Liver dysfunction

Irinotecan (CPT-11) is approved for colorectal tumors. It is given by intravenous infusion. The most severe side effect is diarrhea, which can be severe and needs to be treated by a physician. Temporary liver dysfunction is generally asymptomatic. The other side effects are the same as those produced by topotecan. 

ISONIAZID. Severe and sometimes fatal hepatitis may occur with isoniazid therapy. The nurse must carefully monitor all patients at least monthly for any evidence of liver dysfunction. It is important to instruct patients to report any of tlie following symptoms anorexia, nausea, vomiting, fatigue, weakness, yellowing of Hie skin or eyes, darkening of Hie urine, or numbness in the hands and feet. 

Older adults are particularly susceptible to a potentially fatal hepatitis when taking isoniazd, especially if they consume alcohol on a regular basis. Two other antitubercular drugs rifampin and pyrazinamide, can cause liver dysfunction in the older adult. Careful observation and monitoring for signs of liver impairment are necessary (eg, increased serum aspartate transaminase, increased serum alanine transferase, increased serum bilirubin, and jaundice). 

The miscellaneous anticonvulsants are used cautiously in patients with glaucoma or increased intraocular pressure a history of cardiac, renal or liver dysfunction and psychiatric disorders. When the miscellaneous anticonvulsants are used with other CNS depressants (eg, alcohol, narcotic analgesics, and antidepressants), an additive CNS depressant effect may occur. 

These dm are contraindicated in patients with a hypersensitivity to the dragp and during pregnancy (Category C) and lactation. Tolcapone is contraindicated in patients with liver dysfunction. The COMT inhibitors are used with caution in patients with hypertension, hypotension, and decreased hepatic or renal function. 

When administering the HMG-CoA reductase inhibitors and the fibric acid derivatives, the nurse monitors the patient s fiver function by obtaining serum transaminase levels before the drug regimen is started, at 6 and 12 weeks, then periodically thereafter because of the possibility of liver dysfunction with the drugs. If aspartate aminotransferase (AST) levels increase to three times normal, the primary care provider in notified immediately because the HMG-CoA reductase inhibitor therapy may be discontinued. 

The carbonic anhydrase inhibitors are contraindicated in patients with known hypersensitivity to the dru , electrolyte imbalances, severe kidney or liver dysfunction, or anuria, and for long-term use in chronic non-congestive angle-closure glaucoma (may mask worsening glaucoma). 

The oral antidiabetic drugs are contraindicated in patients with known hypersensitivity to tiie drugs, DKA, severe infection, or severe endocrine disease. The first generation sulfonylureas (chlorpropamide, tolazamide, and tolbutamide) are contraindicated in patients with coronary artery disease or liver or renal dysfunction. Other sulfonylureas are used cautiously in patients with impaired liver function because liver dysfunction can prolong the drug s effect. In addition, the sulfonylureas are used cautiously in patients with renal... 

Unconjugated hyperbilirubinemia can result from toxin-induced liver dysfunction such as that caused by chloroform, arsphenamines, carbon tetrachloride, acetaminophen, hepatitis virus, cirrhosis, and Amanita... 

Nakayama H, Kobayashi M, Takahashi M, et al. 1988. Generalized eruption with severe liver dysfunction associated with occupational exposure to trichloroethylene. Contact Dermatitis 19 48-51. 

Valimaki, M.J., Harju, K.J. and Ylikahri, R.H. (1983). Decreased serum selenium in alcoholics - a consequence of liver dysfunction. Clin. Chim. Acta 130, 291-296. 

In patients with significant liver dysfunction, lorazepam or... 

Progression of alcoholic liver disease moves through several distinct phases from development of fatty liver to the development of alcoholic hepatitis and cirrhosis. Fatty liver and alcoholic hepatitis may be reversible with cessation of alcohol intake, but cirrhosis itself is irreversible. Although the scarring of cirrhosis is permanent, maintaining abstinence from alcohol can still decrease complications and slow development to end-stage liver disease.22 Continuing to imbibe speeds the advancement of liver dysfunction and its complications. 

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. 

Black cohosh has been one of the most studied herbal remedies for vasomotor symptoms, and it has not demonstrated a substantial benefit over placebo. The mechanism of action, safety profile, drug-drug interactions, and adverse effects of black cohosh remain unknown. In non-placebo-controlled trials conducted for 6 months or less, black cohosh demonstrated a small reduction in vasomotor symptoms. It has not been shown to be effective for vasomotor symptoms in women with breast cancer.33 There have been case reports of hepatotoxicity with the use of black cohosh.36 Caution should be exercised when considering the use of this product, especially in patients with liver dysfunction. 

Many experts now consider voriconazole as the initial drug of choice for invasive aspergillosis in patients without significant contraindications (e.g., drug interactions or preexisting liver dysfunction) to azole therapy. 

Paclitaxel Peripheral neuropathy (DLT), nausea/vomiting, alopecia, hypersensitivity reactions Use caution with any elevation in AST (SGOT). Give proper dosing for liver dysfunction. Premedicate dexamethasone, diphenhydramine, and cimetidine. 

Docetaxel Neutropenia (DLT), hyperlacrimation, fluid retention, nail disorders, myelosuppression Use with caution in liver dysfunction. Do not give if biliary tract is obstructed. Premedicate dexamethasone. 

Metabolism J. Hepatic blood flow J. Liver size J. Phase I metabolism 1 Incidence liver dysfunction T t /2 hepatically extracted drugs... 

The answer is a. (Hardman, p 338. Katzung, pp 438-439.) Ester-type local anesthetics are mainly hydrolyzed by pseudocholinesterases. Amide-type local anesthetics are hydrolyzed by microsomal enzymes in the liver. Of the listed agents, only lidocaine is an amide and can be influenced by liver dysfunction. 

Rainbow trout, Oncorhynchus mykiss 0.2-1.0 Exposure of yolk-sac fry for 110 days produced liver dysfunction, reduced growth, and altered blood chemistry no deaths 8, 21... 

Problems associated with these drugs include troublesome and potentially dangerous side effects, including extrapyramidal reactions, hypersensitivity reactions with possible liver dysfunction, marrow aplasia, and excessive sedation. 

Disseminated disease can cause neurologic deficits from CNS metastases, bone pain or pathologic fractures secondary to bone metastases, or liver dysfunction from hepatic involvement. 

Factors that may decrease theophylline clearance and lead to reduced dosage requirements include advanced age, bacterial or viral pneumonia, heart failure, liver dysfunction, hypoxemia from acute decompensation, and use of drugs such as cimetidine, macrolides, and fluoroquinolone antibiotics. 

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