Hepatic disease function effect

AZRI, S. and RENTON, K.W. (1991) Factors involved in the depression of hepatic mixed function oxidase during infection with Listeria monocytogenes. Int. J.Immunopharmacol., 13, 197. HOYIJMPA, A.M. and SCHENKER, S. (1982) Major drug interactions effect of liver disease, alcohol and malnutrition. Rev. Med., 33, 113. 

PRECAUTIONS AND ADVERSE EFFECTS Patients with renal impairment should not receive metformin. Other contraindications include hepatic disease, a history of lactic acidosis, cardiac failure requiring drug therapy, or chronic hypoxic lung disease. These conditions all predispose to the potentially fatal complication of lactic acidosis. Metformin should be discontinued temporarily prior to the administration of intravenous contrast media and prior to any surgical procedure. The drug should not be readministered any sooner than 48 hours after such procedures and should be withheld until renal function is determined to be normal. 

Vecuronium and atracurium. These are commonly used agenUs, Vecuronium has no cardiovascular effects. It depends on hepatic inactivation and recovery can occur within 20—30 minutes, making it an attractive drug for short procedures. Atracurium has a duration of action of 15-30 minutes. It is only stable when kept cold and at low pH. At body pH and temperature it decomposes spontaneously in plasma and llterefore does not depend on renal or hepatic function for its elimination. It is the drug of choice in patients with severe renal or hepatic disease. Atracurium may cause histamine release with flushing and hypotension. 

The characterization of type 2 diabetes has changed over recent years. Previously used terms such as non-insulin-dependent diabetes and adult-onset diabetes are no longer appropriate some individuals with type 2 diabetes do require insulin, and children now have this form of the disease. It is characterized by decreased insulin secretion and insulin resistance, a condition in which insulin is not able to carry out its functions effectively, i.e., it cannot decrease plasma glucose levels via suppression of hepatic glucose and stimulation of glucose use in skeletal muscle and adipose tissne. 

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