Hepatic Impairment

Question 1

Hypoproteinaemia

Answer 1

Reduced protein binding
Increases free drug concentration highly bound drug
Toxicity
E.g nsaid and warfarin

Question 2

Impaired drug metabolism

Answer 2

Reduce dose
Severe then sig reduction of the dose
Elderly have a decline in liver volume
Decreased metabolism of lipid-soluble drugs

Question 3

Reduced bile excretion

Answer 3

In intrahepatic or extrahepatic obstructive jaundice
Fusidic acid and Rifampicin are excreted in bile and can accumulate

Question 4

Hepatic encephalopathy

Answer 4

Hepatic coma
In severe liver disease, drugs can impair cerebral function and percipitate hepatic coma
Constipation drugs, sedating drugs and drugs that cause hypokalaemia
Hepatic encephalopathy is treated with lactulose

Question 5

What can exacerbate oedema and ascites in liver disease

Answer 5

Drugs which cause fluid retention
NSAIDs and corticosteroids

Question 6

Signs of liver toxicity

Answer 6

Jaundice, abdominal pain, nausea and vomiting, malaise, weight loss, dark urine, pale and cloudy stool, drowsiness, confusion
Lab results showed raised liver enzyme - low albumin

Question 7

Drugs and grapefruit juice

Answer 7

Enzyme inhibitor - Increased plasma concentration
CVS - amlodopine, statins, CCBs
CNS - quiteipine, sertraline
Immunosuppressants - tacrolimus, Ciclosporin
Other e.g colchicine, sildenafil

Question 8

Enzyme inhibitors

Answer 8

Sodium valproate,
Isosonazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol
Chloremphenicol
Erythromycin
Sulphonamide
Ciprofloxacin
Omeprazole
Metronidazole

Question 9

Enzyme inducers

Answer 9

Barbiturates
St John’s wort
Carbamezapine
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas