![Page 1: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/1.jpg)
Prescribing in Disease
Clive Roberts
![Page 2: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/2.jpg)
So what are drugs good at treating (or preventing)?
• Pain• Inflammation• Infection• Fluid retention• Heart problems• High blood pressure• Epilepsy• Parkinsonism• Asthma / COPD• Peptic ulcer disease
• Diarrhoea/constipation• Depression• Anxiety/sleeplessness• Psychosis• Metabolic /endocrine
diseases• Malignant disease• Degenerative disease• Haematological
problems• Etc Etc
![Page 3: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/3.jpg)
![Page 4: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/4.jpg)
![Page 5: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/5.jpg)
![Page 6: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/6.jpg)
![Page 7: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/7.jpg)
![Page 8: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/8.jpg)
What could happen to this man?
1) Massive fluid overload
2) Hepatic encephalopathy
3) Gross electrolyte abnormality
4) Renal Failure
5) GI or other Haemorrhage
6) Metabolic abnormaility
7) Exacerbation of liver disease
8) Infection
9) Drug accumulation
![Page 9: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/9.jpg)
And so the risks of drug use in decompensated liver disease
• Precipitate encephalopathy– CNS effect
– Electrolyte effect
– GI effect
• Worsen metabolic effect/features of hepatic failure– Fluid retention
– Sodium retention
– Electrolyte abnormality
– Hypoglycaemia
– Clotting abnormalities
![Page 10: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/10.jpg)
Continued:
• Profound pharmacokinetic disturbance leading to drug accumulation and dose related adverse effects– Decreased systemic clearance of lipid soluble drugs– Increased bioavailability of drugs with high extraction ratio– Decreased plasma protein binding– Altered apparent volume of distribution– Associated impairment of renal function– Failure of pro-drugs– Hepatic blood flow reduction
• Worsened hepatic state – Hepatotoxic drugs
![Page 11: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/11.jpg)
Some examples from the BNF table
• Anticoagulants• Antidepressants, anxiolytics and hypnotics• Anti-psychotics• NSAIDs• Diuretics• Phenytoin, Carbamazepine• Glibenclamide• Opioids• Rifampicin
![Page 12: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/12.jpg)
• Co-amoxyclav, clarythromycin, erythromycin, ketoconazole, isoniazid
• Chloramphenicol• Clopidogrel• Cyclophosphamide, methotrexate• Lignocaine• ACE inhibitors• Metformin• Verapamil and some dihydropyridine Ca
blockers
![Page 13: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/13.jpg)
• Statins
• Antacids
• Theophylline
![Page 14: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/14.jpg)
Other risk situations• Renal disease• The Elderly• Need for many drugs• Allergy• Lung disease • Heart disease• Gastrointestinal disease• Inherited diseases• Blood diseases• Bone disease• Skin disease• Pregnancy
![Page 15: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/15.jpg)
The renal patient
• Pharmacokinetic disturbance – Mainly affecting drug clearance– Also protein binding
• Increased sensitivity
• Poor tolerance of adverse effects
• Decreased effectiveness of some drugs
![Page 16: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/16.jpg)
Drugs in the elderly
• Multiple indications leads to polypharmacy
• Pharmacokinetic disturbance of metabolism, excretion, protein binding and drug distribution
• Increased sensitivity to the actions of drugs on CVS, CNS, GIT
• Poor tolerance of adverse effect
![Page 17: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/17.jpg)
Other risk situations• Renal disease• The Elderly• Need for many drugs• Allergy• Lung disease • Heart disease• Gastrointestinal disease• Inherited diseases• Blood diseases• Bone disease• Skin disease• Pregnancy
![Page 18: Prescribing in Disease Clive Roberts. So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High](https://reader035.vdocuments.us/reader035/viewer/2022062619/5515e2b6550346d46f8b4da5/html5/thumbnails/18.jpg)
Remember
• Every disease represents a potential contra-indication to particular drugs
• Prescribing any drug should only follow a decision that potential benefit outweighs potential risk