wk 8 1 drugs and liver disease

Question 1

what scale is used to determine degrees of liver dysfunction, what score indicates disease with significant functional compromise

Answer 1

Child-pugh classification
7-9 (1 yr - 80%)
10+ = decompensated liver disease

Question 2

patient with severe liver disease requires oral dosing

Answer 2

true

Question 3

an impaired liver will lead to the increase in what hormones

Answer 3

endothelin and oestrogen (gynacomastia)

Question 4

impaired liver leads to heightened levels of angiotensin II, aldosterone, SNS, ADH, endothelin, directed to kidney. explain the effect

Answer 4

K loss, Na & H20 retention (ascites)

aldosteron and endothelin will cause renal vasoconstriction, pushing out renal prostaglandins

Question 5

define moderate hepatic impairment 3

Answer 5

decrease in real clearance
decrease protein binding to drugs, more toxic
renal function reduced

Question 6

consequences of moderate hepatic impairment

Answer 6

gut oedema - poor absorption
liver and kidney congestion - reduced function
gross oedema and ascites
congestive heart failue

Question 7

NSAIDS may be used in hepatic liver disease, explain the effect

Answer 7

reduce synthesis of PGE

• worsen renal impairment by incr sodium retention
• hepato-renal syndrome (renal failure due to liver fulminant liver failure)
• congestive heart failure

Incr peptic ulcers
-incr risk of GI bleed

Question 8

what is the nice guideline to treatment of pain from liver disease

Answer 8

NSAID/COX2 inhibitor
AND
PPI

Question 9

NSAID, Diuretics or Metoclopramide can be prescribed for liver disease. Each has an adverse effect, what drug would be given in response to each

Answer 9

NSAID - incr BP - Anti Hypertensive

Diuretic - Gout - Gout Rx

Metooclopramide - Parkinsonism - L-DOPA

Question 10

drug metabolism can be broken into 2 phases, phase I (P450) and II, explain each

Answer 10

I - Oxidation, Reduction, Hydrolysis (more polar) (biotransformation)

II Conjugation (glucoronidation)

Question 11

give some examples of drugs which would be reduced less in liver disease

Answer 11

Opiates
Benzodiazepines
Chlormethiazole
Cyclosporins
Metronidazole
Ca blocker

Question 12

t/f paracetamol at normal doses for alcoholics is toxic

Answer 12

true

Question 13

explain why paracetamol to alcoholics could be toxic

Answer 13

reduced glutathione stores which increase half-life

Question 14

max given of paracetamol in practice

Answer 14

1g twice daily, dont exceed 3g

Question 15

what is Hy’s rule

Answer 15

ALT/AST > 5x(Upper limit of normal)
Bilirubin > 3mg/dl
(high risk of fatal drug induced liver disease if hepatocellular injury and jaundice - not cholestatic)

Question 16

t/f drug induced liver injury is more common in men

Answer 16

false

Question 17

which diuretic is appropriate for ascites

Answer 17

spironolactone (aldosterone anatagonist)

Question 18

sedation may be required, what drugs are safe to give in liver disease

Answer 18

phase II metabolised benzodiazepines
Lorazepam
Oxazepam
Lormetazepam

Question 19

3 types of antibiotics that are not safe in liver disease

Answer 19

Aminoglycosides (nephrotoxic)
Floroquinolones (epileptogenic)
Metronidazole (reduced metabolism)