Prescribing in liver disease

  • Created by: MazzaW
  • Created on: 07-12-19 16:44

Drugs that undergo extensive 1st pass hepatic metabolism: aspirin, nitrates, levodopa, lidocaine, opiates (especially morphine), propranolol, salbutamol

Ways that liver disease can alter response to drugs:

  • impaired drug metabolism
  • hypoproteinaemia (so more free drug)
  • decreased clotting
  • hepatic encephalopathy may be precipitated by some drugs e.g. diuretics, benzodiazepines
  • fluid overload (especially with drugs containing sodium)
  • hepatotoxic drugs: paracetamol, isoniazid, statins, methotrexate, phenytoin
  • many Abx are affected: hepatotoxicity, adverse effects, BM suppression

Effect on pharmacokinetics:

  • drug accumulation
  • failure to form active/inactive metabolite
  • increased bioavailability after oral administration
  • alteration…


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