Term
hepatocellular or cytotoxic:
metabolic mediated
immune mediated
steatosis mechanisms |
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Definition
| most common mechanisms of hepatocellular/cytotoxic injury |
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Term
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Definition
potential mechanism of drug induced liver disease:
hepatocellular or cytotoxic
drugcovalently binds to intracellular proteins or DNA disrupting cell function
this can lead to production of chemicals toxic to cells and/or sensitization to cytokines that can impact cell function
most common type of DI liver injury
examples: APAP, furosemide
diclofenac
may cause apoptosis and necrosis |
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Term
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Definition
potential mechanism of drug induced liver disease:
hepatocellular or cytotoxic
medication processing forms haptens which stimulate an immune response
these haptens can induce humoral responses (formation of antibodies) or cellular immune responses (T-helper cell mediated)
examples: sulfamethoxazole, nitrofurantoin, cabamazepine, nivirapine, phenytoin, trazodone
may cause apoptosis and necrosis |
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Term
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Definition
potential mechanism of drug induced liver disease:
hepatocellular or cytotoxic
due to accumulation of fatty acids in mitochondria (aka mitochondrial injury)
medications can impair either major pathway involved in hepatocyte fatty acid elimination
primary pathways of fatty acid elimination include microsomal triglyceride transfer protein (MTP) and mitochondrial oxidation
microvesicular steatosis - due to acute injury and accumulation of tiny fat droplets. hepatocyte fat accumulation does not displace the cell's nucleus
macrovesicular steatosis - due to chronic injury and accumulation of large fat droplets. hepatocyte fat accumulation will displace the cell's nucleus.
examples: aspirin, valproic acid, tetracyclines, alcohol |
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Term
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Definition
potential mechanism of drug induced liver disease:
injury is due to blockage or interference of the bile canaliculus or direct bile duct injury (ex. pure cholestasis)
additional mechanisms include disruption of ATP dependent transportation of proteins or pumps
examples: chlorpromazine, erythromycin, amoxicillin/clavulanic acid, carbamazepine, TPN, sulfonamides, sulfonylureas, ACE inhibitors, phenothiazines |
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Term
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Definition
potential mechanism of drug induced liver disease:
injury is due to veno-occlusion or hepatic vein thrombosis of efferent hepatic blood flow
this causes congestion and blood filled cavities (peliosis) within the liver
examples: andorgens, estrogens, azathiopurine, tamoxifen |
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Term
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Definition
injury is due to alterations of DNA that causes benign or malignant neoplasms
examples: hormone agents |
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Term
nausea/vomiting
abdominal pain
fatigue
anorexia
pruritus
weight loss/gain |
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Definition
| common signs and symptoms of DI hepatocholestatic disease are very non-specific and include: |
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Term
jaundice
coagulopathy
hypo/hyperglycemia
ascites
spontaneous bacterial peritonitis (SBP)
electrolyte abnormalitites
encephalopathy with increased intracranial pressue (ICP)
variceal hemorrhage
hepatorenal syndrome (HRS)
malabsorption of fat soluble vitamins (DEAK) |
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Definition
| mpt and complications of severe hepatocholestatic disease include: |
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Term
aspartate aminotransferase (AST)
alanine aminotransferase (ALT)
alkaline phosphatase (Alk Phos)
lactate dehydrogenase (LDH)
gamma-glutamyltransferase (GGT)
5'-nucleotidase (5NC)
albumin (Alb)
transferrin saturation (TSAT)
bilirubin, conjugated/direct
prothrombin time (PT/INR)
liver biopsy is NOT recommended for routine use in the diagnosis of DI hepatocholestatic disease |
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Definition
| common lab measures used in assessing DI liver diseases |
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Term
single increased dose
cumulative dose
pharmacokinetic interactions
pharmacodynamic interactions |
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Definition
| drug related risk factors for patients receiving medications that are potentially hepatotoxic |
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Term
obesity
diabetes mellitus
hyperlipidemia
hyperthyroidism
renal dysfunction
chronic hepatitis B or C
acquired immunodeficiency syndrome
juvenile rheumatoid arthritis
systemic lupus erythematosus |
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Definition
| health condition related risk factors for a patient receiving medications that are potentially hepatotoxic |
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Term
other and younger age
female sex
malnutrition
alcohol consumption
illicit drug use
household or occupational exposures
genetic predisposition (CYP2C19 deficiency, N-acetyltransferase deficiency, glutathione synthetase or transferase deficiency) |
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Definition
| patient related risk factors for patients receiving medicatiosn that are potentially hepatotoxic |
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Term
a. Seek medical attention (ex. primary care provider, pharmacist) if experiencing nausea, vomiting, unexplained weight loss, or abdominal pain for several days with no other identified causes
b. Go to hospital/ER immediately if experiencing increased abdominal girth, altered mental status, peripheral edema, bleeding episodes, prolonged pruritus, jaundice, or reduced urine output
c. Do not take any new medications, OTC products, and/or herbal/health products without consulting a health care professional
d. Inform health care professionals (ex. primary care provider, pharmacist) of all medications and health related products (herbals, vitamins, supplements) being taken for health and/or wellness
e. Avoid excessive alcohol use, illicit drug use, and environmental exposures known to cause hepatotoxic reactions
f. Follow up with primary care/prescribing provider regularly and at appropriate time intervals after initiation and/or medication dose changes. Inform patient if routine liver function monitoring is needed and when follow up is needed for recommended lab monitoring. |
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Definition
| patient education for medications that are potentially hepatotoxic |
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Term
1 = alcohol
2 = acetaminophen |
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Definition
| what are the #1 and #2 causes of DI liver dysfunction? |
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