Drugs in Liver Disease Flashcards
what are the three degrees of liver disease?
A, B and C
what does grade A liver disease mean?
disease is well compensated
what does grade B liver disease mean?
there is significant functional compromise
what does grade C liver disease mean?
disease is decompensated
what is a common end stage issue of liver disease?
cirrhosis
what happens to the liver in cirrhosis?
the liver becomes small, fibrous and unable to repair itself
what sign does high portal pressure cause?
ascites
name three causes of cirrhosis
reduced liver blood flow
reduced metabolic function
reduced plasma proteins
what effect does albumin have on RAAS?
low albumin suggests low plasma volume, so renin is released activating RAAS, causing aldosterone levels to rise
what is secondary aldosteronism?
aldosterone levels becoming high in liver disease because it is not well metabolised
name two hormones that become abundant in liver disease
endothelin
oestrogen
what happens to the kidneys in liver disease?
sodium retention is increased
what happens if an NSAID is given in liver failure?
there is a rapid decrease of renal PGE synthesis
what is PGE?
prostaglandin
what does decreasing renal PGE synthesis cause?
worsened renal impairment and increased sodium retention
what is the NICE recommended first choice for an analgesic in liver disease?
NSAID or a COX-2 inhibitor
what should be co-prescribed with analgesics in liver disease?
a proton pump inhibitor
why should opiates be used carefully or not at all?
they are sedative and if the liver cannot metabolise them they cause confusion and respiratory depression
what is the leading cause of acute liver failure?
paracetamol
what two things make paracetamol toxic?
reduced glutathione stores
increased P4502E1 levels
who has increased P4503E1 levels?
alcoholics
what rule is used to determine if liver failure is severe?
Hy’s rule
what does Hy’s rule mean?
is ALT/AST 5x the upper limit +
is bilirubin over 3mg
which gender more commonly gets drug induced liver injury?
women
what type of drug is beneficial for patients with liver disease?
statins
why do you not want to remove fluid too quickly when there is oedema/ascites in liver disease?
it can damage the kidneys
what is the best diuretic to use in liver disease?
spironolactone
what sedative drugs should be given to people with liver disease if needed and how?
phase II metabolised benzodiazepines in small doses
name two benzodiazepines
lorazepam
oraxepam
what type of antibiotics are nephrotoxic but can be used if in liver disease if done so safely?
aminoglycosides
why are quinolones risky in liver disease?
they can cause seizures, which people with liver disease are already more prone to
