Which of the following drug is contraindicated in liver disease?
**Core Concept**
The question tests the understanding of drug metabolism and the impact of liver disease on pharmacokinetics. The liver plays a crucial role in metabolizing many drugs, and certain drugs may accumulate to toxic levels in patients with liver dysfunction.
**Why the Correct Answer is Right**
The correct answer is a drug that undergoes extensive hepatic metabolism, and its clearance is significantly impaired in liver disease. This can lead to increased levels of the drug, which may cause adverse effects. For example, certain antibiotics, such as **Erythromycin**, are primarily metabolized by the liver and may accumulate to toxic levels in patients with liver disease.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not undergo significant hepatic metabolism. Drugs that are primarily excreted by the kidneys, such as **Furosemide**, may be contraindicated in renal disease but are not necessarily contraindicated in liver disease.
**Option B:** This option is incorrect because it is primarily metabolized by the liver, but its clearance is not significantly impaired in liver disease. **Midazolam**, a benzodiazepine, is metabolized by the liver, but its clearance is not significantly affected by liver disease.
**Option C:** This option is incorrect because it is a drug that is primarily excreted by the kidneys, and its clearance is not significantly impaired in liver disease. **Lisinopril**, an ACE inhibitor, is primarily excreted by the kidneys and is not contraindicated in liver disease.
**Clinical Pearl / High-Yield Fact**
When prescribing medications to patients with liver disease, it is essential to consider the potential for drug accumulation and toxicity. Drugs that undergo extensive hepatic metabolism, such as **Erythromycin**, should be used with caution or avoided in patients with liver dysfunction.
**Correct Answer:** C. Erythromycin