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SETYO PURWONO
PHARMACOLOGY & TOXICOLOGY
DEPARTMENT
FACULTY OF MEDICINE, GMU
Liver Diseases - Management
MECHANISM OF ACTION
inhibits RNA- and DNA-dependent DNA polymerase
activities of reverse transcriptase.
ADVERSE REACTIONS
>10%:
Central nervous system: Headache, fatigue
Gastrointestinal: Nausea, diarrhea, vomiting, pancreatitis
Neuromuscular & skeletal: Peripheral neuropathy,
paresthesia, musculoskeletal pain
Adefovir
Mechanism of action
works by blocking reverse transcriptase,
an enzyme that is crucial for the hepatitis B virus
(HBV) to reproduce in the body.
approved for the treatment of
chronic hepatitis B in adults with active viral replication
persistent elevations in serum aminotransferases
(primarily ALT) or histologically active disease.
Interferons
Interferons (IFN)
glycoproteins released from virus-infected cells.
MECHANISM OF ACTION
Induction of gene transcription.
Inhibits cellular growth, alters the state of cellular
differentiation, interferes with oncogene
expression, alters cell surface antigen
expression, increases phagocytic activity of
macrophages, and augments cytotoxicity of
lymphocytes for target cells
Interferons
Interferons (alpha-2a (Roferon-A®) or alpha 2-b (Intron-A®))
– chronic HCV and HBV
– use alpha-2b (more clinical experience)
– SC or IM (about 3-5 MIU 3 times a week)
– approx 50% effectiveness
– early side effects - influenza-like
use paracetamol
– late SE’s
BM suppression, thrombocytopaenia,
granulocytopaenia
worsening of influenza-like syndrome
PHARMACO KINETICS
Distribution: Vd: 0.223-0.748 L/kg
up to 92%
Flu-like symptoms are common
>10%:
Cardiovascular: Chest pain , edema , hypertension
Central nervous system: Psychiatric disturbances
Dermatologic: Rash, alopecia, pruritus, dry skin
Endocrine & metabolic: Hypocalcemia, hyperglycemia,
transaminases increased ,alkaline phosphatase
increased (48%)
Portal hypertension
Octreotide infusion
(50-100 mcg bolus and 25 - 50 mcg/hr gtt)
should be started in patients with suspected or
known liver disease and UGI bleeding
- Metronidazole , Neomycin
Neomycin
– non absorbable (although some is)
oral and rectal
2 - 4g per day - care nephrotoxicity!!
Lactulose
disaccharide lactic and acetic acid - prevents
absorption of ammonia by changing pH
– also acts as osmotic laxative
– dose is about 40 - 80ml per day
Pharmacotherapy
GALLSTONE DISEASE
Gallstones Epidemiology