3.4:2 Drugs in liver disease part 2 Flashcards
What is drug-induced liver disease and how should it be managed?
Some medications can result in acute liver damage and cholestasis
Monitoring of liver function tests is essential
Baseline LFTs should be takken and then further monitoring as required
Some medicines can result in hepatic enzyme induceders or inhibition
What is the mening id idosyncratic
Where liver injury is unpredictable and occurs at a low incidence
What drugs can be the cause of liver damage ?
Amiodarone Azathiprine Carbamazeprine Isoniazide Phenytoin Rifampicin Sodium Valproate NSAIDs Paracetamol Methatrexate Statins Antibiotics
How would you handle drug induced liver disease in patients?
Consider patient factor:
- SIgns and symptoms, LFTs and diagnosis
Consider drug factors
- Pharmacokinetics, Pharmacodynamics, Side effect profile
- Liver is the main sight of drug metabolism
- Hepatic metabolism is most important for lipid-soluble drugs wherease water soluble drugs are readily renally excreted
True/false? CYP-mediated reactions are affected more in liver diesase than phase II reactions
True
Expression of CYP 1A, 2C19 and 3A in particular are decreased in cirrhosis
True
Why should constipating drugs be avoid/ reduced in liver disease ?
Toxic waste products are not cleared and accumulate and cause or worsen hepatic encephalopathy
What type of constipating drugs should be avoided?
Loperamide, codeine, amitryptline
Laxatives can be given
Why should sedatiung drugs be avoided in liver disease ?
Avoid in patients at risk if encephalopathy as the brain is more sensitive to sedating effects
Give examples of sedating drugsbthat shoudl be avoided in liver disease?
Opioids, sedating antihistammune and tricyclic antidepressants
Why should drugs that lower the seizure threshold be avoided/ reduced in patients with liver disease?
Some drugs have increased the risk of convulsions
Alcholics are at increased risks of seizures due to wiithdrawal.
What are examples of drugs that lower the threshold of siezures?
Tramadol, pethidine , sedating antihistamine , antipsychotics and antidepressants
Why should drugs that increase the risk o GI ulceration and bleeding be avoided in Liver disease and who is most at risk?
Intergrity of the GI mucosa can be affected by excessive ethanol which increases risk of GI ulceration
The synthesis of vit K and clotting factors are impaired
Patients with portal hypertension,varicies, low platlet and degranged clotting
Give examples of drugs that increase the risk of GI ulceration and bleeding?
NSAIDs, aspirin, clopidogrel, warfarin, corticsteroids and SSIs
Give examples of drugs which cause endocrine/metabolic effects that should be avoided in liver disease
Diuretics- cause hypoatraemia and hypkalaemia which can lead to encephalopathy
NSAIDs- Enhance sodium and water retention which can worsen ascites and can precipitate renal failure
