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
