drug induced liver injury Flashcards Preview

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Flashcards in drug induced liver injury Deck (18)
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1
Q

drug induced liver injury definition

A

any injury to liver caused by rx medication, otc, or supplement

2
Q

most common causes of DILI

A
  • acetaminophen

- herbal/dietary

3
Q

main risk factors for DILI

A
  • higher drug doses
  • extent of hepatic metabolism
  • genetic predisposition
4
Q

drugs that are commonly associated with DILI

A
  • acetaminophen
  • augmentin
  • bactrim
  • nitrofurantoin
  • isoniazid
  • NSAIDs
  • phenytoin
  • herbals
5
Q

intrinsic DILI

A
  • most common
  • drug predictably causes injury at high dose
  • short latency period
6
Q

idosyncratic DILI

A
  • only affects susceptible pts.
  • less consistent dose relationship
  • presentation varied
  • longer/variable latency period
7
Q

hepatocellular pattern of injury

A
  • resembles acute viral hepatitis
  • fatigue and weakness
  • AST/ALT elevated
  • AP and GGT only mildly increased
8
Q

cholestatic pattern of injury

A
  • resembles bile duct obstruction
  • jaundice, itching, RUQ pain
  • AST/ALT mildly elevated
  • AP, GGT, bilirubin elevated
9
Q

mixed pattern of injury

A
  • rare
  • mixed symptoms (jaundice, pain, fatigue)
  • elevated ALT and AP
10
Q

R value equation

A

(ALT/ULN) / (AP/ULN)

11
Q

R value injury ratings

A

> 5 hepatocellular
2-5 mixed
<2 cholestatic

12
Q

immune category reaction features

A
  • allergic or hypersensitivity
  • fever, rash, myalgias
  • early onset
  • rapid reinjury on drug rechallenge
  • most common with cholestatic or mixed
13
Q

nonimmune category reaction features

A
  • lacks systemic symptoms
  • later onset (up to a year)
  • not associated with reinjury with drug rechallenge
14
Q

possible adverse outcomes of DILI

A
  • acute liver failure and death
  • vanishing bile duct syndrome
  • cirrhosis
15
Q

DILI treatment

A
  • stop offending agent
  • treat with antidote if available
  • NAC maybe in adults with early stage acute failure
  • don’t rechallenge with offending drug later
16
Q

DILI prognosis

A

-full recovery expected

17
Q

DILI injury pattern with worst prognosis

A

hepatocellular

18
Q

DILI injury pattern that usually takes longer to resolve

A

cholestatic