Prescribing in Liver and Renal Disease Flashcards Preview

Year 3: CSP & PH > Prescribing in Liver and Renal Disease > Flashcards

Flashcards in Prescribing in Liver and Renal Disease Deck (15)
1

Outline the stages of CKD

Stage:
1 = GFR >90
2 = GFR 60-90
3 = GFR 30-60
4 = GFR 15-30
5 = GFR <15

2

What's the best indicator of liver synthetic function?

Prothrombin time

3

What's a good long-term indicator of liver function?

Abumin

4

What is the Child Pugh scoring system used for?

Subjective system to predict death in non-transplanted patients. Can be done at bedside

5

What is the MELD scoring system used for?

Objective calculation to predict death in cirrhotic patients. Can't be done at bedside, as it requires calculations.

6

Evaluate the use of serum creatinine as an indicator of kidney injury

Dependent on muscle mass and is only elevated once 50% of renal function is lost

7

How is an eGFR calculated using the MDRD formula?

Uses age, creatinine levels, race (add 1.21 for african/afro-caribbean) and 0.742 for women and 1 for men.

8

Evaluate the use of the MDRD formula to calculate eGFR

Doesn't take into account weight, so is inaccurate at extremes of weight

9

Name important drugs that can cause liver enzyme inhibition

– Antibiotics (erythromycin, ciprofloxacin, metronidazole, sulphonamides, chloramphenicol, isoniazid)
– Allopurinol
– Amiodarone
– Cimetidine
– Ethanol (acute)
– Ketoconazole
– Diltiazem, verapamil
– Omeprazole
– Sodium valproate
– Quinidine
– 5HT reuptake blockers
– Protease inhibitors

10

Name important drugs that can cause liver enzyme induction

– Rifampicin
– Phenytoin
– Phenobarbitone, other barbiturates
– Carbamazepine
– Ethanol (chronic)
– Sulphonylureas
– Nevirapine
– St John’s wort

11

Which drug, if prescribed in chronic liver disease, increases the risk of developing SBP?

PPIs

12

Which drugs can cause drug-induced hepatitis (raised ALT/AST)

o Dose-dependent: paracetamol, alcohol, azathioprine
o Dose-independent: isoniazid, rifampicin, pyrazinamide, amiodarone, nifedipine

13

Which drugs can cause drug-induced cholestasis (raised bilirubin/ALP)?

Chlorpromazine, chlorpropamide, erythromycin, nitrofurantoin, nifedipine, statins and co-amoxiclav

14

After the age of 40, how does the GFR change every year?

Decreases each year by 0.8ml/min

15

What drugs can increase the risk of developing renal stones/crystals?

Directly precipitate crystals: acyclovir, HIV protease inhibitors, methotrexate

Indirectly increase crystals developing: orlistat, allopurinol