Biliary and Pancreatic Pharmacology Flashcards
How does hepatic dz affect PK
Peak drug conc and duration can inc
Levels of drug with narrow therapeutic index can exceed toxic levels
Reduced effectiveness of prodrugs
PLasma protein biding
Chronic hep dec bdining of both acidic and basic drugs
Bioavail
Chronic will inc the bioavailability of many drugs by slowing metabolism and blood flow
Why is damage to liver diff to predict for drug dosing
Different P450 enzymes are affected
Diff drugs
Highly extracted drugs are so rapidly metabolized that much of drug disappears in single pass
Rate depends on hepatic blood flow which is dec by hep
Adjusting drug dose
Lower peak and higher trouh
Easier to do for high therapeutic index
Accounts for dc metabolism
Adjusting interval
Peak conc is same but the interval is longer
Easier if high therapeutic index
3 types of drug-induced liver toxicity
Dose-dep
Idiosyncratic
Allergy
Elevations in blood of liver enzymes
Statins
ABs
Hepatitis
Acetominophen Phenytoin Isoniazid Diclofenac AMox
Cholestasis
Erythro Bactrim Amp Rifam Estrogen Anabolic roids Naproxen Haloperi
Fatty liver
Methotrex Giseo Tamox Steroids Valpro Amiodaron
Cirrhosis
Metho
Amioda
Methyldopa
Tx of drug-induced liver injury
N-acetylcysteine for acetominophen
L-carnitine for valproic
GCs if due to HS
Antihistamine for itching
Bile acid sequestrats for cholestatic
Bile acid sequestrants
Dec enterohepatic recirculation
