Drug Induced Liver Diseases Flashcards
(38 cards)
AMA is seen in what disease?
Primary biliary cirrhosis
LKM is seen in what disease?
Autoimmune hepatitis
pANCA is seen in what disease?
Primary sclerosing cholangitis
What is the most frequent cause of drug induced liver injury? What drug, specifically?
Abx
Augmentin
What are the labs like in drug induced liver injury?
Transaminitis, elevated alk phos, and cholestatic pattern of bili
What is intrinsic drug induced liver injury? How long does this last?
Results from drug or metabolite inducing direct hepatocellular damage
Occurs with short latency
Does rechallenge with the intrinsic drug induced liver disease result in recurrence? Idiosyncratic?
Intrinsic = No Idiosyncratic = yes
What is the idiosyncratic drug induced liver disease?
Occurs in a minority of people, with prolonged latency, with unexpected effects with
What is the most frequent reason for withdrawal of an approved FDA drug from the market?
Drug induced liver injury
What is Hy’s law? What are the three factors involved?
A pt will have a 10% mortality risk of DILD even if offending drug is discontinued, provided they:
- Serum ALT or AST x3 ULN
- total bili 2x ULN w/o alk phos elevation
- No other reason
What is the most common cause of acute liver failure and transplantation in the West?
DILI
True or false: DILI is a diagnosis of exclusion
True
What are the risk factors for DILI?
- age
- gender
- obesity
- drug/EtOH exposure
What drug are men more likely to have DILI?
Azathioprine
Why does obesity lead to susceptibility of DILI?
Increased p450s in obesity can increase metabolite concentration
What is the most important factor in drug induced liver disease?
Genetic factors
True or false: pts with cirrhosis are more susceptible to DILI
Unclear
What is the most common cause of DILI?
Acetaminophen
What is the max dose of acetaminophen that can be given in 24 hours?
4 g
What are the two pathways in which acetaminophen can be metabolized?
Glucuronide or
NAPQI via p450
What happens to the NAPQI produced with acetaminophen?
can cause necrosis via covalent bonding
or
GSH to mercapturic acid, to excretion in urine (normal)
What is the antidote for acetaminophen overdose?
N-Acetylcysteine (NAC)
Should acetaminophen be given to pts with cirrhosis? Why or why not?
Yes, as long as there is NOT active alcoholism, since this may exacerbate hepatorenal syndrome
What percent of acetaminophen overdoses resolve spontaneously?
65%
