drug induced liver injury Flashcards
1
Q
drug induced liver injury definition
A
any injury to liver caused by rx medication, otc, or supplement
2
Q
most common causes of DILI
A
- acetaminophen
- herbal/dietary
3
Q
main risk factors for DILI
A
- higher drug doses
- extent of hepatic metabolism
- genetic predisposition
4
Q
drugs that are commonly associated with DILI
A
- acetaminophen
- augmentin
- bactrim
- nitrofurantoin
- isoniazid
- NSAIDs
- phenytoin
- herbals
5
Q
intrinsic DILI
A
- most common
- drug predictably causes injury at high dose
- short latency period
6
Q
idosyncratic DILI
A
- only affects susceptible pts.
- less consistent dose relationship
- presentation varied
- longer/variable latency period
7
Q
hepatocellular pattern of injury
A
- resembles acute viral hepatitis
- fatigue and weakness
- AST/ALT elevated
- AP and GGT only mildly increased
8
Q
cholestatic pattern of injury
A
- resembles bile duct obstruction
- jaundice, itching, RUQ pain
- AST/ALT mildly elevated
- AP, GGT, bilirubin elevated
9
Q
mixed pattern of injury
A
- rare
- mixed symptoms (jaundice, pain, fatigue)
- elevated ALT and AP
10
Q
R value equation
A
(ALT/ULN) / (AP/ULN)
11
Q
R value injury ratings
A
> 5 hepatocellular
2-5 mixed
<2 cholestatic
12
Q
immune category reaction features
A
- allergic or hypersensitivity
- fever, rash, myalgias
- early onset
- rapid reinjury on drug rechallenge
- most common with cholestatic or mixed
13
Q
nonimmune category reaction features
A
- lacks systemic symptoms
- later onset (up to a year)
- not associated with reinjury with drug rechallenge
14
Q
possible adverse outcomes of DILI
A
- acute liver failure and death
- vanishing bile duct syndrome
- cirrhosis
15
Q
DILI treatment
A
- stop offending agent
- treat with antidote if available
- NAC maybe in adults with early stage acute failure
- don’t rechallenge with offending drug later
