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Pharm Exam 1 > Pharmacotherapy in Liver Failure > Flashcards

Pharmacotherapy in Liver Failure Flashcards

1
Q

Functions of the liver

A

● 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

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2
Q

Drug and toxins affecting the liver

A

○ Acetaminophen (most common)
○ Chronic alcohol use
○ Use of drugs that induce P-450 enzyme system (many examples)

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3
Q

Viruses affecting the liver

A

○ Hepatitis B
○ Hepatitis C

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4
Q

Portal hypertension results essentially from _____

A

increased resistance to portal blood flow secondary to diseased liver

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5
Q

recanalization of the paraumbilical veins also known as _____

A

Caput medusae

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6
Q

Signs of liver disease

A

Portal Hypertension
Caput Medusae
Ascites
Esophageal Varices
Coagulopathy
Thrombocytopenia
Hypoalbuminemia
Hyperbilirubinemia
Spider angioma

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7
Q

Ascites is an Accumulation of transudative fluid within the peritoneal cavity, secondary to both _____ hydrostatic pressure and ____ oncotic pressure

A

increased; decreased

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8
Q

Coagulopathy in liver disease

A

Diseased, cirrhotic livers have decreased ability to synthesize the
important coagulation factors

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9
Q

Portal hypertension results in splenomegaly and hypersplenism, which decreases the number of platelets, called _____

A

Thrombocytopenia

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10
Q

How does liver disease cause hypoalbuminemia?

A

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

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11
Q

Why can hyperbilirubinemia cause jaundice?

A

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.

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12
Q

Why is spider angioma involved in liver disease?

A

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

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13
Q

Common hepatic labs

A

○ Albumin
○ Alk Phos (Alkaline Phosphatase)
○ ALT (Alanine aminotransferase)
○ AST (Aspartate aminotransferase)
○ GGT (Gamma-glutamyl transpeptidase)
○ Prothrombin time (PT) and INR
○ Serum bilirubin
○ Urine bilirubin

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14
Q

Albumin helps to _____ in the vascular space.

A

maintain osmotic pressure

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15
Q

An enzyme- breaks down proteins by removing phosphate groups, mostly produced and found in the liver

A

Alkaline Phosphatase

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16
Q

Normal Albumin range

A

3.4-5.4 g/dL

17
Q

Normal alkaline phosphatase levels

A

44-147 units/dL

18
Q

T/F ALT and AST are released when hepatocytes become damaged

A

T

19
Q

Normal range for AST/ALT

A

<40 units/L

20
Q

GGT (Gamma-glutamyl transpeptidase)

A

Another enzyme involved in amino acid
metabolism.
High concentrations in the liver, bile
ducts, and kidney

21
Q

_____ is a protein made in the liver that is a vitamin K dependent clotting factor

A

Prothrombin

22
Q

Serum bilirubin types

A

■ Indirect bilirubin: Measure of unconjugated bilirubin
■ Direct bilirubin: Measure of conjugated bilirubin
■ Total bilirubin: Sum of unconjugated and conjugated bilirubin

23
Q

T/F - Even trace amounts of bilirubin are considered abnormal

A

T

24
Q

What is a Child-Pugh score?

A

A scoring system that estimates mortality risk in patients with cirrhosis

25
Q

INR (International Normalized Ratio) is another way to report ___

A

Prothrombin Time

26
Q

T/F a patient that has a class A child-pugh score has a lower one year survival than a class C patient

A

F - Class C is most severe

27
Q

Drugs that are normally hepatically excreted will present the following concerns if there is significant liver impairment

A

○ Reduced drug elimination
○ Increased drug accumulation
○ Excessive plasma drug concentrations
○ Adverse effects

28
Q

If initiating a new medication you should always know or look up the _____

A

safety/monitoring recommendations

29
Q

Major drug classes to be aware of in liver disease

A

■ Antibiotics
■ Sedatives
■ Anesthetic agents
■ Analgesics
■ Anticonvulsants
■ Cardiovascular drugs

30
Q

Tetracycline, isoniazid, and Rifampin have ____ half life in liver disease

A

prolonged

31
Q

_____ are excreted and detoxified by the liver and should be used with
caution in liver disease

A

Macrolides

32
Q

Beta-lactam antibiotics can cause ____

A

leukopenia

33
Q

Aminoglycosides can ____ susceptibility to renal failure

A

increase

34
Q

Antibiotics which need to be used with extra caution in patients with liver failure

A

Ceftriaxone
Azithromycin
Ketoconazole & other fluconozoles

35
Q

Antibiotics causing hepatotoxicity

A

Penicillin, Amoxicillin
Trimethoprim - Sulfmethoxazole
Cephalosporins, Erythromycin

Pharm Exam 1 (7 decks)

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