Hepatic Drugs Flashcards
drug induced liver disease
some acute, some chronic, some cholestatic, some hepatocellular
severe liver injury
bili x 2, encephalopathy, coagulopathy
fulminant liver injury
happens within 4 weeks, fast onset
portal hypertension
every condition of liver damage r/t to this, splenomegaly, hepatic encephalopathy, perotinitis, ascites, bleeding disorders, interstitial fluid shift
tylenol
40% drug induced liver disease, if glutiones depleted in etoh use, liver injury develops more easily, if liver dx no more than 1500mg/24 h
rule of 140
if more than 140 mg/kg r/f hepatotoxicity,
if tylenol level 4 h later, if >140 , 25% to 30% of hepatoxicity
dose of NAC, 140mg/kg loading dose, then 70mg/kg every 4 h for 17 doses
tylenol drug induced injury
if ast>10,000, bili>4, lft elevated, prolongation of PTT,hypoglycemia, —>renal failure and then multio organ failur
n-acetylcysteine, NAC
treatment for tylenol overdose, smells like rotten egg
spironolactone
200-400 mg, decreases Na and therefore ascites, also, restrict sodium, add low loop diuretic 20-40 to reduce hyperkalemia (careful, intravascular depletion)
low albumin
high aldosterone
Treatment for Hep B
Interferon, 16 weeks, 30-40% cure rate
Nucleotide analogs, inc famciclovir and adefovir, don’t cure but decrease viral load and liver injury
Hep C treatment
PEG interferon and ribuviron, 61%cure rate
Genotype 1/4, 48 weeks
Genotype 2/3, 24 weeks
PEG intron monotherapy
better response if non-1 genotype HCV RNA level lower cirrhosis or bridging fibrosis- absence younger age lighter body weight
Protease inhibitors for hep c treatment
boceprevir and telaprevir
boceprevir
CYP 3A4 inhibitor 24,000-48,000$ for 6 mohths take with food preg cat x 12 capsules/day refrigerate no renal dosing
