Drug Induced Liver Injury Flashcards
What is drug induced hepatic injury?
Liver injury caused by various medications, herbs, and other xenobiotics, leading to abnormalities in liver tests or liver dysfunction
What is the most common cause of drug induced hepatic injury?
APAP
The portal vein supplies what?
Low oxygen, accounts for ~75% of blood flow
The hepatic artery supplies what?
High oxygen, accounts for ~25% blood flow
What is zone 1?
Periportal area, high oxygen
What is zone 2?
Transitional phase
What is zone 3?
Pericentral area, low oxygen
What cells make up the majority of the liver?
Hepatocytes
What is Direct or Intrinsic Injury?
- Predictable
- Dose related
- Acute
- Pattern is necrosis
- APAP
What is Idiosyncratic Injury?
- Unpredictable
- Not dose related
- Weeks/Months
- Immune-Mediated/Metabolic
- Troglitazone, Ketoconazole, and Diclofenac
What is Heptatocellular Injury Centrilobular Necorsis?
- Spreading outward from the middle
- Direct and idiosyncratic
- Production of toxic metabolite
= APAP
What drugs cause Heptatocellular Injury Nonalcoholic Steatohepatitis NASH?
Amiodarone, Tamoxifen, Methotrexate, and Vitamin A
What drugs cause Heptatocellular Injury Reye’s syndrome?
ASA
What is used in the diagnosis of hepatic damage?
- Elevated Liver specific enzymes in plasma
- Jaundice from elevated bilirubin
- Decreased protein synthesis
Elevated Liver Specific Enzymes in plasma that reveal hepatic damage are what?
10-500x increase in ALT
ALT and AST = damage of hepatocytes
