Salicylates hepatic effects

Uses Edema, HTN, CHF, hepatic cirrhosis Action Loop diuretic X- reabsorption of Na+ Cl- in ascending loop of Henle distal tubule Dose 5—20 mg/d PO or IV 200 mg/d max Caution [B, ] Contra Sulfonylurea sensitivity Disp Tabs, inj SE Orthostatic X- BP, HA, dizziness, photosens, electrolyte imbalance, blurred vision, renal impair Notes 20 mg torsemide = 40 mg furosemide Interactions T Risk of ototox W/ aminoglycosides, cisplatin T effects W/ thiazides T effects OF anticoagulants, antihypertensives, Li, salicylates X- effects W/ barbiturates, carbamazepine, cholestyramine, NSAIDs, phenytoin, phenobarbital, probenecid, dandelion EMS T Effects of anticoagulants monitor for S/Sxs tinnitus, monitor ECG for hypokalemia (flattened T waves) OD May cause HA, hypotension, hypovolemia, and hypokalemia give IV fluids symptomatic and supportive... 

Aspirin in doses used to treal rheumatoid arthritis can result in uncoupling of oxidative phosphorylation, increased oxygen consumption, depletion of hepatic glycogen, and the pyref c effect of toxic doses of salicylate. Depending on the degree of salicylate intoxication, the symptoms can vary from tinnitus to pronounced CNS and acid-base disturbance. 

Caution [B (D if near term), M] Contra Sulfonamide or salicylate sensitivity, porphyria, GI/GU obst avoid in hepatic impair Disp Tabs SE GI upset discolors urine dizziness, HA, photosens, oligospermia, anemias, Stevens-Johnson synd Interactions T Effects OF oral anticoagulants, oral hypoglycemics, MTX, pheny-toin, zidovudine X effects W/ antibiotics X effects OF digoxin, folic acid, Fe, procaine, proparacaine, sulfonylureas, tetracaine EMS T Effects of anticoagulants monitor EGG and BP for signs of hypovolemia and electrolyte disturbances d/t D skin urine may become yellow-orange may stain contact lenses T risk of photosensitivity Rxns OD May cause NA, drowsiness, HA, abd pain, skin Rxns, lactic acidosis, and jaundice symptomatic and supportive... 

Uses AML, ALL, CML Action Purine-based antimetabolite (substitutes for natural purines interfering w/ nucleotide synth) Dose 2-3 mg/kg/d X in severe renal/hepatic impair Caution [D, -] Contra Resistance to mercaptopurine Disp Tabs SE X BM (leucopenia/thrombocytopenia), NA /D, anorexia, stomatitis, rash, hyperuricemia, rare hepatotox Interactions t Bleeding W/ anticoagulants, NSAIDs, salicylates, thrombolytics EMS t Effects of anticoagulants/salicylates/ NSAIDs T risk of Infxn OD May cause NA, hypotension, and diaphoresis symptomatic and supportive... 

Adverse effects. Nausea, anorexia, vomiting, skin rash, diarrhea, hypersensitivity reactions including to ordinary salicylates, rarely blood dyscrasias, pancreatitis, hepatitis, interstitial nephritis. 

Probenecid can impair the renal active secretion of a variety of acidic compounds, including sulfinpyrazone, sulfonylureas, indomethacin, penicillin, sulfonamides, and 17-ketosteroids. If these agents are to be given concomitantly with probenecid, their dosage should be modified appropriately. Salicylates interfere with the clinical effects of both sulfinpyrazone and probenecid and should be avoided in patients treated with uricosuric agents. Uricosuric agents also can influence the volume of distribution and hepatic metabolism of a number of drugs. 

Tnorpholonluin quaternary compounds have been shown to be active In mice Infected with mouse hepatitis and herpes simplex viruses.vfe n cell culture, N -furfurylblquanlde was active against a variety of RNA viruses.— A lengthy report on the effect of salicylates on EMC virus In cell culture Is not completely convlnclngV Certaln derivatives of it-oxo-5 thlazoll-dlne are claimed to have a wide antiviral spectrum but only data for poliovirus inhibition are presented.V ... 

Keratolytics are available in a multitude of formulations for treating skin diseases. Prolonged use of salicylic acid preparations over large areas, especially in children and patients with renal and hepatic impairment, can result in salicylism. Irritation is a common side effect with higher concentrations. Lactic acid (Lac-hydrin, others) is an emoUient that contains 12% lactic acid, which is an effective moisturizer indicated for the treatment of xerosis and ichthyosis vulgaris. 

Its antipyretic actions are very much akin to those of the salicylates. Its major pharmacological action was in the control and management of chronic gout and rheumatic conditions, but by virtue of its relatively high level of toxic effects, such as hepatic dysfunction ultimately leading to acute jaundice. 

Nordmann R, Ribiere C, Rouach H (1992) Implication of free radical mechanisms in ethanol-induced cellular injury. Free Radical Biol Med 112 219-240 Oh KW, Qian T, Brenner DA, Lemasters JJ (2003) Salicylate enhances necrosis and apoptosis mediated by the mitochondrial permeability transition. Toxicol Sci 73 44—52 Okanoue T, Sakamoto S, Itoh Y, Minami M, Yasui K, Sakamoto M, Nishioji K, Katagishi T, Nakagawa Y, Tada H, Sawa Y, Mizuno M, Kagawa K, Kashima K (1996) Side effects of high-dose interferon therapy for chronic hepatitis C. J Hepatol 25 283-291 Oleinick NL, Corcoran JW (1969) Two types of binding of erythromycin to ribosomes Ifom antibiotic-sensitive and resistant Saci/te suhtilis 168. J Biol Chem 244 727-735 Oyadomari S, Mori M (2004) Roles of CHOP/GADD153 in endoplasmic reticulum stress. Cell Death Diff 11 381-389... 

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