Drugs used in liver disease

Question 1

For all “types” of liver diseases, you may prescribe ______ to reduce inflammation, in addition to the core drugs.

Answer 1

steroids (eg. prednisolone, fluticasone)

Question 2

Ceftriaxone mechanism of action

Answer 2

inhibits bacterial cell wall synthesis

Question 3

Ceftriaxone rationale for its use

Answer 3

Broad spectrum: good coverage against bacterial infection caused by Gram +ve & -ve bacteria

Question 4

Adverse effects of Ceftriaxone

Answer 4

• well tolerated;
• rash & diarrhoea most common effects
• thrombophlebitis

Question 5

Metronidazole (nitromidazole) mechanism of action

Answer 5

disrupts DNA synthesis via oxidative stress

Question 6

Metronidazole (nitromidazole) rationale for its use

Answer 6

good coverage against protozoans, anaerobes

Question 7

Adverse effects of Metronidazole (nitromidazole)

Answer 7

• dizziness
• anorexia
• abdominal pain
• headache
• unpleasant metallic taste & nausea

Question 8

Cholecystectomy vs Laparotomy. Which is preferred?

Answer 8

Cholecystectomy. it carries smaller risk of complications

Question 9

In Hepatitis:
Hepatitis viruses replicate like ____.

How does nucleoside reverse transcriptase inhibitor work?

Answer 9

replicate like HIV

In short:
NRTI slows the growth of the virus, thus decreasing liver damage caused by the virus.

Nucleoside reverse transcriptase inhibitors (NRTIs) block reverse transcriptase (an HIV enzyme). HIV uses reverse transcriptase to convert its RNA into DNA (reverse transcription). Blocking reverse transcriptase and reverse transcription prevents HIV from replicating.

Question 10

Adverse effects of antivirals (eg. entecavir)

Answer 10

• headache
• nausea
• asthenia (abnormal physical weakness or lack of energy)
• dizziness
• fatigue
• nasal disturbances, pancreatitis (lamivudine)
• cardiac arrest (ribavirin)

Question 11

Is there vaccine for hep C? And is it recommended to give immunoglobins?

What is treatment for hep C (chronic)?

Answer 11

Acute: no vaccine & treatment
Not recommended to give immunoglobins

Chronic: Use protease inhibitor (anti-HCV): elbasvir/grazoprevir

Question 12

Protease inhibitor MOA

Answer 12

binds to proteolytic enzymes (proteases), blocking proteases’ function.

stops hep c virus from reproducing itself to keep viral load flow

Question 13

Acetaminophen should be avoided due to the risk of 1. __________.

Patients with alcohol-induced cirrhosis who are taking acetaminophen have an increased risk of worsening liver disease due to the increased 2. _____________.

Besides Acetaminophen, other drugs like 3. ________________ should be avoided.

Answer 13

1. hepatotoxicity;
2. production of a toxic metabolite
3. Azithromycin
   erythromycin
   clindamycin
   Methotrexate

Question 14

List 5 other meds that should be avoided.

Answer 14

• abacavir
• COX-2 inhibitors
• NSAIDs
• sertraline
• anti-tuberculosis drugs (eg. pyrazinamide)
• direct oral anticoagulant agents
• tacrolimus
• metformin
• ACE inhibitors

Question 15

Serve ________ as an antidote

Answer 15

N-acetylcysteine

Question 16

__________&_________ relive pressure caused by excess fluid.

Answer 16

Spironolactone & furosemide

Question 17

____________ is a GI-selective antibiotic with a broad spectrum of antimicrobial activity, minimal drug interactions.

Answer 17

Rifaximin

Question 18

___________ is a DNA synthesis inhibitor, and unaltered in patients with liver cirrhosis.

Answer 18

Ciprofloxacin