Drug Induced Liver Disease Flashcards

1
Q

Intrinsic drug induced liver disease

A

Drugs that cause liver injury predictably in humans and animal models when given at a high dose
Ex: acetaminophen

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2
Q

Idiosyncratic drug induced liver disease

A

Affects susceptible individuals
Variable presentation
Less consistent relationship to dose
Most of the drugs we are exposed to

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3
Q

Non-immune drug induced liver disease (idiosyncratic)

A

Aberrant metabolism of the drug in susceptible individuals
Duration of exposure varies from weeks to months
Reactions can develop weeks after discontinuation
No hypersensitivity features
MOA: metabolites binding to cellular elements = ox stress
Ex: amiodarone, diclofenac, isoniazid

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4
Q

Immune mediated drug induced liver disease (idiosyncratic)

A
Duration of exposure 1-8 weeks
Hypersensitivity features
Recurrence after rechallenge
Modification of proteins due to covalent binding with the drug
Activation of immune system
Ex: amoxicillin, diclofenac, phenytoin
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5
Q

Autoimmune like drug induced liver disease (idiosyncratic)

A
Elevated IgG, ANA, ASMA
Once resolved there is no relapse
Eosinophilia or granulomatous inflam on liver biopsies
Responds to GCs
Ex: minocycline, nitrofurantoin
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6
Q

R value

A

ALT/ULN divided by ALP/ULN
Hepatocellular if R > 5
Cholestatic if R < 2
ULN = upper limit of normal

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7
Q

Antidote for acetaminophen

A

N-acetylcysteine

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8
Q

Risk factors for acetaminophen-induced hepatotoxicity

A
Chronic excessive alcohol ingestion
Fasting
Concomitant medications
Late presentation
Underlying liver disease
Concomitant alcohol ingestion may be protective
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9
Q

Criteria to refer for transplant with tylenol overdose

A
Arterial pH < 7.3
Or all 3 of:
INR > 6.5
Creatinin > 3.3
Hepatic encephalopathy grade 3-4
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10
Q

Anabolic steroid drug induced liver disease

A

Cholestasis without hepatitis
Bilirubin levels > 20x ULN
Very slow resolution to normal levels

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11
Q

Antibiotic drug induced liver disease

A

Amox-clav and fluoroquinolines
Cholestasis with hepatitis
Onset can be delayed by several weeks after the use of the drug

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