Advanced Clinical Pharmacy Practice PMY7045: Managing Drug Treatment


Answer different questions based on provided case studies


Case A

Question A1: What is the likely underlying cause of the abnormal LFT in Mr White?

The liver performs distinct forms of biochemical, synthetic and excretory functions and as such there lacks any single biochemical test for detecting the global functions of a liver. These findings by Thapa and Walia (2007) point out that many diseases and conditions could lead to elevated liver enzymes which are an indicator of abnormal LFT. In regard to white case study, it has been noted that he drinks around 4-6 units of alcohol in every week. As such, he could be suffering from the alcoholic hepatitis. Additionally, the fact that he is under the medication of metformin and amlodipine are indicators that he possess non-alcoholic fatty liver disease and obesity. Also, the ALT of 84 IU/L by the patient could be a contributory factor to the abnormal LFT in Mr White.

Question A2: Briefly explain your rationale for your answer to A1

As noted by Newsome et al. (2018), the liver blood or function tests (LFTs) often produce abnormal results which are as a result of non-specific symptoms with a limited potential link between the symptoms and likelihood of liver disease or the blood tests being performance due to unrelated reasons such as chronic disease monitoring.  The fact that White drinks approximately 4-6 units of alcohol weekly would be an indicator of suffering from Alcohol-related cirrhosis. According to Murray et al. (2013), the majority of the patients with the condition are heavy daily drinkers. The study has equally linked the existence of a relationship between the alcohol consumption and liver cirrhosis being exponential. Further, there exist a synergy between the intake and obesity in an event the body mass index (BMI) is higher than 35 with the risk of liver disease doubling at any particular alcohol intake as shown in figure 1;

Figure 1: Abnormal Liver Blood Tests

Source: Murray et al. (2013)

Additionally, the predominantly raised ALT and AST represent an indicator of hepatocellular liver injury (hepatitis_). The common causes of this condition are inclusive of the viral hepatitis, NAFLD, ARLD, AIH and the drug-induced liver injury. The level of ALT which is above 80 U/L is an indicator of the extent in which the patient receiving statin therapy demand a continued treatment with the statin as compared to the patient with an end-stage alcohol-related liver disease. The normal ALT that cannot be linked with abnormal LFTs is the normal reference interval at 30U/L which can also contribute to life expectancy of weeks. A common assumption is that the detected abnormality represents the initial presentation of the abnormal LFTs in an event it should be a standard practice of reviewing the previous blood tests records and past/current medical history prior making requests on the additional investigations and referrals.

Question A3: Discuss the non-pharmacological management of this condition

The non-pharmacological management of the abnormal LFT in Mr White should start with obtaining a thorough clinical history inclusive of their age, country of birth (determine the level of exposure to hepatitis B or C), symptoms, comorbidity, drug history, travel history, occupational exposure, and alcohol history. Also, the aspects of the metabolic syndrome, family history, and other symptoms also need to be considered. Some of these aspects are already available for the case of White but they need to be rechecked and be reconfirmed as the initial phase of implementing the non-pharmacological management……………..Please click the paypal icon to receive this assessment for only $20