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Toxic Blood, Toxic Brain: A Pharmacist's Consideration of Hepatic Encephalopathy
Danial E. Baker, PharmD, FASHP, FASCP
Professor of Pharmacotherapy
Director, Drug Information Center
College of Pharmacy
Washington State University
Dr. Baker has stated that he has no relationships with commercial sources that may constitute or be perceived as a direct/indirect interest in the subject matter of this educational activity.
Program Description:
Hepatic encephalopathy (HE) is a neuropsychiatric syndrome that develops in patients with acute or chronic liver failure, particularly in alcoholics with cirrhosis of the liver. Five grades of HE describe increasing deterioration of cognitive, psychiatric, and motor function.
There are a number of theories explaining the pathogenesis of this disease, but it is widely accepted that HE is caused by impairment of hepatic clearance of toxic products such as ammonia from the gut. The ammonia accumulates in the bloodstream, then passes across the blood-brain barrier. Ammonia is particularly toxic to the central nervous system, resulting in cognitive, psychiatric, and motor impairments. Failure to treat HE can lead to a medical emergency or death.
Intestinal bacterial flora are involved in the production of ammonia, suggesting that non absorbable antibiotics may be useful in preventing episodes of HE in patients with liver cirrhosis. A nonabsorbed, rather than a systemic, antibiotic would offer high bioavailability, minimizing both antimicrobial resistance outside the gastrointestinal tract and adverse events associated with systemic antibiotics.
Acute HE is a potentially reversible disorder, while chronic forms of hepatic encephalopathy are often progressive. Greater awareness of the condition can help the healthcare professional prevent an HE patient from slipping into a coma; there is an 80% fatality rate for HE patients who develop comas.
HE can have a significant financial impact on patients and healthcare organizations—if the condition is not reversed, the only therapeutic option is liver transplantation, a costly procedure that makes great de mands on personal and institutional resources.
The pharmacist’s increased awareness of HE in patients with disorders affecting the liver, and of the need for quick identification and intervention, can lead to improved patient care and significant healthcare cost savings.
Learning Objectives:
At the completion of this program, the participant should be able to:
- Describe the West Haven Criteria for grading HE
- Discuss precipitating factors in HE
- Distinguish HE from other acute and chronic causes of impairments in mental status or motor ability
- Consider the pharmacokinetics of agents used for the treatment of HE
- Summarize the importance of HE in the managed care setting
Target Audience:
This educational activity is intended for pharmacists in all practice settings.
Faculty Disclosure:
Statement All faculty participating in continuing education activities are expected to disclose to the audience any real or apparent commercial financial affiliations related to the content of their presentations/materials.
Off-Label/Investigational Use:
This activity does include discussion of an unlabeled or investigational use of a product that has not yet been approved by the FDA for the use being presented.
Disclaimers:
Participants have an implied responsibility to use newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.
The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of the University of Florida College of Pharmacy; cme2, an independent subsidiary of Advanstar Communications Inc.; or Salix Pharmaceuticals, Inc. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Fee:
Free!!
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Technologies Used
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 Monograph
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Price: FREE!
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ACPE - Pharmacists Accreditation
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The University of Florida College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
This home study web activity has been assigned a maximum of 1 credit hours and the ACPE UPN: 012-999-06-098-H01-P.
This accreditation expires on 06/14/2009.
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To receive educational credit, participants must complete an online evaluation form and pass the online assessment with a score of 70% or better. If you do not receive a minimum score of 70% or better, you are permitted 2 retake(s). After passing the assessment, you can view, print and track your statements of credit online. There is no fee to participate in this activity.
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The material presented here does not reflect the views of Pharmacy Choice, Inc., RxSchool, or the companies providing educational content. These materials may discuss uses and dosages for therapeutic products, processes, procedures and inferred diagnoses that have not been approved by the United States Food and Drug Administration. A qualified health care professional should be consulted before using any therapeutic product discussed. All readers and continuing education participants should verify all information and data before treating patients or employing any therapies described in this continuing education activity.
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This lesson is supported by:
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