Hepatic abnormalities

The hydantoins are contraindicated in patients widi known hypersensitivity to die drug s. Phenytoin is contraindicated in patients widi sinus bradycardia, sinoatrial block, second and diird degree AV block, and Adams-Stokes syndrome it also is contraindicated during pregnancy (ediotoin and phenytoin are Pregnancy Category D) and lactation. Ediotoin is contraindicated in patients widi hepatic abnormalities. 

Carbamazepine Manufacturer recommends CBC and platelets (and possibly reticulocyte counts and serum iron) at baseline, and that subsequent monitoring be individualized by the clinician (e.g., CBC, platelet counts, and liver function tests every 2 weeks during the first 2 months of treatment, then every 3 months if normal). Monitor more closely if patient exhibits hematologic or hepatic abnormalities or if the patient is receiving a myelotoxic drug discontinue if platelets are less than 100,000/mm3, if white blood cell (WBC) count is less than 3,000/mm3 or if there is evidence of bone marrow suppression or liver dysfunction. Serum electrolyte levels should be monitored in the elderly or those at risk for hyponatremia. Carbamazepine interferes with some pregnancy tests. 

Rifampin Hepatic abnormalities monitor LFTs Reddish-orange discoloration of secretions (e.g., urine, sweat, tears) Potent inducer of CYP-mediated metabolism evaluate for drug-drug interactions... 

TMP-SMX Nausea/vomiting Myelosuppression monitor CBC Hepatic abnormalities monitor LFTs Rash including severe reactions such as Stevens-Johnson syndrome Inhibitor of CYP2C9 evaluate for potential drug-drug interactions such as warfarin... 

Ataxia telangiectasia is an autosomal recessive disease characterized by neurologic, endocrine, and hepatic abnormalities, as well as a predisposition to malignancy (119). The defect has been traced to a gene on chromosome 11, the ATM gene that codes for a phosphatidylinositol 3-kinase-like protein which is related to the catalytic subunit of DNA-dependent protein kinase. This protein has a role in signal transduction, DNA repair, and control of the cell cycle (120). Affected patients have a defect in cell-mediated immunity. A decrease in semm IgA is seen in a majority of affected patients. IgG2 or total IgG and IgE levels may be decreased, with an increase in IgM. Patients are susceptible to chronic respiratory... 

Hepatic Abnormal liver function tests and rare liver failure. 

Nicotinic acid can cause hepatic steatosis and clinical hepatic abnormalities that together can simulate the presentation of hepatobiliary neoplasia (36). 

Common adverse effects include gastrointestinal distress (nausea, vomiting, stomach cramps) and various hypersensitivity reactions (rashes and fever). Disturbances in liver function have also been noted, and serious hepatic abnormalities may occur in patients with preexisting liver disease. 

In athletes Use of anabolic steroids, (for example, nandrolone [nan DRO lone] or stanozolol [sta NO zo lol], by athletes can cause premature closing of the epiphysis of the long bones, which interrupts development. The high doses taken by these young athletes may result in hepatic abnormalities, increased aggression ( roid rage"), and psychotic episodes, as well as the other adverse effects described above. 

May need liver funcfion fesfs for fhose wifh hepatic abnormalities before inifiafing treatment... 

The spectrum of hepatic abnormalities caused by drugs is broad, and encompasses the whole range of liver lesions from other causes. Adverse hepatic effects of drugs, classified as elsewhere in this book (see Chapter 8) include ... 

Buchman, A.L., Ament, M.E., Sohel, M., Dubin, M., Jenden, D.J., Roch, M., Pownall, H., Farley, W., Awal, M., Ahn, C. Choline deficiency causes reversible hepatic abnormalities in patients receiving par-... 

In a study based on European and international data from about 130 million prescriptions, the adverse effects profile of levofloxacin was compared with that of other fluoroquinolones there was a low rate of hepatic abnormalities (1/650 000) (6). However, two cases of severe acute liver toxicity were reported in patients who had received intravenous levofloxacin (20,21). 

In a multicenter, double-blind study, patients with rheumatoid arthritis took pyritinol 600 mg/day or auranofin 6 mg/day for 1 year (7). Of 139 patients randomized to pyritinol, 61 (44%) dropped out because of adverse events or response failure compared with 44 (31%) of the 142 patients randomized to auranofin. Among the rest, adverse events occurred in 64% of patients taking pyritinol and in 58% of patients taking auranofin the main events were mucocutaneous symptoms (pyritinol 36%, auranofin 23%) and gastrointestinal complaints (pyritinol 30%, auranofin 37%). There were single cases of proteinuria, hepatic abnormalities, and hematological abnormalities in both groups. 

Pahner M, Schaffner F. Effect of weight reduction on hepatic abnormalities in overweight patients. Gastroenterology 1990 99 1408-13. 

Before the introduction of effective treatment for thyrotoxicosis, hepatobiliary complications were commonly associated with the disease. Liver biopsy samples taken from hyperthyroid patients often showed morphological changes such as fatty change, glycogen depletion, and cirrhosis but a direct detrimental effect of thyroid hormones on the liver was thought unlikely rather it was thought that hepatic abnormalities resulted from other factors such as altered cardiac output, infection, hypoxia, and malnutrition (K13, S19). 

Ethotoin differs from phenytoin in that one phenyl substituent at position 5 has been replaced by hydrogen, and the N-H at position 3 is replaced by an ethyl group (Fig. 20.5). It may be indicated for treatment of tonic-clonic and complex partial (psychomotor) seizures. Because it is considered to be less toxic but also less effective and more sedating than phenytoin, ethotoin usually is reserved for use as an add-on drug (39). Ethotoin does not share phenytoln s profile of antlarrhythmic action. The metabolism of ethotoin, like phenytoin, is saturable and nonlinear. Its administration Is contraindicated in patients with hepatic abnormalities and hematologic disorders. 

Howard, M.A., AB. Hibbard, D.R. Terrell, et aL 2003. Quinine allergy causing acute severe systemic illness Report of 4 patients manifesting multiple hematologic, renal, and hepatic abnormalities. Proc. Baylor Univ. Med. Cent. 16(l) 21-26. 

Hepatic Encephalopathy (HE) is a serious neuropsychiatric complication of both acute and chronic liver failure. A study group concluded in 2002 that HE is a spectrum of neuropsychiatric abnormalities seen in patients with liver dysfunction after exclusion of other known brain diseases (Ferenci et al., 2002). A multiaxial definition of HE was proposed that defines both the type of hepatic abnormality and the characteristics of the neurological manifestations. Three types of hepatic abnormalities were defined, namely ... 

Whiting-O Keefe QE, Eye KH, Sack KD. Methotrexate and histologic hepatic abnormalities a meta-analysis. Am J Med 1991 90 711-716. 

The exact frequency of hepatic abnormalities on abdominal CT is unknown because aU series have involved a selection bias and/or have been retrospective. However, the radiographic features of hepatic sarcoidosis have been well described. Hepatomegaly is the most common liver abnormality detected on CT (70-73) and is frequently associated with splenomegaly (73). Hepatomegaly from sarcoidosis may occur in patients with normal chest radiographs (Scadding stage 0) (70). 

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