RT Book, Section A1 Schwinghammer, Terry L. A1 DiPiro, Joseph T. A1 Ellingrod, Vicki L. A1 DiPiro, Cecily V. SR Print(0) ID 1178899289 T1 Drug-Induced Liver Disease T2 Pharmacotherapy Handbook, 11e YR 2021 FD 2021 PB McGraw Hill PP New York, NY SN 9781260116694 LK accesspharmacy.mhmedical.com/content.aspx?aid=1178899289 RD 2024/03/29 AB Table Graphic Jump LocationTABLE A6-1An Approach to Evaluating a Suspected Hepatotoxic ReactionView Table||Download (.pdf)TABLE A6-1An Approach to Evaluating a Suspected Hepatotoxic ReactionPoints−3−10+1+2+3What is the temporal relationship? (days)From the start of therapy––??905–90From the end of therapy>30–??––<30Is there evidence of the concurrent use of a hepatotoxinaYesMaybe??––NoIs there an alternate cause, such as, viral hepatitis?YesMost likely—Yes??Most likely—NoNoAre there extrahepatic signs or symptoms?Dermatologic: rash, palmar erythema, cutaneous vasculitis––NoYes (+1 for each)––Dermatologic: spider nevi, white nails (aka Terry nails)––NoYes (+1 for each)––Hematologic: coagulation disorders––NoYes (+1 for each)––Endocrine disorders: insulin resistance, thyroid dysfunction––NoYes (+1 for each)––Endocrine disorders: adrenal insufficiency, hypogonadism––NoYes (+1 for each)––Skeletal muscular: arthralgias, arthritis––NoYes (+1 for each)––Neurological: encephalopathy––NoYes (+1 for each)––Portopulmonary hypertension––NoYes (+1 for each)––Does the literature support a connection with this drug?Listed in the product labeling–––––YesPublished reports in the literature––––Yes–No information available, reaction is undocumented––Yes–––−3+4Results from a rechallenge with the drug.Negative––––Positiveadrug, herbal remedy, or other occupational exposure known to be potentially hepatotoxic.A total score of <7 makes it unlikely that this is a hepatotoxic reaction. As the score approaches 14, the possibility that this is a hepatotoxic reaction increases toward certainty. ?? = uncertain.