Hepat

pharmacology
SYLLABUS
Hepatotoxicity of drugs (p. 267)

HEPATOTOXICITY OF DRUGS Drugs induced liver damage:

Past Questions: Include:
1. Type A (Augmented)
1. Name the drug to be avoided in this case. Give
reasons. (Case was Hepatitis) [3](PBQs 2013 KU) 2. Type B (bizarre or idiosyncratic)
3. Type C (Continued use, cumulative effect)

Type A Mechanism Example

- Liver injury occurs as 1. Interference with bilirubin - Estrogen, rifampicin, fusidic acid
dose of some drugs is metabolism and excretion - Paracetamol in over dose
increased 2. Centrilobular necrosis - Carbon tetrachloride, salicylate V
3. Hepatocellular necrosis - Tetracyclines
4. Fatty change

Type B Mechanism Example

- Drugs can cause 1. Acute hepatocellular necrosis - General anesthetics (halothane)

hepatic damage at - Anti epileptics: Carbamazepine, Phenytoin, Sod
therapeutic doses
- Antidepressants: MAO inhibitors
- Antiinflammatory: Indomethacin, Ibuprofen
- Antimicrobials: Isoniazide, Sulphonamides,
Nitrofurantoin
- Methyldopa, hydralazine

2. Cholestatic hepatitis - Antidiabetics (tolbutamide, Glibenclamide)

- Carbimazole
- Chlorpropamide

FAST TRACK BASIC SCIENCE MBBS -267-

 Pharmacology

Type C Mechanism Example

Liver damage at 1. Chronic active hepatitis - Methyldopa,

continuous dose, - Isoniazid
cumulative effect
- Dantrolene
- Nitrofurantoin

2. Hepatic fibrosis or cirrhosis - Methotrexate

- Amiodarone

-268- FAST TRACK BASIC SCIENCE MBBS