Liver Disease & Therapeutics

Question 1

Explain why high dose lactulose is given to patients with liver impairment?

Answer 1

-Lactulose given for Wernicke’s Encephalopathy
-Lactulose helps absorb the ammonia waste made by bacteria and reduce intestinal production which can cross into the BBB causing encephalopathy
-Inhibits colonic absorption

Question 2

What dose is Lactulose given for the indication of Wernicke’s Encephalopathy?

Answer 2

30-50mL TDS

Question 3

What is in Pabrinex® ?

Answer 3

vitamin B substances (thiamine) with ascorbic acid

Question 4

Chlorphenamine indication in liver impairment?

Answer 4

pruritus
antihistamine to help with the itching caused by increase in bile salts that accumulate in the skin

Question 5

What drug is used for alcohol withdrawal in hospital settings?

Answer 5

Chlordiazepoxide

Question 6

Mechanism of action of chlordiazepoxide?

Answer 6

Chlordiazepoxide binds to stereospecific benzodiazepine (BZD) binding sites on GABA (A) receptor complexes at several sites within the central nervous system, including the limbic system and reticular formation. This results in an increased binding of the inhibitory neurotransmitter GABA to the GABA(A) receptor.

Question 7

What results in LFTS would you see in acute hepatocellular damage?

Answer 7

raised plasma ALT and AST levels
Normal albumin and PT

Question 8

What results in LFTS would you see in chronic hepatocellular damage?

Answer 8

decreased albumin levels
longer Prothrombin Time
Normal or slightly raised AST or ALT

Question 9

What results in LFTS would you see in choleostatsis?

Answer 9

increased ALP, increase GGT and conjugated bilirubin

Question 10

List some if the long term clinical manifestations of liver impairment

Answer 10

-Jaundice
-encephalopathy
-Ascites
-Spidea nivea
-Varices

Question 11

2nd line treatment for Wernicke’s Encephalopathy?

Answer 11

Rifaximin (recurrent)

Question 12

What class of antidepressants to avoid in liver impairment?

Answer 12

Tricyclic antidepressants

Question 13

What is given following paracentesis?

Answer 13

Human Albumin Solution 20% for every 2-3 litres of liquid removed

Question 14

What diuretics are given in liver impairment?

Answer 14

Furosemide
Spironolactone

Question 15

Discuss the analgesia used in liver impairment

Answer 15

-non sedating
-paracetamol okay but better not to recommend
-avoid NSAIDS and Cox-2 inhibitors

Question 16

Why are statins avoided in acute and decompensated liver disease?

Answer 16

statins can cause an elevation in transaminase which can lead to inflammation

Question 17

Prophylaxis of variceal bleeding in portal hypertension?

Answer 17

propranolol hydrochloride

Question 18

Examples of CYP450 inhibitors

Answer 18

erythromycin, amiodarone, ciproflxacin, ketoconazole

Question 19

Examples of CYP450 inducers

Answer 19

barbituates, carbamazepine, ethanol, phenytoin, St John’s Wort

Question 20

Drugs to avoid in liver impairment?

Answer 20

ACE, aminoglycosides, alpha-adrenergic blocker