Objectives
•
Know the normal functions of the liver
•
Be aware of the prevalence and causes of the common non-infectious liver diseases
•
Be able to interpret various biochemical tests as a guide to liver function
•
Know the clinical signs and symptoms of liver disease
•
Know the common drugs which may cause liver disease
•
Be able to advise on the use of drugs in the management of the complications of liver
disease
•
Be aware of the limitations of drug use in patient’s with significant liver diseases
Multiple Choice Questions
1. Which of the following types of liver disease is the MOST common in Australia?
a) Primary liver cancer
b) Secondary cancer from bowel cancer
c) Fatty liver
d) Alcoholic liver disease
e) Drug induced liver disease
2. Which of the following liver function test results would be MOST consistent with cholestatic
jaundice?
Alkaline
Alanine
Gamma glutamyl
Bilirubin
Phosphatase
Aminotransferase
transpeptidase
Reference Range
<20 micromol/L
35-135 IU/L
<36 IU/L
<60 IU/L
a)
10
38
23
21
b)
16
400
37
33
c)
28
240
40
110
d)
36
140
123
187
e)
42
56
28
32
3. Which of the following is LEAST likely to be a common clinical consequence of chronic
advanced liver disease?
a. Oesophageal varices
b. Portal hypertension
c. Hypoalbuminaemia
d. Elevated Ammonia Levels
e. Diarrhoea
4. Which ONE of the following drugs is LEAST likely to be used to directly manage the
complications of chronic liver disease?
a. Vitamin D
b. Vitamin K
c. Spironolactone
d. Propranolol
e. Neomycin
5. Of the following drugs, which ONE is LEAST likely to be responsible for cholestatic jaundice?
a. Flucloxacillin
b. Glibenclamide
c. Erythromycin
d. Chlorpromazine
e. Sodium valproate
6. Which of the following statements concerning selection of drugs and doses for medications
in patients with liver disease is LEAST appropriate?
a. All drugs that are liver metabolised should not be used in such patients
b. An understanding of the activity and effects of a drug’s liver metabolites will assist in
determining the signs and symptoms to monitor for when using the drug in patients
with liver dysfunction
c. Drugs that are known hepatotoxins should be avoided in patients with liver disease
d. Drugs that are solely metabolised by Phase two processes are better tolerated in
patients with liver disease
e. Patients with liver dysfunction may have a reduced first pass metabolism of
morphine, and the starting dose should be reduced in such patients.