CA - Drugs for liver disease Flashcards
(20 cards)
Whats the treatment and prevention for Hep A?
Before exposure:
- Prevent with vaccinations
After exposure:
- post-exposure prophylaxis with Hep A immunoglobulins (HAIg) -> boosts immune system & fights off infection
- No treatment
What’s the treatment and prevention for acute and chronic Hepatitis B virus (HBV)? What’s the MOA of the drugs used?
Prevent: Vaccination
Recent exposure:
- Post exposure prophylaxis (PEP): Hep B immunoglobulins HBIG.
Treatment:
Acute: No treatment
Chronic:
1. lifelong chronic treatment with nucleoside inhibitors
- Entecavir, Tenofovir
- MOA: Inhibits DNA polymerase -> reduce viral replication/load and liver damage.
- 4 months of Interferon alfa or PEG interferon
Whats the therapy used for HBV?
- Used in some cases to boost the immune response to fight the virus.
- Essential regular monitoring of liver function (LFT) and HBV viral load
Whats the treatment and prevention for Hep C Virus (HCV)? Whats the MOA for the drugs used?
Treatment:
Acute: No treatment
Recent exposure: Not recommended to give immunoglobulins / post-exposure prophylaxis (PEP)
Chronic
- Long-term protease inhibitors
- Elbasvir/Grazoprevir
- MOA: Block viral protease enzymes -> stop viral replication
- HC: leading cause of liver transplants worldwide
No vaccine available
- virus’s high genetic variability
What are the drugs to avoid in liver cirrhosis and liver failure?
Drugs are mainly metabolised in the liver, care is required in patients with compromised liver function
- Acetaminophen / Paracetamol
- risk of hepatotoxicity - Azithromycin, erythromycin, and clindamycin
- used for bacterial infections
- increased risk of hepatotoxicity - Abacavir: treats HIV/AIDs
- NSAIDs: pain relief
- anticoagulants
- tacrolimus: immunosuppressant
5.. Anti-tuberculosis drugs
- can cause hepatotoxicity and should be avoided in patients with liver failure.
- Herbal supplements
- induce liver injury
- Green tea most commonly associated with liver injury
- not recommended in cirrhosis patients
What drug is used for Portal Hypertension and varices?
- Beta-blockers
- Propranolol
- Reduce portal pressure and prevents variceal bleeding.
What drugs are used to treat ascites?
Diuretics:
1. Spironolactone (potassium-sparing):
- First-line treatment for fluid retention
- blocks aldosterone which causes fluid retention
- Furosemide (loop diuretic):
- Used in combination if spironolactone is not enough to control ascites
- relieves pressure caused by excess fluid
Paracentesis:
1. Removal of ascitic fluid if diuretics are insufficient.
What drugs are used to treat Hepatic Encephalopathy?
- Lactulose:
- Reduces ammonia absorption in the gut
- acidifies colonic contents and promoting
excretion.
- flush out toxins - Rifaximin:
- Antibiotic that reduces ammonia-producing gut bacteria
What drugs are used to treat Spontaneous Bacterial Peritonitis (SBP)?
Antibiotics:
1. Rifaximin:
- Gastrointestinal-selective abx antimicrobial activity
- Broad-spectrum antimicrobial activity
- Minimal liver toxicity & drug interactions
- Ciprofloxacin:
- Effective for SBP
- MOA: DNA synthesis inhibitor
- Broad-spectrum
- Eliminated in the kidneys -> liver dysfunction doesn’t affect its excretion from the body -> has minimal pharmacokinetic changes in cirrhotic patients
Whats the drug used for treating Acetaminophen Overdose in Liver Failure?
- N-acetylcysteine:
- Acts as an antidote by replenishing glutathione and detoxifying harmful metabolites.
- prevents acute liver failure
What are the Advanced Interventions used for liver cirrhosis and failure?
- Transjugular Intrahepatic Portosystemic Shunt (TIPS):
- Procedure to reduce portal hypertension -> create a bypass between portal & systemic venous systems. - Liver Transplant:
- definitive treatment for end-stage liver failure or decompensated cirrhosis
- Criteria: irreversible liver damage, life-threatening complications, & good overall health
Whats the Management of Cholecystitis?
- Initial Stabilization
- Antibiotic Therapy
- Fasting and Bowel Rest
- Pain Management
- Surgical Intervention
- Other Treatment Options
How to Initially Stabilise patients with acute cholecystitis?
1 Hospital Admission: Most patients with acute cholecystitis need hospitalization
- Supportive Care:
* IV & Electrolytes
* Pain relief - analgesics (NSAIDS or opioids)
What are the drugs used in Antibiotic Therapy for acute cholecystitis? What are their adverse effects?
To manage bacterial infection; antibiotics are critical in acute cholecystitis
- Ceftriaxone (3rd Gen Cephalosporin):
◦ MOA: Inhibits bacterial cell wall synthesis.
- Broad-spectrum -> Good coverage against Gram+ and Gram- bacteria
◦ Adverse Effects: Rash, diarrhoea
- Rare: hypersensitivity reactions & thrombophlebitis - Metronidazole (Nitroimidazole):
◦ MOA: DNA synthesis inhibitor
◦ Targets anaerobic bacteria and protozoans
◦ Adverse Effects: Metallic taste, nausea, dizziness;
- avoid alcohol & alcohol products like mouthwash due to disulfiram-like (unpleasant) reaction
Whats the management for patients during Fasting and Bowel Rest for cholecystitis?
- Patients kept Nil By Mouth to reduce gallbladder stimulation.
- NGT suctioning may be used if vomiting is severe.
Whats the Surgical Intervention for cholecystitis and when isit required?
Surgical management may be required if symptoms persist, or complications arise.
Cholecystectomy (Gallbladder Removal):
1. Laparoscopic Cholecystectomy:
• Minimally invasive
- gold standard treatment!!
• Recommended within 24–48 hours of diagnosis for stable patients.
- Open Cholecystectomy:
• Used for severe cases or when laparoscopy is contraindicated - Percutaneous Cholecystostomy:
• temporary measure in patients who are too ill for surgery.
• Put a tube to drain bile from gallbladder.
What are the symptoms of chronic cholecysitis?
- may not cause any symptoms
- can damage walls of the gallbladder
- walls can become scarred -> thicker & smaller -> less able to store and release bile - surgery to remove the gallbladder is then required
What are other Treatment Options for cholecystitis?
- Oral Dissolution Therapy:
- Medicines made from bile acids to dissolve gallstones
- Only for patients unable to undergo surgery. - Dietary Management:
- low-fat diet when allowed to eat
- to prevent further episodes
Management of Chronic Cholecystitis?
- Lifestyle and Diet
* Low-Fat Diet: Reduces gallbladder stimulation.
* Hydration: Maintains bile flow.
* Weight Management: Gradual weight loss to prevent gallstone formation. - Medications
* NSAIDs: For mild pain relief.
* Ursodeoxycholic Acid (UDCA): Dissolves cholesterol gallstones (limited efficacy) - Surgical Treatment
* Laparoscopic Cholecystectomy:
- Minimally invasive, definitive treatment
- gallbladder removal through small incision
- Open Cholecystectomy: For complex cases (e.g., adhesions)
