Hepatic Dysfunction

Question 1

What common drugs are ok to continue in severe liver disease

Answer 1

Spironolactone UNLESS there is hyperkalemia and renal dysfunction

Propanolol - for variceal bleeding prophylaxis

Thiamine - for prevention of Wernickes

Question 2

What common drugs should be stopped in severe liver disease

Answer 2

NSAIDS

ACEi

Long term paracetamol

FLUCLOXACILIN
C

Question 3

Child Pugh score
-what is it
-what does it measure

MELD
-what is it

Answer 3

Measure of the degree of liver dysfunction
-A - mild
-B - moderate
-C - severe

Bilirubin
Albumin
INR
Ascites
Hepatic encephalopathy

MELD - measure of liver function for ranking for liver transplant

Question 4

Common causes of drug induced liver damage

Answer 4

Long term paracetamol

FLUCLOXACILIN
COAMOX

NSAIDs

Anti TB meds

Methotrexate

Amiodarone

Question 5

Paracetamol induced liver damage
-what amount is dangerous
-treatment

Answer 5

150mg/kg acute ingestion

Staggered
More than 150mg/kg in any 24hr period unless
-[paracetamol] undetectable
-asymptomatic
-LFT, creatinine, INR normal

Question 6

What medications require dose adjustments in liver dysfunction

Answer 6

Fluoxetine
Nifedipine
PhenytoinH

Question 7

How does hepatic dysfunction affect what we prescribe

Answer 7

Decreased 1st pass metabolism
-increased bioavailability
-increased half life

Decreased albumin => decreased binding

Decreased ability to clot, caution with NSAIDs, blood thinners, AP, ACs

Greater risk of renal dysfunction

Decreased liver excretion