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Gastrointestinal > Drug Induced Liver Diseases > Flashcards

Drug Induced Liver Diseases Flashcards

1
Q

AMA is seen in what disease?

A

Primary biliary cirrhosis

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2
Q

LKM is seen in what disease?

A

Autoimmune hepatitis

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3
Q

pANCA is seen in what disease?

A

Primary sclerosing cholangitis

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4
Q

What is the most frequent cause of drug induced liver injury? What drug, specifically?

A

Abx

Augmentin

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5
Q

What are the labs like in drug induced liver injury?

A

Transaminitis, elevated alk phos, and cholestatic pattern of bili

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6
Q

What is intrinsic drug induced liver injury? How long does this last?

A

Results from drug or metabolite inducing direct hepatocellular damage

Occurs with short latency

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7
Q

Does rechallenge with the intrinsic drug induced liver disease result in recurrence? Idiosyncratic?

A 
Intrinsic = No
Idiosyncratic = yes
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8
Q

What is the idiosyncratic drug induced liver disease?

A

Occurs in a minority of people, with prolonged latency, with unexpected effects with

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9
Q

What is the most frequent reason for withdrawal of an approved FDA drug from the market?

A

Drug induced liver injury

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10
Q

What is Hy’s law? What are the three factors involved?

A

A pt will have a 10% mortality risk of DILD even if offending drug is discontinued, provided they:

  1. Serum ALT or AST x3 ULN
  2. total bili 2x ULN w/o alk phos elevation
  3. No other reason
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11
Q

What is the most common cause of acute liver failure and transplantation in the West?

A

DILI

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12
Q

True or false: DILI is a diagnosis of exclusion

A

True

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13
Q

What are the risk factors for DILI?

A
  • age
  • gender
  • obesity
  • drug/EtOH exposure
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14
Q

What drug are men more likely to have DILI?

A

Azathioprine

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15
Q

Why does obesity lead to susceptibility of DILI?

A

Increased p450s in obesity can increase metabolite concentration

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16
Q

What is the most important factor in drug induced liver disease?

A

Genetic factors

17
Q

True or false: pts with cirrhosis are more susceptible to DILI

A

Unclear

18
Q

What is the most common cause of DILI?

A

Acetaminophen

19
Q

What is the max dose of acetaminophen that can be given in 24 hours?

A

4 g

20
Q

What are the two pathways in which acetaminophen can be metabolized?

A

Glucuronide or

NAPQI via p450

21
Q

What happens to the NAPQI produced with acetaminophen?

A

can cause necrosis via covalent bonding
or
GSH to mercapturic acid, to excretion in urine (normal)

22
Q

What is the antidote for acetaminophen overdose?

A

N-Acetylcysteine (NAC)

23
Q

Should acetaminophen be given to pts with cirrhosis? Why or why not?

A

Yes, as long as there is NOT active alcoholism, since this may exacerbate hepatorenal syndrome

24
Q

What percent of acetaminophen overdoses resolve spontaneously?

A

65%

25
Q

What is the level of ALT and AST at which the liver is at risk of severe necrosis?

A

100x

26
Q

Over what level of bili is concerning for cholestasis, and mixed injury?

A

more than 3x

27
Q

What is the timeframe of acute DILI?

A

less than 3 months

28
Q

What is the formula used to calculate the DILI?

A

ALT / alk phos

29
Q

Which is more common, acute or chronic DILI?

A

Acute

30
Q

What are the ssx of chronic DILI? What can this lead to?

A

Mimic complete extrahepatic obstructive jaundice with arrested bile flow

May lead to cirrhosis

31
Q

DILI can mimic what viral infection?

A

Mono (LAD, lymphocytosis)

32
Q

What are the extrahepatic ssx of DILI?

A

Fever
Rash
Eosinophilia

33
Q

What is the risk of statins causing DILI?

A

Low

34
Q

What is the treatment for DILI?

A

Stop the drug

35
Q

What is the antidote for Valproate?

A

L-Carnitine

36
Q

What is the cutoff for immediately stopping a drug with elevated LFTs?

A

greater than 5x normal

37
Q

What is cutoff of LFTs for repeating liver enzymes every 3 month? every month?

A

less than 3x normal then 3 months

3-5x normal, repeat every 1 month

38
Q

Should you rechallenge pts with DILI?

A

No, unless that’s the only drug that will work for them, and they need it.

Gastrointestinal (42 decks)

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