Exam 2 - D-I Liver

Question 1

What are the physiologic purposes of the liver? (3)

Answer 1

metabolism (gluconeogenesis, glycogenolysis, glycogenesis), synthesis (proteins, Igs, thrombopoietin), detoxification

Question 2

What is the cutoff for AST and ALT labs?

Answer 2

40 U/L

Question 3

What is the cutoff for ALP labs?

Answer 3

140 U/L

Question 4

What is the cutoff for GGT labs?

Answer 4

45 U/L

Question 5

What is the cutoff for bilirubin labs?

Answer 5

1.0 mg/dL

Question 6

What is the most common cause of DILI? Second?

Answer 6

acetaminophen; antibiotics (amox-clav)

Question 7

What is the criteria for DILI? (5)

Answer 7

total bili >2.5 mg/dL and any elevation in ALT/AST/ALP, ALT >5x ULN, AST >5x ULN, ALP >2x ULN, INR >1.5 with elevated AST/ALT/ALP

Question 8

What is the formula for determining the type of DILI?

Answer 8

R = [ALT/ULN]/[ALP/ULN]

Question 9

What are the values of R and to which type of DILI do they correspond? (3)

Answer 9

</= 2 (cholestatic), 2-5 (mixed), >/= 5 (hepatocellular)

Question 10

What are the top individual agents for DILIN? (10)

Answer 10

amoxicillin-clavulanate, isoniazid, nitrofurantoin, sulfamethoxazole-trimethoprim, minocycline, cefazolin, azithromycin, cipro/levofloxacin, diclofenac

Question 11

What are the top therapeutic classes for DILIN? (2)

Answer 11

antimicrobials, herbal and dietary supplements

Question 12

What is the cutoff for AST in APAP toxicity?

Answer 12

1000 U/L

Question 13

What is an early-on (< 4 hrs) treatment for APAP overdose?

Answer 13

activated charcoal

Question 14

What is the MOA of N-acetylcysteine? (2)

Answer 14

precursor to glutathione, allow for more nontoxic metabolism through increased sulfation

Question 15

Explain the dosing and side effects of PO NAC?

Answer 15

72-hr protocol, bad taste and N/V (50%)

Question 16

Explain the dosing and side effects of IV NAC?

Answer 16

20-hr protocol, anaphylactoid reactions, preferred in liver failure and pregnancy

Question 17

When should therapy be continued past protocol for APAP toxicity? (2)

Answer 17

ongoing liver failure present (elevated PT/INR, encephalopathy), detectable APAP