Ursodeoxycholic acid
Gallstone Buster: Diet & Med Mix!
As a nutritional support pharmacist, you should know that gallstones are closely linked to diets rich in animal fat and protein, lacking in fiber. Traditional Asian and African diets, predominantly plant-based, show lower incidences of gallstones compared to Westernized diets. Key dietary factors associated with reduced gallstone risk include... Plant-based Die…
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Nutrition
Nutrition guide for CIRRHOSIS patients
As a nutrition support pharmacist, you will be asked more about the recent recommendations to ensure proper nutrition in patients with cirrhosis . Malnutrition is a significant concern for patients with cirrhosis, affecting up to 20% of those with compensated cirrhosis and 50% of those with decompensated cirrhosis . A state of malnutrition in cirrhosis has also been…
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GIT and Liver
Appropriate treatment for acute variceal bleeding
As a clinical pharmacist, you must be kept up to date. One-third of patients with varices will have variceal bleeding , the most life-threatening complication of cirrhosis . Expect patients to be resuscitated with fluids and blood if needed, then to have an endoscopy within 12 hours for esophageal banding. Start an octreotide bolus f…
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Terlipressin
Assess TERLIpressin for Hepatorenal Syndrome
As a clinical pharmacist, you should evaluate the use of terlipressin for hepatorenal syndrome. Terlipressin ( Glypressin, Haemoxamine ) will be the first FDA-approved medication for hepatorenal syndrome with acute kidney injury (HRS-AKI). HRS-AKI typically occurs in patients with cirrhosis and ascites who develop splanchnic vasodilation. This causes decreased perf…
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Meds in Liver Disease
Using of albumin for decompensated liver disease
As a hospital pharmacist, you’ll be asked about the role of IV albumin in patients hospitalized with acute decompensated liver disease . New evidence shows that giving these patients DAILY albumin to raise and maintain levels above 3 g/dL does NOT reduce infection, kidney dysfunction, or death. Plus albumin may increase pulmonary edema risk, and It is also expensiv…
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Meds in Liver Disease
Myths about drugs in chronic LIVER disease
As a pharmacist, you will hear myths perpetuated about medications in chronic liver disease. This means that patients with viral hepatitis, fatty liver disease , or cirrhosis can miss out on appropriate therapy. Get our note, " Prescribing medications in patients with liver cirrhosis "... Myth 1. Medications often impair liv…
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GIT and Liver
Safety of using anticoagulants in patients with cirrhosis
As a hospital pharmacist, you'll see anticoagulants used more often to treat thrombosis in patients with cirrhosis . We're used to thinking of these patients as having an increased bleeding risk due to impaired clotting factor production and thrombocytopenia. But don't consider them "auto-antico…
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Infectious Diseases
Pay attention when STARTING medications in patients taking hepatitis C antivirals
As a pharmacist, you'll face MANY potential drug interactions with hepatitis C antivirals ( Epclusa [ Qurevo ], Mavyret , etc) even if you didn't start these medications. Interactions can lead to toxicity or treatment failure. And this can be an expensive mistake. Plus, hepatitis C medications may fly under the radar if the physician didn't prescribe the…
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GIT and Liver
Prescribing medications in patients with liver cirrhosis
Overview ― The liver is responsible for the selective uptake, concentration, metabolism, and excretion of most drugs. Both prescription and over-the-counter medications can cause hepatotoxicity through a variety of mechanisms. Measures such as drug dose adjustment can help prevent adverse drug reactions (e.g., acute kidney injury) in patients with cirrhosis. …
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GIT and Liver
Clinical management of ascites
OVERVIEW ㅡ Ascites is a pathological accumulation of fluid in the peritoneal cavity . There are two broad categories of ascites... (1) Associated with a normal peritoneum . (2) Due to a diseased peritoneum ( see Table 1 ) . Most common cause is portal hypertension secondary to chronic liver disease (> 80% of cases) . Other …
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Terlipressin
Pharmacotherapy of cirrhosis
Overview ㅡ Cirrhosis is defined as diffuse injury to liver characterized by destruction of hepatocytes and their replacement by fibrous tissue. Typically, the disease develops slowly over months or years. Early on, there are often no symptoms. As the disease worsens, a person may become tired, weak, itchy, have swelling in the lower legs, develop yellow skin (elevat…
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