drug induced liver injury

Question 1

drug induced liver injury definition

Answer 1

any injury to liver caused by rx medication, otc, or supplement

Question 2

most common causes of DILI

Answer 2

• acetaminophen

- herbal/dietary

Question 3

main risk factors for DILI

Answer 3

• higher drug doses
• extent of hepatic metabolism
• genetic predisposition

Question 4

drugs that are commonly associated with DILI

Answer 4

• acetaminophen
• augmentin
• bactrim
• nitrofurantoin
• isoniazid
• NSAIDs
• phenytoin
• herbals

Question 5

intrinsic DILI

Answer 5

• most common
• drug predictably causes injury at high dose
• short latency period

Question 6

idosyncratic DILI

Answer 6

• only affects susceptible pts.
• less consistent dose relationship
• presentation varied
• longer/variable latency period

Question 7

hepatocellular pattern of injury

Answer 7

• resembles acute viral hepatitis
• fatigue and weakness
• AST/ALT elevated
• AP and GGT only mildly increased

Question 8

cholestatic pattern of injury

Answer 8

• resembles bile duct obstruction
• jaundice, itching, RUQ pain
• AST/ALT mildly elevated
• AP, GGT, bilirubin elevated

Question 9

mixed pattern of injury

Answer 9

• rare
• mixed symptoms (jaundice, pain, fatigue)
• elevated ALT and AP

Question 10

R value equation

Answer 10

(ALT/ULN) / (AP/ULN)

Question 11

R value injury ratings

Answer 11

> 5 hepatocellular
2-5 mixed
<2 cholestatic

Question 12

immune category reaction features

Answer 12

• allergic or hypersensitivity
• fever, rash, myalgias
• early onset
• rapid reinjury on drug rechallenge
• most common with cholestatic or mixed

Question 13

nonimmune category reaction features

Answer 13

• lacks systemic symptoms
• later onset (up to a year)
• not associated with reinjury with drug rechallenge

Question 14

possible adverse outcomes of DILI

Answer 14

• acute liver failure and death
• vanishing bile duct syndrome
• cirrhosis

Question 15

DILI treatment

Answer 15

• stop offending agent
• treat with antidote if available
• NAC maybe in adults with early stage acute failure
• don’t rechallenge with offending drug later

Question 16

DILI prognosis

Answer 16

-full recovery expected

Question 17

DILI injury pattern with worst prognosis

Answer 17

hepatocellular

Question 18

DILI injury pattern that usually takes longer to resolve

Answer 18

cholestatic