Pharmacotherapy of Liver Disorders

Question 1

HAV vaccine

Answer 1

• Communities and countries with high infection rates
• The immunoglobulins induce passive protection and provide prophylaxis for about 3 months

Question 2

HBV vaccine

Answer 2

• Recommended for all children
• Post-exposure treatment: hep-B immunoglobulins and antiviral agents such as interferon alfa-2a,
  lamivudine, or adefovir

Question 3

HCV drug therapy

Answer 3

• Rebetron (interferon alfa-2b and ribavirin) → after 24 weeks, 30-50% will respond with ↑liver function
• If response not attained, can be continued as long as 12-18 months

Question 4

Hepatitis B Immune globulin (HyperHep B)

Answer 4

Indication:
- Prophylactic
therapy for infants and
individuals who have
been exposed to
hepatitis B
Desired effect:
- Passive
immunity against
hepatitis B

Question 5

Interferon alpha-2b

Answer 5

Classification:
- biological response modifier with anti-viral properties
Indication:
- Hepatitis C infection
Mechanism of action
- Binds to uninfected cells and signals them to secrete immunomodulatory and
antiviral proteins and enhances the activity of existing leukocytes
Desired effect
- Absence of Hepatitis C virus
Adverse effects
- Flu-like syndrome of fever, chills, dizziness, fatigue
- Nausea, vomiting, diarrhea, anorexia
- With prolonged therapy immunosuppression and hepatotoxicity

Question 6

Ribavirin

Answer 6

Indication:
- Hepatitis C infection
Mechanism of action
- Inhibition of viral RNA replication and synthesis
Desired effect
- Absence of Hepatitis C infection
Adverse effects
- Nausea, vomiting, constipation, diarrhea, dry mouth, difficulty
concentrating

Question 7

Harvoni (ledipasvir & sofosbuvir)

Answer 7

Indication:
- Chronic hepatitis C virus
Mechanism of action
- Inhibits viral replication
Desired effect
- Hepatitis C RNA reduction
Adverse effects
- Fatigue, headache, insomnia, nausea, vomiting, diarrhea

Question 8

Hyperosmotic Laxatives: Lactulose

Answer 8

Indication:
- Chronic constipation, portal-systemic encephalopathy (PSE) in patients with hepatic disease
Mechanism of action
- Promotes ammonia excretion in the stool by acidifying the colon contents. It also increases osmotic pressure and water content which softens stool.
Desired effect
- Decreased constipation, decreased blood ammonia level
Adverse effects
- Nausea, vomiting, anorexia, abdominal cramps, diarrhea, flatulence, distention, belching

Question 9

Spironolactone

Answer 9

Indications
* severe stages of HF
* liver disease (aldosterone not metabolized)
Mechanisms of action
* blocks aldosterone receptors (distal convoluted tubules &
collecting ducts); blocks sodium reabsorption
Desired effects
* sodium and water excretion is increased
* ↓ cardiac preload
* ↓ morbidity and mortality rates in severe HF when added to
standard therapy
Adverse effects
* hyperkalemia
* muscle weakness, ventricular tachycardia, fibrillation