Drugs used in liver diseases

Question 1

List the drugs used in treating the symptoms of cholecystitis (2 ab).

Answer 1

Ceftriaxone/cephalosporin and Metronidazole (Nitroimidazole)

antibiotics

Question 2

2 AB drugs for cholecystitis: class/MOA and adverse effects

Answer 2

1. Ceftriaxone (cephalosporin): inhibit cell wall synthesis as a beta lactam AB. adverse effects: Well-tolerated but Rash and diarrhoea most common adverse effect
2. Metronidazole: inhibit DNA synthesis
   Adverse effects: Dizziness, headache, anorexia, abdominal pain, unpleasant metallic taste and nausea
   Try to avoid alcohol and alcohol products (like mouthwash) when taking this antibiotic

Question 3

Identify viral infections that benefit from pharmacotherapy

Answer 3

Hep A, B and C

Question 4

Viral hepatitis drugs B and C

Answer 4

Hep B : Nucleoside: Entecavir, Tenofovir, Lamivudine

Hep C : Protease Inhibitor (Anti-HCV): Elbasvir/grazoprevir

Question 5

Hepatitis: know representative drugs and explain the mechanism of drug action, primary actions and important adverse effects

Answer 5

1. Hep A:
   Before exposure: Mainly through vaccination
   After exposure: Hepatitis A immunoglobulin or HAIg to be given as Post-exposure prophylaxis or (PEP)
2. Hep B:
   recent exposure: Hep B Immunoglobulins (this is called post-exposure prophylaxis or PEP)

chronic exposure: 4 months of Interferon alfa or PEG interferon OR Use nucleoside inhibitors (long term): Entecavir (least SE, 1st line), Tenofovir, Lamivudine

3. Chronic exposure to Hep C:
   - 4 months of Interferon alfa or PEG interferon
   - Use Protease Inhibitor (Anti-HCV): (long term): Elbasvir/grazoprevir

Question 6

antidote: how to treat patients with liver failure or liver cirrhosis? (antidote, 3 drug classes, 2 ab)

Answer 6

**Antidote: N-acetylcysteine **

K Sparing diuretics: Spironolactone

PEE: Loop diuretics: Furosemide

SHIT: Laxative: Lactulose

Antibiotics: Rifaximin, Ciprofloxacin (for spontaneous bacterial peritonitis)

Question 7

List the drugs to avoid in liver cirrhosis and failure (6).

Answer 7

Acetaminophen: risk of hepatotoxicity. Patients with alcohol-induced cirrhosis who are taking acetaminophen have an increased risk of worsening liver disease due to the increased production of a toxic metabolite, N-acetyl-p-benzoquinone imine. If acetaminophen therapy is necessary, then the maximum daily amount should be less than 2,000 mg.

AzithroMYCIN, erythromycin, and clindamycin: risk of hepatotoxicity. Azithromycin has been shown to have not only an increased risk of acute liver injury but also increased mortality in patients with cirrhosis. 

Methotrexate has been shown to cause hepatotoxicity, possibly due to folate depletion. Because these effects can be increased in patients with cirrhosis, methotrexate should be avoided. If the benefit of methotrexate therapy outweighs the risk, frequent monitoring is required.

Other medications that should be avoided include **abacavir, COX-2 inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), direct oral anticoagulant agents, sertraline, and tacrolimus. **

Anti-tuberculosis drugs, especially pyrazinamide, can cause hepatotoxicity and should be avoided in patients with liver failure.

Herbal supplements have been shown to induce liver injury. Green tea extract is most commonly associated with liver injury; however, the mechanism is unknown. The use of herbal supplements is not recommended in cirrhosis patients.

Question 8

Madam Wong Si Ling is 72-year-old retiree vwho is HBsAg (+), HBeAg (+),anti-HBc (+), anti-HBsAg (-) and has an elevated serum alaninetransaminase (ALT). Her hepatitis B virus (HBV) DNA is 18000 international units/mL. Madam Wong also has ascites and known esophageal varices. She has Liver Cirrhosis.

Which one of the following medications should be avoided as it has potential to cause harm in cirrhotic patients?

A. Amoxycillin

B. Furosemide

C. Insulin

D. Pyrazinamide (Anti-tuberculosis drug)

Answer 8

D

Question 9

Chronic hepatitis C may be treated with:
(a) sulfasalazine.
(b) interferon and ribavirin (nucleoside).
(c) metronidazole (DNA synthesis inhibitor) or ciprofloxacin (ab).
(d) acetaminophen

Answer 9

B
D is hepatotoxic, C metronidazole for cholecystitis and ab for liver cirrhosis