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Gastro > Prescribing in Liver Disease > Flashcards

Prescribing in Liver Disease Flashcards

1
Q

Name some causes of abnormal liver tests

A 
Obesity
Alcohol
Drugs 
Fatty foods 
Fizzy drinks
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2
Q

What is cirrhosis?

A

Cirrhosis is scarring of the liver as a result of continuous, long-term liver damage. Scar tissue replaces healthy tissue in the liver and prevents the liver from working properly.

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3
Q

Name 3 major factors contributing to cirrhosis?

A

Reduced liver blood flow as it is hard for the blood to get through from the portal system
Reduced metabolic function
Reduced plasma proteins

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4
Q

Describe a standard case of cirrhosis

A

Middle aged man, alcoholic, complaining of severe chest pain due to many fractured ribs from falling over drunk

Increased creatinine, decreased Na and K+
Low blood pressure

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5
Q

How can we treat cirrhosis?

A

NSAID
Paracetamol
Opiate

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6
Q

What is a clue of first pass metabolism

A

Oral dose is greater than the IV dose

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7
Q

What type of blood does not go through the liver?

A

Blood that is shunted

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8
Q

What is the result of 70-90% metabolism

A

Increased plasma levels

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9
Q

What has to happen to pro drugs to become active? Give an example of a pro drug

A

They need to be metabolised first

Codeine

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10
Q

What happens to the plasma volume if albumin is low

A

The plasma level is low

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11
Q

What is aldosterone?

A

A steroid with a complex structure

No steroid is well metabolised in the liver

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12
Q

What do patients with aldosteronism require and why

A

IV vitamins all the time to prevent brain damage

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13
Q

What happens to the plasma concentration of hormones

A

It increases as the liver cannot metabolise them very well

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14
Q

Why can male alcoholics get female characteristics?

A

Because they dont metabolise oestrogen so it builds up in their body

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15
Q

What happens to a patient with hepato-renal syndrome>

A

It is very hard to reverse and there is a high mortality rate as the kidney is basically falling apart

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16
Q

What type of drugs can induce renal failure?

A

NSAID as they get rid of protoglandins

17
Q

describe 3 signs of moderate hepatic impairment

A

Decrease renal clearance
effect on unbound drug masked by decrease protein binding
renal function reduced

18
Q

describe 3 consequences of moderate hepatic impairment

A

Gut oedema
Liver and kidney congestion
Gross oedema and ascites
CHF

19
Q

Name 8 adverse affects of NSAIDs

A 
UGI ulcer complications
CV toxicity
Hypertension
CHF
Sodium Retention
Asthma
Diarrhoea / Colitis
Renal Failure
20
Q

What should always be co-prescribed with a proton pump inhibitor (PPI)

A

NSAID or COX2 inhibitor

21
Q

Describe the prescribing cascade

A

One drug that is prescribed may give unwanted side effects which have to be treated with another drug. This is not cost effective

22
Q

Why might the diaphragm not be able to be pushed down in breathing?

A

Ascities - fluid blocks it

23
Q

What are the phases of drug metabolism

A

Phase 1 (early) and phase 2 (late)

24
Q

What drugs are are best for treating early stages of lvier disease?

A

Phase 2 metabolised drugs so that they will be properly metabolised

25
Q

Name some drugs which have reduced metabolism

A 
Opiates (codeine)
Benzodiazepines
Chlormethiazole
Cyclosporin
Metronidazole
Calcium blockers
26
Q

How long does it take for symptoms of a paracetamol overdose to appear?

A

Around 4 days

27
Q

What does alcohol do to the receptors

A

It blocks the receptors if it is on board which is good

28
Q

What happens for chronic alcoholics and paracteramol

A

It gets metabolised faster which is worse for the patient

29
Q

Name 4 effects of Paracetamol in liver disease

A

reduced glutathione stores
longer half-life
increased P450 in acloholics
Toxicity with normal doses

30
Q

Name 2 other drugs which cause liver disease

A

Flucloxiclav and Amoxicillin

31
Q

Is drug induced liver injury more common in men or women

A

Women

32
Q

What is the best diuretic to give in liver disease?

A

Spironolactone

33
Q

What are the requirements for patients to be on spironolactone?

A 
Fluid restriction (1L)
Use at high doses
1kg/day weight loss (aim)
34
Q

Are antibiotics safe to give in liver disease?

A

Yes

35
Q

What are the worst hepatic disorders?

A

Fulminant hepatic failure
Decompensated cirrhosis
severe acute or chronic hepatitis
severe congestive heart failure

36
Q

What is the main message of drugs and liver disease

A

Dose reduction regardless of the route of elimination of drug or metabolite

37
Q

Name some general principles in presribing in liver disease

A 
Avoid pro drugs
Use drugs with renal excretion
Be wary of sedatives, CNS drugs, anticoagulants, NSAIDs, theophyllines, aminoglycosides
high inter-inividual variability
Liver tests not predictive 
Start low, go slow

Gastro (67 decks)

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