1.
Pain control in patients with hepatic disease
(1) Avoid : NSAIDs (GI toxicity, 잠재적 신부전의 위험), Opioid
(2) Use
① Acetaminophen (short term, < 2g/day)
② Gabapentin & pregabalin (neuropathic pain)
③ Fentanyl & tramadol (reduced dose, increased dosing interval)
④ Propofol (sedation)
2.
Medication dose adjustment (다음 페이지 Table 80-4 참조해주십시오)
(1) Be careful with drugs with a narrow therapeutic range and high toxicity
(2) Drugs with high hepatic extraction may have clinically significant increased bioavailability
in cirrhotic patients → Reduce the initial and maintenance doses
(3) Drugs with intermediate hepatic extraction, initially use the low range of the normal dose
and reduce maintenance dosing
(4) Drugs with low hepatic extraction, initial dosing remains unchanged, but reduce the
maintenance dose
3.
Pregnancy
•
HELLP syndrome (Hemolysis, Elevated Liver enzyme, Low PLT)
(1) Third trimester~postpartum period
(2) HTN (80~90%), Proteinuria (85~100%), Headache, Malaise, Nausea, Vomiting
(3) 34주 이상에서는 분만이 definitive treatment, 그 외 Ch 100 참고
1.
Liver transplant patient
(1) 통이나 압통이 없어도 rejection of transplant 생각해야 한다
(2) Rejection 증상은 모호할 수 있고 nausea, vomiting, malaise, anorexia, jaundice 등 포함
•
Ch 297 참고
