Exam 2 - D-I Liver Flashcards
(17 cards)
What are the physiologic purposes of the liver? (3)
metabolism (gluconeogenesis, glycogenolysis, glycogenesis), synthesis (proteins, Igs, thrombopoietin), detoxification
What is the cutoff for AST and ALT labs?
40 U/L
What is the cutoff for ALP labs?
140 U/L
What is the cutoff for GGT labs?
45 U/L
What is the cutoff for bilirubin labs?
1.0 mg/dL
What is the most common cause of DILI? Second?
acetaminophen; antibiotics (amox-clav)
What is the criteria for DILI? (5)
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
What is the formula for determining the type of DILI?
R = [ALT/ULN]/[ALP/ULN]
What are the values of R and to which type of DILI do they correspond? (3)
</= 2 (cholestatic), 2-5 (mixed), >/= 5 (hepatocellular)
What are the top individual agents for DILIN? (10)
amoxicillin-clavulanate, isoniazid, nitrofurantoin, sulfamethoxazole-trimethoprim, minocycline, cefazolin, azithromycin, cipro/levofloxacin, diclofenac
What are the top therapeutic classes for DILIN? (2)
antimicrobials, herbal and dietary supplements
What is the cutoff for AST in APAP toxicity?
1000 U/L
What is an early-on (< 4 hrs) treatment for APAP overdose?
activated charcoal
What is the MOA of N-acetylcysteine? (2)
precursor to glutathione, allow for more nontoxic metabolism through increased sulfation
Explain the dosing and side effects of PO NAC?
72-hr protocol, bad taste and N/V (50%)
Explain the dosing and side effects of IV NAC?
20-hr protocol, anaphylactoid reactions, preferred in liver failure and pregnancy
When should therapy be continued past protocol for APAP toxicity? (2)
ongoing liver failure present (elevated PT/INR, encephalopathy), detectable APAP
