Flashcards in Prescribing in Liver and Renal Disease Deck (15)
Outline the stages of CKD
1 = GFR >90
2 = GFR 60-90
3 = GFR 30-60
4 = GFR 15-30
5 = GFR <15
What's the best indicator of liver synthetic function?
What's a good long-term indicator of liver function?
What is the Child Pugh scoring system used for?
Subjective system to predict death in non-transplanted patients. Can be done at bedside
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.
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
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.
Evaluate the use of the MDRD formula to calculate eGFR
Doesn't take into account weight, so is inaccurate at extremes of weight
Name important drugs that can cause liver enzyme inhibition
– Antibiotics (erythromycin, ciprofloxacin, metronidazole, sulphonamides, chloramphenicol, isoniazid)
– Ethanol (acute)
– Diltiazem, verapamil
– Sodium valproate
– 5HT reuptake blockers
– Protease inhibitors
Name important drugs that can cause liver enzyme induction
– Phenobarbitone, other barbiturates
– Ethanol (chronic)
– St John’s wort
Which drug, if prescribed in chronic liver disease, increases the risk of developing SBP?
Which drugs can cause drug-induced hepatitis (raised ALT/AST)
o Dose-dependent: paracetamol, alcohol, azathioprine
o Dose-independent: isoniazid, rifampicin, pyrazinamide, amiodarone, nifedipine
Which drugs can cause drug-induced cholestasis (raised bilirubin/ALP)?
Chlorpromazine, chlorpropamide, erythromycin, nitrofurantoin, nifedipine, statins and co-amoxiclav
After the age of 40, how does the GFR change every year?
Decreases each year by 0.8ml/min