Drugs and Liver Disease

Question 1

How does liver disease result in secondary aldosteronism?

Answer 1

Low albumin detected by kidneys → renin release by kidneys → angiotensin enzyme converts angiotensin-I to angiotensin-II to aldosterone → aldosterone not broken down in liver → secondary aldosteronism

Question 2

There are high concentrations of which hormones in liver disease?

Answer 2

Endothelin and oestrogen

Question 3

Consequences of moderate hepatic impairment

Answer 3

Gut oedema, liver and kidney congestion, gross oedema and ascites, CHF

Question 4

Adverse drug reactions of NSAIDS

Answer 4

Upper gastrointestinal ulcer complications, CV toxicity, hypertension, CHF, sodium retention

Question 5

Which phase of drug metabolism is affected in early liver disease?

Answer 5

Phase I

Question 6

Which phase of drug metabolism is affected in late liver disease?

Answer 6

Phase II

Question 7

Highly reactive intermediate of paracetamol that is toxic to liver cells

Answer 7

P4502E1

Question 8

What happens to P4502E1 in normal people?

Answer 8

Glutathione immediately activates and produces cysteine and mercapturic acid conjugates

Question 9

What happens in a paracetamol overdose?

Answer 9

Glutathione runs out and P4502E1 starts to cause liver damage

Question 10

What happens when lots of ethanol is taken with a paracetamol overdose?

Answer 10

Ethanol prevents paracetamol from binding to 2E1 and therefore it takes longer for paracetamol to become toxic

Question 11

What is the best diuretic to use in cirrhosis?

Answer 11

Spironolactone - with fluid restriction, aim at 1kg/day weight loss

Question 12

Antibiotics best avoided in liver disease

Answer 12

Aminoglycosides - necrotic
Quinolones - epileptic
Metronidazole - reduced metabolism