Drug-induced hepatotoxicity, also called drug-induced liver injury or drug-induced liver disease, is injury to the liver that is associated with impaired liver function caused by exposure to a drug. Adverse drug reaction has to be considered one of the major causes of iatrogenic disease. Though some of the adverse drug reactions are predictable & preventable, there are many others which cannot be predicted or prevented as there is failure to understand and unravel why, how and in whom they occur.
Methyldopa (L-α-Methyl-3, 4-dihydroxyphenylalanine) is a centrally acting sympatholytic agent (selective α2-adrenergic receptor agonist) that reduces sympathetic drive to the heart and peripheral circulation, leading to decreased cardiac output and lowered peripheral arterial resistance. It was introduced by Oates and his co-workers more than 50 years ago for the treatment of hypertension. Over the years it has been replaced by newer class of antihypertensives in the general population. Nevertheless, during pregnancy it is still the first line agent in treating non complicated pregnancy induced hypertension [1, 2], especially in developing countries. Advantages of methyldopa include the ability to maintain the reduction of blood pressure while the patient is in recumbent position along with the relative absence of orthostatic hypotension. The drug has a half life of two hours with a bioavailability of 42%. Methyldopa sulphate is the major metabolite recorded [3]. It is known to cause mild or reversible but not invariably benign liver disease. Reactive hepatitis is a severe, uncommonly reported side effect. We present here such a case of alpha methyldopa induced hepatotoxicity in pregnancy.
Case Report: A 32 year old woman presented wi...
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...r some days after birth. It can be an infrequent cause for newborn hyberbilirubinaemia with positive Coomb’s test without blood group incompatibility, due to drug induced development of IgG auto antibodies against red blood cells which can cross the placenta and cause haemolysis [10].
Conclusions
Alpha methyldopa is one of the most widely prescribed antihypertensive agents used during pregnancy. It is still the first line agent in treating non complicated pregnancy induced hypertension especially in developing nations. Jaundice has been reported as a rare complication of alpha methyldopa therapy, and abnormalities in liver function tests are occasionally found in patients taking the drug, should be considered in the differential diagnosis. However, the adverse affect alarm or possibility does not herald a contraindication for its use in patients when necessary.
Ace Inhibitors are used to treat hypertension and congestive heart failure (CHF). Most of the drugs that are Ace Inhibitors have the common ending –pril. It inhibits an enzyme; that decreases the tension of blood vessels and the blood volume, thus lowering blood pressure. Lotensin (benzapril) comes in tablets and is used for oral administration. It is one of the ace inhibitors that are indicated for treating hypertension. There is warning while using Lotensin when pregnant, it indicates to stop using immediately when pregnancy is detected. Vasotec (enalpril) comes in tablets and injection. It is indicated for the treatment of hypertension and is effective alone or in combination with other Ace Inhibitors agents, especially thiazide-type diuretics. There is a warning for fetal toxicity; when pregnancy is detected; stop using.
Thrombocytopenia affects 6% to 10% of all pregnant women and, other than anemia, is the most common hematologic disorder in pregnancy (McCrae, 2010). The blood consists of three main ingredients: red blood cells, white blood cells, and platelets. Each plays an essential function to provide the human body with elements and protects the body against any exterior viral and infection. Platelets are responsible to help blood to clot. The deficiency or disorder of platelets lead to disease called Thrombocytopenia. This issue is diagnosed when platelets are less than 150,000 platelets per microliter of blood (Erkurt, et. al, 2012).
An Rh factor is a protein on the surface of red blood cells. Rh incompatibility happens when a mother has Rh-negative blood and her baby has Rh-positive blood. During pregnancy or delivery, blood from the baby can cross into the mother’s bloodstream. If a mother is Rh-negative and the baby is Rh-positive, the mother’s antibodies can destroy the baby 's red blood cells.
“Crack-babies” a media induced phenomena brought about by the climax of public outcry from the results of the 1980’s war on drugs. This term laid the foundation for biased prosecutions which sparked a political crusade during climate of the time. Thus exploiting the public’s fear of children born to substance addicted mother and creating a firestorm of litigation to prosecute pregnant drug addicts. According to Flavin, Paltrow (2010), current evidence points to public stigmas and prejudice as posing a greater danger to both maternal and fetal health than use of the drug itself. Leaving the question as to why addicted women are still publicly reviled for the outcomes of their circumstances. From this abhorrence stems the likelihood that these women would be deterred from seeking prenatal care than to seek help for their addiction; expelling an even greater issue as the concern of health care is then added to the mix. The complex social issues then must be taken into consideration to underscore the need for policymakers to allow for the legal and medical systems to better create programs for these women and allot for rehabilitation instead of punitive solutions.
Osmara is a 22yo, primigravida, who is currently 34 weeks 5 days. She has been followed for an elevated inhibin. On her visit 2 weeks ago she was noted to be LGA that was symmetric and growth > 90%ile. Amniotic fluid was normal but generous at 19 cm. In the last week, she has gained a fairly significant amount of weight and has noted edema. She does tend to wake-up with the edema but it can be relieved with elevation. She has an occasional headache and has not really taken Tylenol but otherwise has no visual changes or nausea/vomiting.
...heir diet during their pregnancy to treat all types of ailments. It is important to rule out any side effects, drug interactions or harm if any associated during pregnancy.
I would ask the patient to rate her pain (0-10). I would check to see if the physician changed the meperidine to a more appropriate form. If the patient’s pain decreased, I would then educated the patient about the acetaminophen and meperidine. I would tell her advise her to take her meperidine q 3-4 hours if pain is severe and if it’s mild pain like what she was previously experienced I would encourage her to take the acetaminophen 1 to 2 tablets every 4 hours. When taking meperidine do not drink or take sedatives for at least 24 hours. This medication may also cause dizziness, drowsiness, and confusion; so avoid getting up without assistance. Be careful making positions changes which can cause dizziness. There are adverse effect that may occur and if the patient experience trouble breathing, seizures, increase heart rate to not hesitate to come back in. It is common to experience minor side effects like dizziness, headaches, nausea, and vomiting when this medication. When taking acetaminophen do not exceed the recommended dosage, because acute poisoning with the liver damage may result nausea, vomiting, abdominal pain. If this occurs notify your prescriber. Also, if you see bruising, bleeding, fever, dark brown urine notify your
Liver disease resulting from alcohol affects more than two million Americans and is one of the primary causes of illness and death. The liver frees the body of harmful substances, such as alcohol. While the liver breaks down alcohol, it produces toxins that can be even more dangerous than the alcohol consumed (“Beyond Hangovers: Understanding Alcohol's Impact on Your Health” 13). “These by-products damage liver cells, promote inflammation, and weaken the body’s natural defenses. Eventually, these problems can disrupt the body’s metabolism and impair the function of other organs” (“Beyond Hangovers: Understanding Alcohol’s Impact on Your Health” 13).
The primary cause of hepatic cirrhosis in the United States is long-term alcoholism. Men respond differently than women to alcohol. With women one or two drinks a day can cause them liver damage. Men can consume two to five drinks a day and be ok. One drink a day can create liver scarring. So like everything else in life it varies, it might affect everyone differently. The individual who drinks alcohol on a daily basis, or more often then others have a higher risk of developing cirrhosis. Hepatic cirrhosis has also been linked to serious liver infections such as hepatitis B and hepatitis C. Patients who are HIV positive have died from developing cirrhosis through the hepatitis virus. Other causes of cirrhosis come from reactions to prescribed medications, injuries to the liver, exposure to toxic substances, and episodes of heart failure with liver congestion. Obt...
This case study is about Abdul Chidiac, a 51 year old male, married with 4 children. He had a medical history of hypertension, hypercholesterolaemia and cirrhosis with two admissions in the last six months. He is a smoker and drinks beer, 5-6 bottles per day. As Carithers & McClain (2010) explained the patient’s medical history is another indicator of the risk for cirrhosis; the progression to cirrhosis is adaptable and may take time over weeks or many years. Cirrhosis is a liver disease characterized by permanent scarring of the liver that interferes with its normal functions including alcoholism. Most people who drink large amounts of alcohol cause harm to the liver in some way (Heidelbaugh & Bruderly, 2006). The cause of cirrhosis is not yet known, but the connection between cirrhosis and excessive alcohol ingestion is established (Jenkins & Johnson, 2010). Common causes of cirrhosis include: alcohol abuse, hepatitis B infection, hepatitis C infection and non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (Schuppan & Afdhal, 2008).
Pregnancy Induced Hypertension (PIH) is a multi-organ disease process that develops as a result of pregnancy and regresses in the postpartum period. It usually develops after 20 weeks of gestation in a woman who had normal blood pressure. It is defined as an elevation of systolic and diastolic pressures equal to or above 140/90 mm Hg. In clinical practice, the terms PIH and preeclampsia are used interchangeable, but in preeclampsia the woman also has protein in her urine indicating that there is renal involvement as well. The only know cure for preeclampsia is delivery of the fetus. It is a relatively common problem of pregnancy and affects about 8% of all pregnancies. (Murray, p680)
Although debates generally center around the political side of abortion rights, it seems that Americans overlook the small, yet significant percentage of women who meet their demise during childbirth. Statistics show that only 9.1 out of 100,000 actually suffer from labor-induced afflictions, most being younger mothers aged 15-18. In fact, the lack of safe abortion methods has resulted in childbirth being the primary cause of death among teenagers throughout the world. It is estimated that 50,000 young women die from childbirth per year by reason of underdeveloped bodies. Common complications are “...postpartum bleeding (15%), hypertensive disorders (10%)...” and “preexisting conditions (28%).”, The hypertensive disorder occurs in the form
While pregnant a women can risk harm to their unborn child when they abuse drugs. The amount of harm would depend on the type of drug, the severity of the drug and the amount of time the drug was used while the baby was developing. Not only are any type of drugs harmful to the baby but as well as prescribed drugs. Prescription drugs can be harmful towards both the mother and the baby. Prescription Drug Abuse occurs when the mother takes the drugs without being subscribed to her or because she takes high doses than what she is supposed to take.
Chambers, C. D., Polifka, J. E., & Friedman, J. M. (2008). Drug safety in pregnant women and their babies: ignorance not bliss. Clinical Pharmacology & Therapeutics, 83(1), 181-183.
Alcohol in the form of alcoholic beverages has been consumed by humans since pre-historic times, for a variety of hygiene dietary, medicinal, religions and recreational reasons. According to the NIH Senior Health, drinking too much alcohol affects many parts of the body. It can be especially harmful to the liver, the organ that metabolizes (breaks down) alcohol and other harmful substances. People who drink heavily for a long time can develop diseases such as liver inflammation (alcoholic hepatitis) or severe liver scarring (cirrhosis). Alcohol-related liver disease can cause death. According to the statistics in the year 2010 by the CDC (Centers for Disease Control and prevention) the number of discharges with chronic liver disease and cirrhosis as the first-listed diagnosis was 101,000 persons, while the number of deaths has been 31,903 persons.