Hepatotoxicity: Assessment and Evaluation (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Okay.

    00:01 We've just looked at drugs that were nephrotoxic, they were toxic to your kidneys.

    00:06 Now, we're going to look at drugs that are hepatotoxic, that means they're toxic to your hepato, or your liver.

    00:13 So think of things like when you hear the word "hepatitis," that means inflammation of your liver.

    00:18 Hepatotoxic means toxic to your liver.

    00:21 Now, you're going to see some old friends up here again.

    00:23 Notice that you see ACE inhibitors.

    00:25 Remember, that's the medication that we use to treat high blood pressure.

    00:29 Now, if I were you, my brain does better when I chunk or group information together.

    00:34 So take a minute and let's just run through a little exercise that you can use while you're studying.

    00:38 Write the word "ACE inhibitors" somewhere in the side margin of your notes.

    00:43 Okay, now, I want you to see if you can… I like to do it this way and put a circle around the word ACE inhibitors and then draw off, like, these little spikes.

    00:51 What I want you to do at the end of each 1 of those line is write something that you remember from this video presentation about ACE inhibitors.

    00:59 Remember, we've talked about angioedema.

    01:01 We've talked about allergic reactions.

    01:04 We've talked about having problems with your kidneys.

    01:07 All those involve ACE inhibitors.

    01:09 So, anytime you're studying pharmacology and you start to see patterns in things that are similar, if you chunk that information together, it will help it stick in your brain better.

    01:20 Now, next up, our other friend, alcohol.

    01:23 Now, why would we list alcohol under hepatotoxic drugs? First of all, alcohol is considered a drug.

    01:30 Second, it takes a lot of your liver's energy to detox any alcohol that you drink.

    01:37 So if you're drinking large amounts of it, you're going to see some really nasty changes to that liver, experiences lots of damage.

    01:44 It does kind of come back, but it comes back all gnarly and it's really hard for blood to go through it, so it gives us all kinds of problems.

    01:52 So know that too much alcohol can really become hepatotoxic.

    01:56 Now, when we look at anti-infectives, you've got erythromycin up there and you've got some zoles, see those? Fluconazole, itraconazole, those guys goes after fungi.

    02:06 So, those are some pretty big…that's why they're under the title, anti-infectives.

    02:10 These are some pretty big hitters.

    02:12 If you're on any 1 of those 3 medications, we're going to watch your liver function really closely.

    02:18 Next up, tuberculosis.

    02:20 Now, you know, you can have latent tuberculosis, which means you're not actively infective.

    02:26 You can't give it to somebody.

    02:27 But we also want you to usually think about taking prophylactic medications, meaning you don't have active tuberculosis, but stress or something in your life could make it appear again.

    02:37 So, we usually try to recommend that the patient take prophylactic medication, like, rifampin, or INH.

    02:43 Well, here's the problem.

    02:45 These drugs make you feel kind of bad.

    02:47 So, a lot of people are hesitant to take it prophylactically.

    02:51 They only want to take it if they absolutely have tuberculosis because of the way it makes them feel.

    02:56 In fact, I just had a friend the other day who was afraid that she would… been exposed supposed to tuberculosis.

    03:01 We're waiting for our test results to come.

    03:03 And we had to have that whole discussion of should she take the medication, should she not take the medication, because we both knew how terrible she was going to feel.

    03:11 Good news.

    03:12 She was negative.

    03:13 She was exposed to the patient, but she did not contract the disease.

    03:16 So, that was good news and that she didn't have to take the meds.

    03:19 Now, pain medicines.

    03:21 We've got acetaminophen, which is your friend Tylenol and NSAIDs.

    03:24 Remember, we talked about those in some other sections.

    03:26 NSAIDs are non-steroidal anti-inflammatory drugs, like your ibuprofen, Aleve, naproxen, Motrin.

    03:34 Those are like your NSAIDs.

    03:36 Those are the over-the-counter ones, like we talked about previously.

    03:39 There's also some more potent NSAIDs, but they can not only be bad on the kidneys, they can also be bad on your liver.

    03:47 But I want to go back to acetaminophen because this is a really common thing that happens in children and adults.

    03:53 Acetaminophen is in multiple, different over-the-counter medications.

    03:59 So, oftentimes, people have any number of over-the-counter cold medications in their medicine cabinet.

    04:05 It's almost like they went to the grocery store and just cleared a shelf and put it in their basket.

    04:09 So when you have these different types of medications, you want to make sure that you read all the ingredients in the cold medications, because when you start combining over-the-counter medications, they might all contain acetaminophen, which puts you at a risk for a Tylenol or acetaminophen overdose, and that will definitely damage your liver.

    04:29 So be very careful about the individual ingredients that are included in over-the-counter medications, because too much acetaminophen or giving acetaminophen to someone whose liver is struggling is a bad idea.

    04:42 Now, the last group of medications is a psych meds, phenothiazines.

    04:45 It can also be bad on your liver.

    04:47 And I want to make sure that you're very clear that these drugs can cause hepatotoxicity, and I don't ever want to give them to patients whose livers are already struggling.

    04:58 So, let's say, I have a patient who is an alcoholic.

    05:00 They have alcoholic cirrhosis.

    05:03 These medications are going to be almost not considered for them if they have really severe liver disease.

    05:09 So keep that in mind that the liver problems make medication treatment plans really problematic, because the drug that might have been the most effective, we won't be able to give that patient because it could cause further damage to organs that are struggling.

    05:23 Well, how do you know how patient's liver is doing? Well, you want to watch for the signs.

    05:27 Some of them are really obvious, like when they start to turn yellow or look like a pumpkin, that's a really obvious sign, but it's also a really late sign.

    05:36 So what they'll start feeling initially is just really tired or weak.

    05:40 They won't be hungry because your liver is a big player in your GI system.

    05:45 They might have some really severe pain in their upper abdomen.

    05:48 But here's the deal with abdominal pain.

    05:51 It can be all over the map.

    05:53 Abdominal pain can be all over your body, it can bounce back and forth, and it can be anything that's as simple as gas to, you know, stage 4 cancer.

    06:03 So, abdominal pain is really vague, but when you start seeing it with all these other symptoms, it really is cause for alarm.

    06:11 Their urine might become very dark colored.

    06:13 We already talked about yellowing of their skin and their eyes.

    06:16 But here's a lab test that you need to watch for.

    06:19 There's 2 tests: AST and ALT.

    06:24 The ALT is the one that's more specific for the liver.

    06:29 So don't think loser when you see this.

    06:31 Think liver when you see ALT.

    06:33 You want the normal between 7 to 56 units.

    06:36 So, I would know that my patient's liver was struggling if they came back with an ALT… a serum lab test drawn from their arm… they came back with an ALT that was higher than 56.

    06:48 That would be a huge red flag that this patient's liver was struggling.

    06:51 AST is another one that we use, but know that ALT is much more specific for the liver.

    06:59 So there you have it, some of the most horrible things that can happen from the good intentions when we try to treat people with medications to help them feel better.

    07:08 So keep in mind, it's the nurse's responsibility to know what are the possible effects, negative adverse effects they can get from this medication, know how to monitor it, and know what to do about it.

    07:20 Thank you for watching our video today.

    About the Lecture

    The lecture Hepatotoxicity: Assessment and Evaluation (Nursing) by Rhonda Lawes, PhD, RN is from the course Pharmacology and Implications for Nursing.

    Included Quiz Questions

    1. Angiotensin-converting enzyme (ACE) inhibitors
    2. Angiotensin II receptor blockers (ARBs)
    3. Beta-adrenergic blocking agents
    4. Calcium channel blockers
    1. Erythromycin
    2. Fluconazole
    3. Itraconazole
    4. Meropenem
    1. Jaundice
    2. Lack of appetite
    3. Abdominal pain
    4. Fatigue and weakness
    1. Alanine transaminase (ALT)
    2. Aspartate aminotransferase (AST)
    3. Alkaline phosphatase
    4. Blood urea nitrogen (BUN)

    Author of lecture Hepatotoxicity: Assessment and Evaluation (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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