The patient with liver disease may have alterations in the pharmacological effects of drugs in addition to, or independent of, changes in their pharmacokinetics, for example increased central nervous system sensitivity to opioids and other sedatives. These differences may result from increased numbers of GABA receptors. With chronic alcohol use, a tolerance to sedative agents may be explained by the reduction in mRNA that makes the GABA receptor ( Mhatre..and.Ticku 1.992).
While measures of the clinical effect of some drugs such as the catecholamines may be possible, for others it may not be so easy. Estimation of plasma concentrations in this latter group may also be of limited value because of altered pharmacodynamics.
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