

37
Q

Why is albumin an indicator of chronic liver disease rather than acute?

A

It has a half life od about 20 days

38
Q

What can an increase INR tell us about a patient?

A

Synthetic function of the liver has decreased or absorption of Vit K is impaired

39
Q

Is INR peramiters specific or non specific and why?

A

Non-specific as deranged in patients on vitamine K antagonist or individuals with coagulopathy disorders

40
Q

What can changed is Prothrombin time tell us ?

A

Useful in predicting hepatocellular damage ina cute situations

Occurs more rapidly than changes in albumin

41
Q

What are the types of liver diseases?

A
  • Acute and chronic
  • Cirrhosis
    Healthy liver -> Fatty liver (steatosis) -> alcoholic hepatitis -> cirrhosis
  • Cholestasis
  • Compensated and decompensated
42
Q

What is the child pugh score used for?

A

Assess the severity of chronic liver disease but no indication about metabolic capacity

43
Q

What are the 5 parameters in child pugh score ?

A

Ascites, encephalopathy, nutritional status, albumin and bilirbin

Gastrointestinal and Liver Disorders (GIL) (25 decks)

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