Drugs and the Liver

Question 1

Name 2 drugs contraindicated in severe liver disease?

Answer 1

NSAIDs and ACEi

Question 2

Name 1 treatment for ascites?

Answer 2

Spiro

Question 3

Name 1 prophylaxis for variceal bleeding

Answer 3

Propanolol

Question 4

Prevention of wernicke’s and korsakoff’s?

Answer 4

IV pabrinex for anyone admitted with a chronic alcohol problem.
Oral thiamine too (tbc on discharge)

Question 5

Name a hepatic side effect of flucloxacillin and co amoxiclav

Answer 5

Hepatitis and cholestatic jaundice

Question 6

What affect can paracetamol have on the liver?

Answer 6

dose dependent acute liver injury
can lead to acute liver failure

Question 7

What affect can NSAIDs have on the liver?

Answer 7

idiosyncratic hepatitis
Aspirin can cause dose dependent hepatitis
Ibuprofen can cause cholestatic hep

Question 8

What affect can MTX have on the liver?

Answer 8

severe fibrosis and cirrhosis

Question 9

What affect can amiodarone have on the liver?

Answer 9

steato hepatitis

Question 10

Do ciprofloxacin and fluclox need dose adjustment in liver diease?

Answer 10

no

Question 11

Does fluoxetine need dose adjustment in liver disease?

Answer 11

yes

Question 12

Aspirin and tramadol - safe, caution or CI?

Answer 12

caution
tramadol - incr constipation which is risk for encephalopathy and may mask signs. Metabolised using CYP450
aspirin - incr risk of bleeding