Drug Induced Liver Disease Tutoring By Alaina Darby

Chronic hepatocellular damage Acute hepatocellular damage JD is a 24 yo WM who presents complaining of RUQ pain. He has been taking isoniazid due to his PPD coming back positive. Which of the following types of liver disease does he likely have? Chronic hepatocellular damage Acute hepatocellular damage Chronic cholestatic jaundice Acute cholestatic jaundice b

JD is a 24 yo WM who presents complaining of RUQ pain JD is a 24 yo WM who presents complaining of RUQ pain. He has been taking isoniazid due to his PPD coming back positive. Which of his values would be least likely to be elevated? AST ALT Alkaline phosphatase INR c

Which of the following would be elevated in liver disease due to use of sulfonamides? AST ALT Alkaline phosphatase All of the above d

Which of the following is chlorpromazine most likely to cause? Chronic hepatocellular damage Acute hepatocellular damage Chronic cholestatic jaundice Acute cholestatic jaundice d

Which would most likely be elevated with chlorpromazine-induced liver disease? AST ALT Alkaline phosphatase All of the above c

Which of the following medications causes the accumulation of fat in the liver? Nitrofurantoin Acetaminophen Sulfasalazine Amiodarone d

Elevated alkaline phosphatase Presence of rash FK is a 32 yo WF who has been taking Bactrim for a UTI. Which of the following might be the earliest indication of the potential for liver failure based on mechanism of DILI? Elevated AST Elevated ALT Elevated alkaline phosphatase Presence of rash d

Elevated alkaline phosphatase Elevated INR JD is a 22 yo AAM who wants to increase his basketball skills. His friend was able to get him anabolic steroids, which he started taking 3 months ago. Which of the following would be most indicative of DILI due to the steroids? Elevated AST Elevated ALT Elevated alkaline phosphatase Elevated INR c

Discontinue chlorpromazine Biopsy the liver HR is a 45 yo WF with HIV who is taking Truvada, isoniazid, chlorpromazine, APAP, and prophylactic Bactrim. Her AST is 3x ULN and bilirubin is 1.5x ULN. Which of the following should be done first? Discontinue Truvada Discontinue Bactrim Discontinue chlorpromazine Biopsy the liver b

HR is a 45 yo WF with HIV who is taking Truvada, isoniazid, chlorpromazine, APAP, and prophylactic Bactrim. Her AST is 3x ULN and bilirubin is 1.5x ULN. Which of the following medications is least likely to cause her elevated labs? Truvada Isoniazid Chlorpromazine APAP a

All but Truvada and chlorpromazine None of them HR is a 45 yo WF with HIV who is taking Truvada, isoniazid, chlorpromazine, APAP, and prophylactic Bactrim. Her AST is 3x ULN and bilirubin is 1.5x ULN. Which medications should be discontinued? All of them All but Truvada All but Truvada and chlorpromazine None of them b

At lower doses all at the same time HR is a 45 yo WF with HIV who is taking Truvada, isoniazid, chlorpromazine, APAP, and prophylactic Bactrim. Her AST is 3x ULN and bilirubin is 1.5x ULN. How should the medications be reinstated? At lower doses all at the same time At the same dose all at the same time At lower doses one at a time At the same dose one at a time d… probably

HR is a 45 yo WF with HIV who is taking Truvada, isoniazid, chlorpromazine, APAP, and prophylactic Bactrim. Her AST is 3x ULN and bilirubin is 1.5x ULN. Which medication should be reinstated first? Chlorpormazine Bactrim APAP Isoniazid d

HR is a 45 yo WF with HIV who is taking Truvada, isoniazid, chlorpromazine, APAP, and prophylactic Bactrim. Her AST is 3x ULN and bilirubin is 1.5x ULN. Which medication should be reinstated first? Chlorpormazine Bactrim APAP Isoniazid a

ST is taking allopurinol. When should you monitor for DILI? First weeks First month First 6 months First year All of the above a

ST is taking allopurinol. How do you minimize risk of DILI? Hepatic dosing Renal dosing Frequent LFT monitoring Watch for clinical symptoms b

JR is taking isoniazid. When should you monitor for DILI? First weeks First month First 6 months First year All of the above c

Which of the following baseline characteristics puts JR at risk for isoniazid-induced DILI? Age 49 Bilirubin 3x ULN AST 1.5x ULN ALT 2x ULN c

OF is taking nitrofurantoin. When should you monitor for DILI? First weeks First month First 6 months First year All of the above e

Which patient is most at risk for APAP toxicity? Patient who had 2 drinks 8 hours ago Patient who had 8 drinks 2 days ago Patient who is a chronic alcoholic who has not recently consumed alcohol Patient who is a chronic alcoholic who had 8 drinks 2 days ago a

Why would the patient who had 2 drinks 8 hours ago be at higher risk? Increase of CYP2E1 Decrease of CYP2E1 Increase of glucuronidated APAP Decrease of glucuronidated APAP a

PA is an alcoholic who has not recently consumed alcohol PA is an alcoholic who has not recently consumed alcohol. He has cirrhosis and is currently taking propranolol to prevent variceal hemorrhage. Which of the following should you monitor if he is taking APAP for headaches? AST ALT INR Alk phos a

PA is an alcoholic who has not recently consumed alcohol PA is an alcoholic who has not recently consumed alcohol. He has cirrhosis and is currently taking propranolol to prevent variceal hemorrhage. Which of the following values would you expect for AST if he weren’t taking APAP? 20 200 2,000 20,000 b

PA is an alcoholic who has not recently consumed alcohol PA is an alcoholic who has not recently consumed alcohol. He has cirrhosis and is currently taking propranolol to prevent variceal hemorrhage. Which of the following values would most concern you in this patient if he starts taking APAP? 20 200 2,000 20,000 d

PA is an alcoholic who has not recently consumed alcohol PA is an alcoholic who has not recently consumed alcohol. He has cirrhosis and is currently taking propranolol to prevent variceal hemorrhage and APAP for headaches. Which of the following would increase his risk? Obesity Not eating Anorexia High fat meal b

Maximum of 2 g/day of APAP Maximum of 3 g/day of APAP PA is an alcoholic who has not recently consumed alcohol. He has cirrhosis and is currently taking propranolol to prevent variceal hemorrhage and APAP for headaches. Which of the following would you recommend? Maximum of 2 g/day of APAP Maximum of 3 g/day of APAP Maximum of 4 g/day of APAP Maximum of 5 g/day of APAP b

PA is an alcoholic who has not recently consumed alcohol PA is an alcoholic who has not recently consumed alcohol. He has cirrhosis and is currently taking propranolol to prevent variceal hemorrhage and APAP for headaches. Which of the following do you expect to be elevated in this patient? AST/ALT CYP2E1 NAPQI INR d

Give N-acetylcysteine A&B All of the above PA is an alcoholic who has not recently consumed alcohol. He has cirrhosis and is currently taking propranolol to prevent variceal hemorrhage and APAP for headaches. He accidentally takes too much APAP and presents to you approximately 36 hours after OD. What should you do? Monitor vitals Get an APAP level Give N-acetylcysteine A&B All of the above d

Acute hepatocellular damage Acute cholestatic jaundice Which of the following is usually the cause of DILI by herbal medications? Acute hepatocellular damage Acute cholestatic jaundice Chronic hepatocellular damage Chronic cholestatic jaundice A&B C&D All of the above e

PMH: CKD, HTN, and gouty arthritis. RT is a 25 yo AAM who complains of RUQ pain, fever, a rash, and yellow eyes. Symptoms reportedly began 3 days ago. PMH: CKD, HTN, and gouty arthritis. Medications: iron supplement (x1 year), lisinopril (x6 months), APAP (x1 year), and allopurinol (x1 week) Labs: CrCl 55, BP 130/79, HR 89, RR 22, AST 150, ALT 100, bilirubin 9.1 Which of the following would be a likely culprit for his symptoms? Iron Lisinopril APAP Allopurinol d

PMH: CKD, HTN, and gouty arthritis. RT is a 25 yo AAM who complains of RUQ pain, fever, a rash, and yellow eyes. Symptoms reportedly began 3 days ago. PMH: CKD, HTN, and gouty arthritis. Medications: iron supplement (x1 year), lisinopril (x6 months), APAP (x1 year), and allopurinol (x1 week) Labs: CrCl 55, BP 130/79, HR 89, RR 22, AST 150, ALT 100, bilirubin 9.1 How should he be treated? Discontinue allopurinol Supportive care Discontinue APAP A&B All of the above d

PMH: CKD, HTN, and gouty arthritis. RT is a 25 yo AAM who complains of RUQ pain, fever, a rash, and yellow eyes. Symptoms reportedly began 3 days ago. PMH: CKD, HTN, and gouty arthritis. Medications: iron supplement (x1 year), lisinopril (x6 months), APAP (x1 year), and allopurinol (x1 week) Labs: CrCl 55, BP 130/79, HR 89, RR 22, AST 150, ALT 100, bilirubin 9.1 Should allopurinol be restarted? If so, how? Absolutely not Yes, start back at a dose that is calculated on CrCl Yes, start at a low dose and titrate up Yes, start back at the same dose b