hepatic Flashcards
Acetylcysteine MOA
Used for paracetamol overdose.
Maintains and restores glutathione concentrations which is required to inactivate NAPQI which is hepatotoxic. Also has mutolytic action
Aluminium hydroxide
neutralises HCL secretion in the stomach. Helps with hyperphosphotemia
Calcitriol
Active form of vitamin D
Calcium carbonate
neutralises HCL secretions in the stomach. Helps with hyperphosphotemia
Calcium gluconate
Is a calcium suppliment which helps with the normal function of the renal system
Ciclosporin
used to reduce rejection of an organ transplant. It inhibits calciceurin which is usually responsible for activating interleukin 2. It is also responsible for inhibiting lymphokine production and interleukin release
cinacalcet
secondary hyperparathyroidism in dialysis patients with end-stage renal disease. Works by reducing parathyroid hormone which leads to a decrease in serum calcium concentrations.
Colecalciferol
used in vit D defficiancy
Dasabuvir
Part of viekira pak used for treatment of chronic Hep C. It works by inhibiting NS5A which stopped RNA synthesis of Hep C
Diazepam
A short term anti anxiety and insomnia drug. used in alcohol withdrawal. Works by binding to the benzodiazepine receptors which mediates sleep and affects muscle relaxation. Alongside this it is thought to be coupled with the GABA receptors resulting in increased effects of GABA. This results in the opening of chloride channels which hyperpolarses the cells and prevents further excitation of the cell.
Diclofenac
NSAID works by inhibiting COX 1 and COX 2 and leukocyte migration. Reduced prostaglandins results in analgesic effects. Also has antipyretic effects due to dissipation of heat through peripheral dilation of blood vessels.
Entecavir
1st line Treatment of Hep B by inhibiting all three activities of the HBV polymerase. 1. Base priming 2. reversed transcription of the negative strand in RNA 3. synthesis of the positive strand DNA.
Erythropoietin
growth factor produced in the kidney released to stimulate the making of red blood cells.
Fluconazole
inhibits fungal CYP450 dependent lanosterol 14- alpha demethylase resulting in impaired sterol synthesis in fungal cell membranes and increased membrane permeability
Furosemide
Loop diuretic which works by inhibiting sodium and chloride re-absorption in the ascending loop of henle. This promotes excretion of water
Lactulose
used to help reduce hepatic encephalopathy by excreting ammonium through increased feacal excretion.
Lamivudine
used in prophylaxis of Hep B. Used when the virus is inactive but there is increased risk of activation eg high dose immunosuppressant. Once activated it works by being incorporated into the growing viral DNA by reverse transcriptase. This causes early chain termination and stops viral replication.
Ledipasvir
Part of Harvoni used as second line Hep C treatment. It is a replication inhibitor of Hep C virus protein NS5A which is necessary for both RNA replication and vision assembly
Mycophenolate mofetil
used for prophylactic organ rejection. Works by inhibiting T and B cell proliferation and inhibits B cell antibody production
Nadalol
Acts on B1 receptors inhibiting the binding of NA. This results in decreases heart contractility, decreased cardiac output and decreasing blood pressure. It also acts on the juxtaglomerular B2 receptors which inhibits the production of renin therefore inhibiting Ang 11 and renin production. This results in vasodilation and excretion of water.
Ombitasvir
Part of the Viekeira pak used for the treatment of chronic Hep C. A Direct acting antiviral that inhibits the replication of the HCV protein NS5A which is used for RNA replication
Paracetamol
Cox 1 and Cox 2 enzyme inhibitor which results in inhibiting prostaglandin production. Works on the CNS and not on the peripheral cells it increases pain tolerance having analgesic effects.
Paritaprevir
Part of the Viekeira Pak used for the treatment of Hep C. It is a direct acting antiviral and is an protease inhibitor which cleaves the HCV polyprotein
Pravastatin
It is a HMG- COA inhibitor which is the rate limiting step to cholesterol synthesis in the liver. It also increases the LDL receptors on the hepatocyte membrane which increases the re-uptake of LDL from the blood to be metabolised in the liver.
Propranolol
Non cardio-selective beta blocker which competes at the Beta receptor binding sites resulting in decrease Heart rate, decreased contractility of the heart and decreased Blood Pressure. Secondary treatment for ascites
Ribavirin
Used for Chronic Hepatitis C treatment. It exact mechanism of action is unknown but it is thought to prevent and inhibit the synthesis and replication of HCV.
Rifaximin
used for treating hepatic encephalopathy. It is not absorbed in the gastro-intestinal tract. Works by inhibiting RNA synthesis of the bacteria.
Sofosbuvir
Part of the Harvoni treatment of Hep C. It is a direct acting antiviral and is metabolised intracellularly into its active form. It is an inhibitor of the HCV NS5B RNA- dependent RNA polymerase which is essential for viral replication.
Tacrolimus
Calcineurin inihbitor. It binds to FK-protein which inhibits Calcineurin which inhibits B-Cell activation.
Terlipressin
An analogue of vasopressin. It binds to V1 receptors in vascular smooth muscle which results in vasoconstriction which decreases portal pressure and decreases blood flow. Used for ascites.
Sirolimus
Works similarly to tacrolimus but instead works by interfering with lymphocytes through binding of mTOR
First line drug therapies for Kidney Transplant
Ciclosporin - calcineurin inhibitor
Steriod - prednisone
Induction Agent - basiliximab
Antiproliferative drugs - mycophenalate mofetil
Prophylactic meds - antiviral - acyclovir or antibiotics - cefuroxime or co-tromizole
First line drug therapy for Kidney/pancreas
Tacrolimus - calcicuerin inhibitor
steroid - prednisone
induction agent - basiliximab
Antiproliferative agent - mychophenolate mofetil
Prophylactic meds - antiviral - acyclovir or antibiotics - cefuroxime or co-tromizole
First Line drug therapy for liver transplant
Caliceneurin inhibitor - tacrolimus
Steroid - prednisone
Induction agents - basiliximab
Prophylactic meds - antiviral - acyclovir or antibiotics - cefuroxime or co-tromizole
Treatment therapy for Chronic Hepatitis C
Vikeira Pak with Ribavirin for HVC genotype 1
(dasabuvir, paritaprevir, ritonavir, ombitsvir)
Of eGFR < 30 mL/min = no ribarvirin
Treatment paracetamol over dose and hyperglycaemia
-Activated charcoal if within 8 hrs Once off
Acetylcytisene in glucose.
- dextrose
Treatment for alcoholic liver cirrhosis
Abstinence from alcohol
Oxazapam (faster acting) - start 15mg every 6 hrs then titrate down
Prednisone for inflammation
Nutritional therapy
Treatment for ascites
restrict salt intake, give spirinolactone
Pruritis liver cirrhosis
cholestyramine
Hepatic Enchephaly
Lactulose
AKI
Reperfusion. Stop triple whammy and give IV saline
Hyperphosphotemia
Aluminium hydroxide and calcium carbonate
Hyperkalaemia
Calcium resonium - give with lactulose
Calcium gluconate
Nebulised salbutamol
Insulin + glucose
CKD Anaemia
IV: iron polymaltose
Epoetin Alpha sc
CKD Oedema
Furosemide IV
Uremia pruritis
Low dose Gabapentin
LT Bone disease
Calictriol (activated vit D)
