Liver Disease Drugs Flashcards
What are the rules of drugs with high metabolism?
drugs don’t work very well if you swallow them so put under tongue
If oral dose is huge and IV dose is small then the drug is highly metabolised
What does low albumin represent?
low plasma volume
In the presence of low plasma volume, how does albumin react?
Tries to retain salt and water
What group of people have enormously high levels of aldosterone and angiotension 2?
people with cirrhosis
What are spider neivi produced by?
oestrogen not being metabolised
What are the biochemical signs of water retention?
Low K
Low Na
Which hormones stimulate the kidney to release renal prostaglandins?
Angiotensin 2
Aldosterone
SNS
ADH
What are NSAIDs effect on renal prostaglandins?
shut them off
What can NSAIDs cause?
Hypertension Heart failure CV toxicity UGI ulcer complications Sodium retention Asthma Diarrhoea/Colitis Renal Failure
What should NSAID or COX-2 inhibitor always be prescribed with?
Protein Pump Inhibitor
What toxic substance is paracetemol metabolised in to? By what?
N-acetly-p-benzoquinonimine by P450
How does the body get rid of N-acetly-p-benzoquinonimine?
Glutathione
What is the effect of paracetmol in liver disease?
Reduced Glutathione stores
Longer half-life
Increased P450 in Alcoholics
Toxicity with ‘normal’ doses
What is Hy’s Rule?
ALT/AST > 5 x ULN
And
Bilirubin > 3mg/dl
What drugs are used for sedation?
Phase II metabolised benzodiazepines:
Lorazepam
Oxazepam
Lormetazepam
