Drug-related intrahepatic cholestasis

Question 1

What should be the approach to management of drug-induced hepatitis?

Answer 1

• monitor three times a week or admitted for observation
  
  • many serious and may not resolve
• stop suspected drug immediately and observe

Question 2

What features in addition to drug-related jaundice should you look for and what could this be indicative of?

Answer 2

rash and eosinophilia: drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, life-threatening drug-induced hypersensitivity reaction

also exclude other causes

Question 3

What are 4 features of drug reaction with eosinophilia and systemic symptoms (DRESS)?

Answer 3

1. Skin eruption
2. Haematologic abnormalities (eosinophilia, atypical lymphocytosis)
3. Lymphadenopathy
4. Internal organ involvement: liver, kidney, lung

Question 4

Who should all drug-induced cause sof jaundice be reported to and why?

Answer 4

Medicines and Healthcare Products Regulatory Agency (yellow pages back of BNF); is associated with poor prognosis

Question 5

What are 3 types of mechanisms via which drugs can cause jaundice?

Answer 5

hepatitis, cholestatic, mixed

Question 6

What are 9 examlpes of drugs which can cause a hepatitic jaundice?

Answer 6

1. Paracetamol
2. Rifampicin
3. Allopurinol
4. NSAIDs
5. Halothane
6. Methyldopa
7. Hydralazine
8. Isoniazid
9. Phenytoin

Question 7

What 9 drugs which can cause a cholestatic jaundice?

Answer 7

1. Chlorpromazine
2. Flucloxacillin
3. Azathioprine
4. Captopril
5. Co-amoxiclav
6. Penicillamine
7. Erythromycin
8. Anabolic steroids
9. Oral contraceptive

Question 8

What are 8 drugs which can cause a mixed (cholestatic and hepatitis) jaundice?

Answer 8

1. Sulfonamides
2. Sulfasalazine
3. Carbamazepine
4. Dapsone
5. Ranitidine
6. Amitriptyline
7. Nitrofurantoin
8. Co-amoxiclav