Beruflich Dokumente
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CholestasisMedication
Updated:Aug21,2015
Author:HishamNazer,MB,BCh,FRCP,,DTM&HChiefEditor:CarmenCuffari,MDmore...
MEDICATION
Cholereticagents
ClassSummary
Ursodeoxycholicacidactstoincreasebileformationandantagonizestheeffectofhydrophobicbile
acidsonbiologicalmembranes.
Ursodeoxycholicacid(Actigall,Urso)
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Showntopromotebileflowincholestaticconditionsassociatedwithapatentextrahepaticbiliary
system.Decreasesthecholesterolcontentofbileandthereforereducesbilestoneandsludge
formation.
Barbiturates
ClassSummary
Theseagentsareusedtoinducehepaticenzymemetabolisminordertodecreaseserumbilirubin
levelsinsomepatientswithcholestasisinordertoimprovefunction.
Phenobarbital(Luminal)
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Mainlyusedasananticonvulsant,whichinterfereswithtransmissionofimpulsesfromthalamusto
cortexofbrain,resultinginimbalanceincentralinhibitoryandfacilitatorymechanisms.Usedin
cholestasistoinducetheCYP450systemintreatmentofneonatalhyperbilirubinemiaandloweringof
bilirubininchroniccholestasis.
Vitamins
ClassSummary
FatsolublevitaminsA,D,E,andKmustbeadministeredasindividualsupplementstoassureproper
absorption.
Phytonadione(AquaMEPHYTON)
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VitaminK.Fatsolublevitaminabsorbedbythegutandstoredintheliver.Necessaryforthefunction
ofclottingfactorsinthecoagulationcascade.Usedtoreplaceessentialvitaminsnotobtainedin
sufficientquantitiesinthedietortofurthersupplementlevels.
VitaminE(LiquiE)
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VitaminE.Preventionandtreatmentofhemolyticanemiasecondarytovitamindeficiencyorneedfor
dietarysupplementation.Protectspolyunsaturatedfattyacidsinmembranesfromattackbyfree
radicalsandprotectsRBCagainsthemolysis.
VitaminA(AquasolA)
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Neededforbonedevelopment,growth,visualadaptationtodarkness,testicularandovarianfunction,
andasacofactorinmanybiochemicalprocesses.
Ergocalciferol(Drisdol,Calciferol)
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VitaminD.Stimulatesabsorptionofcalciumandphosphatefromsmallintestineandpromotesrelease
ofcalciumfromboneintoblood.POsolutioncomesas8000U/mL(200mcg/mL,40U/mcg).
Opioidantagonists
ClassSummary
Theseagentsareusedtoalleviateprurituscausedbycholestasis.Theyblockopioidmediated
pathwaysofafferentnerves,whichmaybeproducingtheitchingsensation.
Naltrexone(ReVia)
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Cyclopropylderivativeofoxymorphonethatactsasacompetitiveantagonistatopioidreceptors.Do
notadministerthismedicationuntilthepatientisopioidfreefor710d.Availableas50mgtab.
Bilesaltresins
ClassSummary
Bileacidbindingresinsformanonabsorbablecomplexwithbileacidsintheintestine,whichinhibits
enterohepaticreuptakeofintestinalbilesaltsandtherebyincreasesthefecallossesofbilesaltbound
lowdensitylipoproteincholesterol.
Cholestyramine(Questran,Prevalite)
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Mayuseasadjunctinprimaryhypercholesterolemia.Formsanonabsorbablecomplexwithbileacids
intheintestine,which,inturn,inhibitsenterohepaticreuptakeofintestinalbilesalts.Dosebasedon
resincontent.
Antibiotics
ClassSummary
Antitubercularagentsinduceliverenzymesandamelioratepruritussecondarytocholestasis.
Rifampin(Rimactane,Rifadin)
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InhibitsRNAsynthesisinbacteriabybindingtobetasubunitofDNAdependentRNApolymerase,
which,inturn,blocksRNAtranscription.
Followup
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