Pharmacotherapy in Liver Failure Flashcards
Functions of the liver
● Helps regulate digestive metabolism
● Removes bilirubin, ammonia, and other toxins from the blood.
● Produces cholesterol and proteins such as albumin.
● Produces clotting factors.
● Metabolizes alcohol and many drugs
Drug and toxins affecting the liver
○ Acetaminophen (most common)
○ Chronic alcohol use
○ Use of drugs that induce P-450 enzyme system (many examples)
Viruses affecting the liver
○ Hepatitis B
○ Hepatitis C
Portal hypertension results essentially from _____
increased resistance to portal blood flow secondary to diseased liver
recanalization of the paraumbilical veins also known as _____
Caput medusae
Signs of liver disease
Portal Hypertension
Caput Medusae
Ascites
Esophageal Varices
Coagulopathy
Thrombocytopenia
Hypoalbuminemia
Hyperbilirubinemia
Spider angioma
Ascites is an Accumulation of transudative fluid within the peritoneal cavity, secondary to both _____ hydrostatic pressure and ____ oncotic pressure
increased; decreased
Coagulopathy in liver disease
Diseased, cirrhotic livers have decreased ability to synthesize the
important coagulation factors
Portal hypertension results in splenomegaly and hypersplenism, which decreases the number of platelets, called _____
Thrombocytopenia
How does liver disease cause hypoalbuminemia?
Albumin is the most abundant serum protein and is produced by the liver, so a liver that is dying produces less albumin than a
healthy liver
Why can hyperbilirubinemia cause jaundice?
A specialized transferase in the liver normally converts unconjugated, water-insoluble bilirubin into a water-soluble, conjugated form to facilitate excretion in the bile and feces.
In liver disease, this doesn’t happen effectively, leading to jaundice.
Why is spider angioma involved in liver disease?
It is likely due to the failure of a muscle
sphincter around a skin arteriole, which may be secondary to abnormal estrogen levels during hepatic cirrhosis
Common hepatic labs
○ Albumin
○ Alk Phos (Alkaline Phosphatase)
○ ALT (Alanine aminotransferase)
○ AST (Aspartate aminotransferase)
○ GGT (Gamma-glutamyl transpeptidase)
○ Prothrombin time (PT) and INR
○ Serum bilirubin
○ Urine bilirubin
Albumin helps to _____ in the vascular space.
maintain osmotic pressure
An enzyme- breaks down proteins by removing phosphate groups, mostly produced and found in the liver
Alkaline Phosphatase
Normal Albumin range
3.4-5.4 g/dL
Normal alkaline phosphatase levels
44-147 units/dL
T/F ALT and AST are released when hepatocytes become damaged
T
Normal range for AST/ALT
<40 units/L
GGT (Gamma-glutamyl transpeptidase)
Another enzyme involved in amino acid
metabolism.
High concentrations in the liver, bile
ducts, and kidney
_____ is a protein made in the liver that is a vitamin K dependent clotting factor
Prothrombin
Serum bilirubin types
■ Indirect bilirubin: Measure of unconjugated bilirubin
■ Direct bilirubin: Measure of conjugated bilirubin
■ Total bilirubin: Sum of unconjugated and conjugated bilirubin
T/F - Even trace amounts of bilirubin are considered abnormal
T
What is a Child-Pugh score?
A scoring system that estimates mortality risk in patients with cirrhosis
INR (International Normalized Ratio) is another way to report ___
Prothrombin Time
T/F a patient that has a class A child-pugh score has a lower one year survival than a class C patient
F - Class C is most severe
Drugs that are normally hepatically excreted will present the following concerns if there is significant liver impairment
○ Reduced drug elimination
○ Increased drug accumulation
○ Excessive plasma drug concentrations
○ Adverse effects
If initiating a new medication you should always know or look up the _____
safety/monitoring recommendations
Major drug classes to be aware of in liver disease
■ Antibiotics
■ Sedatives
■ Anesthetic agents
■ Analgesics
■ Anticonvulsants
■ Cardiovascular drugs
Tetracycline, isoniazid, and Rifampin have ____ half life in liver disease
prolonged
_____ are excreted and detoxified by the liver and should be used with
caution in liver disease
Macrolides
Beta-lactam antibiotics can cause ____
leukopenia
Aminoglycosides can ____ susceptibility to renal failure
increase
Antibiotics which need to be used with extra caution in patients with liver failure
Ceftriaxone
Azithromycin
Ketoconazole & other fluconozoles
Antibiotics causing hepatotoxicity
Penicillin, Amoxicillin
Trimethoprim - Sulfmethoxazole
Cephalosporins, Erythromycin
