title: How to manage medications in the setting of liver disease with the application of six questions.
abstract: OBJECTIVE
  Reviewing the current literature to guide clinicians managing medications in the setting of liver disease.
  
  
  METHODS
  Using the terms liver disease, medication management, and therapeutic monitoring, a literature review was conducted to identify peer-reviewed articles in MEDLINE (1966-April 2009). Reference citations were reviewed as an additional resource. Published English-language literatures, articles and trials were reviewed. Emphasis was placed on prospective, randomised, double-blind, placebo-controlled clinical trials.
  An informed decision on how to manage medications in the setting of liver disease should account for changes that transpire in a medication's first-pass metabolism, protein binding, volume of distribution, clearance and pharmacodynamic interactions. To incorporate these issues within one's thought process, clinicians can utilise the following six questions to evaluate a medication use: (i) Is the patient experiencing acute or chronic liver failure? (ii) Does the drug have high hepatic first-pass metabolism? (iii) Is the medication highly protein-bound? (iv) Is there a change in the volume of distribution for the medication? (v) Is the clearance of the medication significantly altered? and (vi) Is there a pharmacodynamic interaction with the medication?
  
  
  CONCLUSIONS
  The introduction and use of six clinically relevant questions in the setting of liver disease can serve as a guide to clinicians who manage patients with liver disease.
authors.affiliation: Pharmacy Practice, Western University of Health Sciences, College of Pharmacy, Pomona, CA 91766-1854, USA. mnguyen3@westernu.edu
authors.forename: H M
authors.initials: HM
authors.lastname: Nguyen
authors.forename: A J
authors.initials: AJ
authors.lastname: Cutie
authors.forename: D Q
authors.initials: DQ
authors.lastname: Pham
mesh_terms: D001682:Biological Availability; D000075202:Contraindications; D058625:End Stage Liver Disease / Q000150:complications* / Q000378:metabolism; D006801:Humans; D017114:Liver Failure, Acute / Q000150:complications* / Q000378:metabolism; D004364:Pharmaceutical Preparations / Q000378:metabolism*; D011485:Protein Binding; D011795:Surveys and Questionnaires
chemical_list: D004364:Pharmaceutical Preparations