Liver disease treatment choices

Whole and partial liver transplants have become the treatments of choice for patients with imminent liver failure. Advances in surgical techniques and immune suppression are responsible for this progress. Treatments for liver diseases were unknown in the 1960s. Despite our improved knowledge of the function and physiology of the liver, one of every 10 individuals in the U.S. has been or will be diagnosed with liver disease. Hepatitis C virus (HCV) is a public health problem approximately 170 million people are infected worldwide, and 8,000 to 10,000 deaths per year... 

ADH is also elevated in response to diminished effective circulating blood volume. When treatment by volume replacement is not possible, as in heart failure or liver disease, hyponatremia may result. As for SIADH, water restriction is the treatment of choice, but if it is not successful, demeclocycline may be used. 

All the scenarios describe why each of the five patients has different issues that should be taken into account when considering drug choice, thus demonstrating the importance of knowing as much as you can about the patient s liver disease. The scenarios are not all-encompassing and do not include all potential drug treatments. Drugs are included in the options purely to demonstrate some of the principles involved. 

Based on their pharmacokinetic profile alone, the safest statins in chronic compensated liver disease and a history of decompensation are prohahly pravastatin and rosnvastatin. However, clinical experience with rosnvastatin in liver disease is lacking, and so it cannot be recommended. In addition, the true rate of post-marketing adverse drug reactions is not yet clear. Pravastatin is therefore the drug of choice in these patients, where treatment is deemed necessary. It should, however, be avoided in acute episodes until liver function or transaminases stabilise/return to normal. 

Currently, disulfiram, naltrexone, and acamprosate are currently the only treatments approved for the management of alcohol dependence. Studies in animals have demonstrated that a diet enriched in vitamin E and saturated fatty acids reduces alcoholic liver injury by decreasing hpid per-oxidation. " Liver transplantation is the treatment of choice in end-stage liver disease. The results of transplantation in alcoholic liver disease are comparable to those with other forms of hver disease. ... 

Loop diuretics are used in the treatment of edema associated with CHF, cirrhosis of the liver, and renal disease, including the nephrotic syndrome. These drug s are particularly useful when a greater diuretic effect is desired. Furosemide is the drug of choice when a rapid diuresis is needed or if the patient has renal insufficiency. Furosemide and torsemide are also used to treat hypertension. Ethacrynic acid is also used for the short-term management of ascites caused by a malignancy, idiopathic edema, or lymphedema. 

Ivermectin prevents onchocerciasis and is the drug of choice in the individual and mass treatment of the disease. The only other dmgs effective against Onchocerca volvulus are suramin and diethylcarbamazine (not listed in the question). The World Health Organization no longer recommends diethylcarbamazine for onchocerciasis, since it is less effective and more toxic than ivermectin. Suramin is toxic to the kidney, liver, and nervous system and would not be used prophylactically in this case. The answer is (B). 

Liver transplantation is the treatment of choice in patients with fulminant Wilson disease and in patients with decompensated cirrhosis. Besides improving survival, liver transplantation also corrects the biochemical defect underlying Wilson disease. However, the role of this procedure in the management of patients with neurological Wilson disease in the absence of hepatic insufficiency is still uncertain. 

The liver plays an essential role in metabolism, detoxification, and homeostasis. When the liver is injured, these functions are severely impaired and can lead to multiorgan failure and death. Orthotopic liver transplantation is the treatment of choice to restore normal liver functions, but organs are in short supply and patients who receive a transplant must take immunosuppressive medications and are at risk for infection, graft rejection, and disease recurrence. Liver support devices aim to replace the various liver functions to permit organ recovery or serve as abridge to transplantation when spontaneous organ recovery is not possible. A number of devices have been developed that have demonstrated some limited efficacy in clinical trials, but the ideal liver support device is still elusive. 

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