Drugs in Liver Disease

Question 1

what are the three degrees of liver disease?

Answer 1

A, B and C

Question 2

what does grade A liver disease mean?

Answer 2

disease is well compensated

Question 3

what does grade B liver disease mean?

Answer 3

there is significant functional compromise

Question 4

what does grade C liver disease mean?

Answer 4

disease is decompensated

Question 5

what is a common end stage issue of liver disease?

Answer 5

cirrhosis

Question 6

what happens to the liver in cirrhosis?

Answer 6

the liver becomes small, fibrous and unable to repair itself

Question 7

what sign does high portal pressure cause?

Answer 7

ascites

Question 8

name three causes of cirrhosis

Answer 8

reduced liver blood flow
reduced metabolic function
reduced plasma proteins

Question 9

what effect does albumin have on RAAS?

Answer 9

low albumin suggests low plasma volume, so renin is released activating RAAS, causing aldosterone levels to rise

Question 10

what is secondary aldosteronism?

Answer 10

aldosterone levels becoming high in liver disease because it is not well metabolised

Question 11

name two hormones that become abundant in liver disease

Answer 11

endothelin

oestrogen

Question 12

what happens to the kidneys in liver disease?

Answer 12

sodium retention is increased

Question 13

what happens if an NSAID is given in liver failure?

Answer 13

there is a rapid decrease of renal PGE synthesis

Question 14

what is PGE?

Answer 14

prostaglandin

Question 15

what does decreasing renal PGE synthesis cause?

Answer 15

worsened renal impairment and increased sodium retention

Question 16

what is the NICE recommended first choice for an analgesic in liver disease?

Answer 16

NSAID or a COX-2 inhibitor

Question 17

what should be co-prescribed with analgesics in liver disease?

Answer 17

a proton pump inhibitor

Question 18

why should opiates be used carefully or not at all?

Answer 18

they are sedative and if the liver cannot metabolise them they cause confusion and respiratory depression

Question 19

what is the leading cause of acute liver failure?

Answer 19

paracetamol

Question 20

what two things make paracetamol toxic?

Answer 20

reduced glutathione stores

increased P4502E1 levels

Question 21

who has increased P4503E1 levels?

Answer 21

alcoholics

Question 22

what rule is used to determine if liver failure is severe?

Answer 22

Hy’s rule

Question 23

what does Hy’s rule mean?

Answer 23

is ALT/AST 5x the upper limit +

is bilirubin over 3mg

Question 24

which gender more commonly gets drug induced liver injury?

Answer 24

women

Question 25

what type of drug is beneficial for patients with liver disease?

Answer 25

statins

Question 26

why do you not want to remove fluid too quickly when there is oedema/ascites in liver disease?

Answer 26

it can damage the kidneys

Question 27

what is the best diuretic to use in liver disease?

Answer 27

spironolactone

Question 28

what sedative drugs should be given to people with liver disease if needed and how?

Answer 28

phase II metabolised benzodiazepines in small doses

Question 29

name two benzodiazepines

Answer 29

lorazepam

oraxepam

Question 30

what type of antibiotics are nephrotoxic but can be used if in liver disease if done so safely?

Answer 30

aminoglycosides

Question 31

why are quinolones risky in liver disease?

Answer 31

they can cause seizures, which people with liver disease are already more prone to