Liver disease is a widespread and increasing problem throughout the world, however little is published on how different types and degrees of liver dysfunction affect the body's ability to handle medicines."Drugs and the Liver" is designed to assist practitioners in making pragmatic choices for their patients. It aims to: enable the practitioner to assess liver function using biochemical markers, other tests, signs, symptoms and disease knowledge; identify which pharmacokinetic and pharmacodynamic parameters of a drug are likely to be affected by different types of liver disease; and consider the impact of a drug's side effects on a patient with liver disease.This practical guide covers background information on liver function, the principles of drug use in liver disease and includes a section of worked examples of commonly asked questions. It will be invaluable to clinical pharmacists and anyone making medicine choices in patients with liver impairment.
Author(s): Penny North-Lewis
Edition: 1
Publisher: Pharmaceutical Press
Year: 2008
Language: English
Pages: 345
Cover......Page 1
Table of contents......Page 6
Preface......Page 8
About the editor......Page 10
Contributors......Page 12
Acknowledgements......Page 16
Introduction......Page 18
Part One Understanding liver function......Page 20
Introduction......Page 22
Embryology......Page 23
Anatomy......Page 24
Cellular biology of the liver......Page 31
Biliary tree and gallbladder......Page 37
Guided further reading......Page 39
References......Page 40
Introduction......Page 42
Protein handling......Page 44
Carbohydrate handling......Page 50
Lipid handling......Page 52
Bile......Page 56
Hormone inactivation......Page 62
Immunological function......Page 65
Further reading......Page 66
Classification of liver disease......Page 68
Causes of liver disease......Page 73
Guided further reading......Page 90
References......Page 91
Introduction......Page 92
Liver function tests (LFTs)......Page 94
Other tests carried out in suspected hepatobiliary dysfunction......Page 105
Signs and symptoms of liver dysfunction......Page 108
Methods of grading overall liver function......Page 116
Guided further reading......Page 118
Part Two Principles of drug use in liver disease......Page 120
Introduction......Page 122
Hepatic disease and drug pharmacokinetics......Page 123
Pharmacokinetic principles......Page 124
Hepatic clearance......Page 127
Biliary excretion......Page 131
Drug metabolism in liver disease......Page 132
Altered drug metabolism in liver disease......Page 135
Effects of liver disease on the pharmacokinetics of hepatically cleared drugs......Page 142
References......Page 145
Hepatotoxicity......Page 154
Biliary effects......Page 155
Gastrotintestinal effects......Page 156
Neurological effects......Page 157
Haematological effects......Page 158
Renal effects......Page 159
References......Page 161
Part Three Putting the theory into practice......Page 164
Part 3 Outline......Page 166
How will this section help you?......Page 167
Introduction to the treatment choice scenarios......Page 169
Applying the principles to your patient: what information do you need to obtain and where can you find it?......Page 171
References......Page 174
Step 1: Gathering patient information......Page 176
Step 2: Drug information......Page 183
Conclusions......Page 185
Reference......Page 188
Summary......Page 190
Pharmacokinetics of paracetamol......Page 191
Some relevant adverse effects......Page 193
Some relevant drug interactions......Page 195
Clinical studies......Page 196
Summary......Page 197
Pharmacokinetics......Page 198
Some relevant adverse effects......Page 201
Clinical studies......Page 204
Summary......Page 206
Some relevant adverse effects......Page 212
Some relevant drug interactions......Page 213
Clinical studies......Page 214
Patient 1 – Mild hepatitis without cirrhosis......Page 216
Patient 2 – Cholestasis......Page 217
Patient 3 – Compensated cirrhosis......Page 219
Patient 4 – Decompensated cirrhosis......Page 223
Patient 5 – Acute liver failure......Page 224
References......Page 226
Summary......Page 230
Pharmacokinetics......Page 233
Some relevant adverse effects......Page 234
Some relevant drug interactions......Page 235
Clinical studies......Page 236
Patient 1 – Mild hepatitis without cirrhosis......Page 238
Patient 3 – Compensated cirrhosis......Page 239
Patient 4 – Decompensated cirrhosis......Page 240
Patient 5 – Acute liver failure......Page 241
References......Page 242
Summary......Page 244
Background......Page 247
Pharmacokinetics......Page 248
Some relevant adverse effects......Page 256
Hepatic adverse effects......Page 258
Some relevant drug interactions......Page 262
Patient 1 – Mild hepatitis without cirrhosis......Page 265
Patient 2 – Cholestasis......Page 267
Patient 3 – Compensated cirrhosis......Page 269
References......Page 272
Introduction......Page 276
Summary......Page 277
Pharmacokinetics......Page 279
Some relevant drug interactions......Page 283
Clinical studies and case reports......Page 284
Patient 1 – Mild hepatitis without cirrhosis......Page 288
Patient 2 – Cholestasis......Page 289
Patient 3 – Compensated cirrhosis......Page 290
References......Page 291
Summary......Page 294
Pharmacokinetics......Page 296
Some relevant adverse effects......Page 299
Some relevant drug interactions......Page 301
Clinical studies......Page 302
Patient 1 – Mild hepatitis without cirrhosis......Page 307
Patient 2 – Cholestasis......Page 308
Patient 4 – Decompensated cirrhosis......Page 309
References......Page 310
Patient 1 – Mild hepatitis without cirrhosis......Page 314
Patient 2 – Cholestasis......Page 316
Patient 3 – Compensated cirrhosis......Page 318
Patient 4 – Decompensated cirrhosis......Page 320
Patient 5 – Acute liver failure......Page 322
Appendix 2 Drugs in liver dysfunction –
blank aide mémoire form......Page 324
Index......Page 328
