Hepatic function abnormalities

Monitoring Monitor liver function in patients with pre-existing hepatic function abnormalities or those who have experienced liver toxicity with other medications consider monitoring in all patients. Stop treatment immediately and conduct liver function testing in patients who develop signs and symptoms suggestive of liver... 

Hepatic function abnormal Liver and biliary system disorders 27,769 0.8... 

Hepatic function abnormalities and severe venous pain and inflammation may occur. 

Despite the fact that it is difficult to define a relationship between PK parameters and measures of hepatic function, the most appropriate statistical approach is to calculate geometric means and 95% confidence intervals to compare the healthy and impaired groups (see example). Investigation of the relationships between hepatic functional abnormalities and selected PK parameters using linear and non linear models in order to derive dose recommendations are an appropriate alternative, yet, in spite of many constraints. 

Hepatic function abnormalities may suggest metastatic disease. 

Dacarbazine is the most active compound used for treating metastatic melanoma. It is also combined with anthracyclines and other cytostatics in the treatment of different sarcomas and Hodgkin s disease. Dacarbazine may cause severe nausea and vomiting. Myelosuppres-sion results in leukopenia and thrombocytopenia. Alopecia and transient abnormalities in renal and hepatic function also occur. 

Hepatotoxicily is the principal adverse reaction seen witii pyrazinamide use Symptoms of hepatotoxicily may range from none (except for slightly abnormal hepatic function tests) to a more severe reaction such as jaundice Nausea, vomiting, diarrhea, myalgia, and rashes also may be seen. 

The primary health care provider may also order laboratory and diagnostic tests, renal and hepatic function tests, complete blood count, serum enzymes, and serum electrolytes. The nurse reviews these test results before the first dose is given and reports any abnormalities to the primary health care provider. The patient is usually placed on a cardiac monitor before aiitiarrhytiuiric drug therapy is initiated. The primary health care provider may order an ECG to provide baseline data for comparison during therapy. 

When these drugs are given to the female patient with inoperable breast carcinoma, tire nurse evaluates the patient s current status (physical, emotional, and nutritional) carefully and records tire finding in tire patient s chart. Problem areas, such as pain, any limitation of motion, and the ability to participate in tire activities of daily living, are carefully evaluated and recorded in tiie patient s record. The nurse takes and records vital signs and weight. Baseline laboratory tests may include a complete blood count, hepatic function tests, serum electrolytes, and serum and urinary calcium levels. The nurse reviews these tests and notes any abnormalities. 

In the ED setting, the diagnosis of ketamine intoxication is a clinical one. Ketamine is not routinely detected by urine toxicology tests, although it can be detected with high-performance liquid chromatography (Koesters et al. 2002). As with MDMA, the initial assessment for ketamine intoxication includes the use of routine laboratory tests to detect electrolyte abnormalities and to evaluate renal and hepatic functioning (Koesters et al. 2002). 

The reported risk factors for HIV-associated sensory neuropathy are varied and may have changed since the availability of HAART. In the pre-HAART era, age, nutritional deficiencies, alcohol exposure, higher HIV viral load, and low CD4 counts (Moyle and Sadler 1998 Childs et al. 1999), as well as mood, other neurologic disorders and functional abnormalities (Schifitto et al. 2002) were neuropathy risk factors. In the HAART era, the use of NRTI (Cherry et al. 2006 Pettersen et al. 2006) and exposure to protease inhibitor (PI) medication (Pettersen et al. 2006 Smyth et al. 2007) are considered additional risk factors. Although hepatitis C mono-infection has been associated with peripheral nerve disease, and there is... 

Abnormal renal and hepatic function will increase drug concentration and predispose the patient to toxicity. 

Metabolic abnormalities / Renal and hepatic function / Concomitant drug therapy... 

As indicated in Table 1, statins, which block cholesterol biosynthesis by inhibition of hepatic HMGCoA reductase, have been used extensively to reduce LDL-C levels. At most therapeutic doses, statins marginally increase HDL levels by 5-10% [3,16]. The HDL elevation observed with statins has been highly variable and not easily extrapolated from the effects on LDL. A recent study (STELLAR) demonstrated increased HDL elevation with the use of rosuvastatin compared to simvastatin, pravastatin or atorvastatin (10% vs. 2-6%) [16,24], Although the mechanism of HDL elevation by statins is not clearly understood, it is proposed that statins enhance hepatic apoA-I synthesis [25] and decrease apoB-containing lipoproteins [26]. A number of clinical trials have demonstrated that statins reduce the risk of major coronary events. However, it is not clear if the statin-induced rise in HDL levels is an independent contributor to the reduced risk of coronary events. The observed small increase in HDL and adverse side effect profile related to liver function abnormalities and muscle toxicity limits the use of statins as monotherapy for HDL elevation [27],... 

Tenidap (Figure 8.26) is a dual cyclooxygenase (COX) and 5-lipoxygenase (5-LPO) inhibitor developed as an anti-inflammatory agent. Severe abnormalities in hepatic function were reported in Japanese clinical trials [28]. Although the thiophene is not directly implicated in these findings, the ready activation of this system to potential reactive metabolites may be suggestive of the involvement of this function. 

Lab test abnormalities Abnormalities of hepatic function tests, decreased glucose tolerance, gout, hyperuricemia. 

Hepatic function impairment Use caution in those patients with liver function abnormalities since finasteride is metabolized extensively in the liver. 

Etidronate Convulsions, constipation, nausea, stomatitis, abnormal hepatic function, hypomagnesemia, hypophosphatemia, dyspnea, taste perversion, fever, fluid overload. 

Hepatic function impairment Since mexiletine is metabolized in the liver, and hepatic impairment prolongs the elimination half-life, carefully monitor patients with liver disease. Observe caution in patients with hepatic dysfunction secondary to CHF. Abnormal liver function tests have been reported, some in the first few weeks of therapy with mexiletine. Most have occurred along with CHF or ischemia their relationship to mexiletine has not been established. 

Hepatotoxicity Fever has occasionally occurred within the first 3 weeks of therapy, sometimes associated with eosinophilia or abnormalities in 1 liver function test or more. Jaundice with or without fever may occur, usually within the first 2 to 3 months of therapy. Incidence of elevated serum transaminase levels and impaired hepatic function ranges from 1% to 27%. 

Hepatic function impairment Use with extreme caution in patients with advanced hepatorenal disease or abnormal liver function hepatic coma may be precipitated. Pregnancy Category C. 

Evaluate liver function tests at the start of and during the course of voriconazole therapy. Monitor patients who develop abnormal liver function tests during voriconazole therapy for the development of more severe hepatic injury. Discontinuation of voriconazole must be considered if clinical signs and symptoms consistent with liver disease develop that may be attributable to voriconazole. Hepatic function impairment It is recommended that the standard loading dose regimens be used but that the maintenance dose be halved in patients with mild to moderate hepatic cirrhosis (Child-Pugh class A and B) receiving voriconazole. 

Monitor patients who develop abnormal liver function tests during caspofungin therapy for evidence of worsening hepatic function and evaluate them for risk/benefit of continuing caspofungin therapy. 

Hepatic function impairment Only give patients with abnormal liver tests or liver disease rifapentine in cases of necessity and then with caution and under strict medical supervision. In these patients, carefully monitor liver tests (especially serum transaminases) prior to therapy and then every 2 to 4 weeks during therapy. If signs of liver disease occur or worsen, discontinue rifapentine. 

Hepatic function impairment Exercise caution when administering saquinavir to patients with hepatic insufficiency. Exacerbation of chronic liver dysfunction, including portal hypertension, in patients with underlying hepatitis B or C, cirrhosis or other underlying liver abnormalities have been reported. 

Hepatic function impairment Ritonavir is principally metabolized by the liver. Exercise caution when administering this drug to patients with pre-existing liver diseases, liver enzyme abnormalities, or hepatitis. 

Many patients have underlying liver disease with liver function abnormalities. It may be difficult to determine superimposed drug-induced liver injury in patients with viral hepatitis, passive congestion of the liver from heart failure, fatty liver... 

Abnormal hepatic function, lower extremity edema, and palpitations occur rarely. 

Contraindications Gallbladder disease, severe renal or hepatic dysfunction (including primary biliary cirrhosis, unexplained persistent liver function abnormality)... 

Abnormal hepatic function, including jaundice, hepatitis, and hepatic necrosis alopecia anaphylaxis breast enlargement erythema multiforme peripheral edema and seizures have been reported. 

Baseline tests CBC, hepatic function, pregnancy test, TSH, renal function, uric acid, HCVRNA level. Exclusions to treatment platelet count <90,000 cells/mm (as low as 75,000 cells/mm in patients with cirrhosis) absolute neutrophil count < 1,500 cells/mm serum creatinine concentration > 1.5 X upperlimit of normal abnormal thyroid function... 

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