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PHAR 255 > Liver 3 > Flashcards

Liver 3 Flashcards

1
Q

What is the most common reason for drug recall?

A

Drug-induced hepatotoxicity

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2
Q

T or F: drug induced hepatotoxicity can be acute or chronic

A

True

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3
Q

Examples of hepatotoxins

A

Arsenic
Carbon tetrachloride
Copper
Dimethylformamide
Fluorine
Toluene
Vinyl chloride

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4
Q

How is DILI classified?

A

Can be difficult because:
- drugs may cause >1 pattern of damage
- cause not always possible to determine
- in some cases, different types may occur at once
- mechanisms are not fully understood

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5
Q

How is DILI diagnosed?

A

Temporal relationship to drug use
Exclusion of other causes of liver damage

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6
Q

What drug can cause hepatocellular injury?

A

Allopurinol

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7
Q

What drugs can cause steatonecrosis?

A

Tetracycline
Valporic acid
Alcohol

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8
Q

What drug can cause fibrosis?

A

Methotrexate

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9
Q

What drugs can cause cholestatic injury?

A

Carbemazapine
Arithromycin

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10
Q

What is the definition of hepatotoxicity?

A

ALT>3x the upper limit of normal AND
Total bilirubin >2x the upper limit of normal
*indicators of injury and functional changes

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11
Q

What is the R value and what is it used for?

A

(Measured ALT/upper normal limit of ALT) / (measured ALP/upper normal limit of ALP)
- used to determine cause of liver injury

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12
Q

What does an R value >/= 5 determine?

A

Hepatocellular injury

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13
Q

What does an R value between 2-5 determine?

A

Mixed injury

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14
Q

What does an R value </= 2 determine?

A

Cholestatic injury

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15
Q

What are the general mechanisms of DILI?

A

Intrinsic: predictable
Idiosyncratic: unpredictable

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16
Q

What is the most common cause of acute liver failure?

A

Acetaminophen - intrinsic DILI
Extremely high AST/ALT levels (>3500)

17
Q

What causes acetaminophen toxicity?

A

CYP becomes primary pathway which produces NAPQI (toxic), this covalently binds to and modifies critical hepatic cell proteins?

18
Q

T or F: acetaminophen toxicity leads to survivors having chronic hepatic dysfunction.

A

False. It is an acute event

19
Q

What are the toxic doses of acet?

A

Adults: >7.5g
Kids: >150mg/kg

20
Q

When can we use the Rumack-Matthew nomogram?

A

When <24hours
Not reliable for extended release products
- predicts only the likelihood of AST/ALT >1000
- does not predict survival or death

21
Q

What is the antidote of choice for acet toxicity?

A

Acetylcysteine (Mucomyst)

22
Q

What Child Pugh?

A

Scoring system to evaluate survival rate
Higher score = worse survival rate
A = 5-6 points
B = 7-9 points
C = 10-15 points

PHAR 255 (8 decks)

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