Farmasi Klinik Dan

Komunitas
Elly Wahyudin
Program Studi Magister Ilmu Farmasi
UNHAS
 MONITORING PATIENTS
WITH LIVER DISEASES

 Common symptoms of liver disease

 Drug-induced liver damage
 Changes in pharmacokinetics in liver disease
 Clinical pharmacy – liver cheklist
 Acute liver disease : general symptoms of
lethargy, anorexia and malaise and jaundice,
but present asymptomatically
 Chronic liver disease can be asymptomatic
and clinically identified through abnormal
biochemistry. Late presentation shows
complications for liver disuse such as ascites,
haematemesis, melaena, confusion and
drowsiness. Other symptoms include pruritus,
with or without signs of systemitic disease
 Bilirubin
 enzymes
 Aminotransferases
 Alkaline phosphatase
 Gamma-glutamyl transpeptidase
 Albumin
 Coagulation factors, prothrombin
• Propranolol
• Morphine
• Clomethiazole
• Glyceryl trinitrate
• Diazepam
• Phenytoin
• Chloramphenicol
• Paracetamol
• theophylline
Prescription items
 Lactulose high-dose, e.g. 30-40ml q.d.s.
 Neomycin
 Metronidazole
 Spironolactone
 Furosemide or metolazone
 Magnesium salts
 Vasopressin
 Octreotide
 Omeprazole
Prescription items
 Lamivudine
 Magnesium salts
 Chlorpheniramine
 Cholestyramine
 Vitamin K
 Multivitamins
 Ranitidine
 Bile salts
 Clomethiazole
The patient may be on the following
 Low-sodium diet
 Low-protein diet
 Sedatives restricted
The patient’s physical appearance or clinical
symptoms may be useful
Look for :
 Fatigue, generally run down and weight loss
 Girth measurements
 Skin sclera looks yellow
 Spider naevi
 Red palms
 Clubbing
 Dupuytren’s contracture
 Confusion
 Ascites
 Oedema – lower-limb swelling
The patient may be monitored
Look for :
 Liver function tests
 Haematology screen
 Specific markers
Routine monitoring of laboratory tests
 Transaminases
 Gamma-glutamyl transferase
 Alkaline phosphatase
 Bilirubin
 Serum albumin