Pulgar- Liver, Pancreas, Chelating Agents

uhhh lets see if this goes well

Alcoholic Liver Disease (ALD)

Fatty Acid infiltrates your hepatocytes - Large yellow, greasy liver

No actual symptoms though

Can be reversed with abstinence- If not, will likely get cirrhosis

What is another Enzyme that can digest Ethanol aside from ADH?

CYP2E1

Naltrexone / Revia

Used to treat ALD

μ and κ-opioid Receptor antagonist

Reduces alcohol-induced dopamine release- less reward for drinking

Side Effects: HA, anxiety, N, anorexia, dyspepsia

Dose Dependent hepatic toxicity associated

Nalmefene/Revex

Used to treat ALD

μ and δ-opioid receptor antagonist

Controls Craving for alcohol- No dose dependent Liver toxicity

Acamprosate / Campral

Used to treat ALD

GABA Analogue Inhibitory Neurotransmitter

Fomepizale / Antizol

Competitive inhibitor of Alcohol Dehydrogenase

Used to treat alcohol poisoning (and when you drink antifreeze)

Disulfiram / Antabuse

Inhibits ALDH and increased Blood acetaldehyde

Causes ADEs when Alcohol is consumed, ie HA, N/V Sweating, dizziness, etc.

Anti-cytokine Therapy

TNFa inhibitors like Pentoxifylline, Infliximab, Etanercept, Adalimumab

treat ALD but make more susceptible to infections

SAMe (S-adenosylmethionine)

Anti-inflammatory and anti-oxidant therapy that can help general liver funtion s but has limited help in regenerating liver cells

Benzodiazepines

Used to treat ALD by combatting Alcohol withdrawal syndrome

GABAb agonists that inhibit dopamine excretion mediated by alcohol reinforced behaviors

Drugs associated with reducing alcohol intake less used

BAclofen, Sodium oxybate, Gabapentin

Goal of pharmacological and other methods for ALD

Alcohol abstinence

NAFLD / Nonalcoholic Fatty Liver Disease

Presence of hepatic steatosis without evidence of hepatocellular injury

NASH / Non-Alcoholic Steatohepatitis

presence of hepatic steatosis and inflammation with hepatocyte injury (ballooning) w/ or w/out fibrosis

NAFLD prevention

Lifestyle Changes- Exercise, becoming a healthy weight, decreasing alcohol consumption

NAFLD Medications

Peroxisome Proliferator Receptor Activator Gamma (PPARy) signaling interference - Decrease oxidative stress and inflammation

TZDs - agonists PPARy

NAFLD Antioxidant to reduce Oxidative Stress, which regulates and minimizes other problems associated with NAFLD

Vitamin E

T/F Statins and other Lipid Lowering Agents can be used to help NAFLD

True

NAFLD Medications

Fibrates, Metformin, Statins, Vit E, TZDs

Exocrine Pancreatic Insufficiency - EPI

Pancreas basically just stops making digestive enzymes

Pancreas Enzyme Replacement Therapy (PERT) Or Pancreatic Enzyme Products (PEPs)

Pancreatic Enzymes strain your body

Pancreatin or other brands - Pancrelipase

Metal Poisoning is treated with what medication class

Chelating Agents

How do chelating agents bind to metal ions

Covalently

EDTA

Effective for Lead poisoning

Doesn’t work for Mercury or arsenic in vivo

Dimercaprol & Succimer

Used to treat Arsenic, Gold, Copper, and Mercury poisoning

Ferriprox / Deferiprone

Used to treat Iron overload in people from blood transfusions

Not great against metals other than Iron

Deferasirox / Exjade

Used to remove Iron from patients with too many Blood transfusions or similar syndromes.

Iron specific

Can cause Liver and kidney dysfunction

Deferoxamine / Desferrioamine / Desferal

Iron Chelation

Wilson’s Disease

Genetic Disease that prevents body from removing copper when it should or needs too. Copper eventually builds up in the brain, eyes, liver and other organs

D-Penicillamine

Treats Wilson’s Disease

Chelates Copper, lead, Iron and mercury.

Trientine

Treats Wilson’s Disease

Only chelates Copper