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Consider… LFTs – INR, ALT, ALP, AST, GGT, bilirubin, albumin and pattern of change SIGNS AND SYMPTOMS OF LIVER DISEASE – eg. ascites, oesophageal varices, jaundice, encephalopathy CAUSE OF LIVER IMPAIRMENT – chronic (eg. alcoholic liver disease) or acute (eg. drug induced) CREATININE – ensure no hepato-renal syndrome/renal impairment if using medications which are renally cleared PHARMACOKINETICS – favourable characteristics in liver impairment are renal excretion, short half-life, low protein binding, no high first-pass metabolism, no active metabolites and no enterohepatic recirculation PHARMACODYNAMICS – avoid or use with caution any medications with side effects which might worsen signs/symptoms of liver disease (eg. blood thinning, oesophageal reflux, fluid retention, sedation/CNS activity, constipation, hepatotoxic) HEPATOTOXICITY – consider current drug causes, hold/suspend any non-essential medications which may cause severe/fatal hepatotoxicity |
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