Drug Idiosyncrasy In Ophthalmic Practice

Idiosyncratic drug reactions, denoting non-immunological hypersensitivity to a substance, have been a neglected entity. The idiosyncrasy, more often than not, is confused with hypersensitivity, which is an undesirable reaction of normal immune system. The present article gives an insight of the various aspects of idiosyncrasy and idiosyncratic responses of drugs commonly used in ophthalmic practice.

Hepatotoxicidade induzida por sulfassalazina: relato de caso / Hepatotoxicity induced by sulfasalazine: case report

A sulfassalazina é ainda muito utilizada nas doenças inflamatórias intestinais, sobretudo na retocolite ulcerativa leve e moderada. Entretanto, seu uso é relacionado a vários efeitos colaterais, incluindo disfunção hepática grave.Este é um relato do caso de paciente masculino, 21 anos, portador de retocolite ulcerativa moderada, com queixa de inapetência, febre, artralgia e icterícia, há sete dias. Antecedente pessoal de uso de sulfassalazina 4 g/dia há seis semanas. Ao exame físico apresentava-se ictérico, com exantema em membros e edema de membros inferiores. Exames complementares mostravam aumento de bilirrubinas, enzimas hepáticas e canaliculares e da proteína C reativa. Com o diagnóstico de hepatotoxicidade por sulfassalazina, foi suspensa a medicação e introduzido prednisona 20 mg/dia e ciprofloxacino 1 g/dia. Recebeu alta no terceiro dia de internação após melhora clínica e laboratorial. Atualmente encontra-se assintomático e em uso de azatioprina 150 mg/dia.

The sulfasalazine is widely used in inflammatory bowel disease, especially in mild and moderate ulcerative rectocolitis. However, its use is related to several side effects, including severe liver dysfunction. We report the case of male patient, 21 years, with the moderate ulcerative rectocolitis, complaining of inappetence, fever, arthralgia and jaundice for seven days. Personal history includes use of sulfasalazine 4 g/day during six weeks. The physical examination revealed jaundiced, with members in rash and lower extremity edema. Laboratory exams showed an increase in bilirubin, liver enzymes and canalicular and C-reactive protein. With the diagnosis of hepatotoxicity by sulfasalazine, this medication was suspended, and introduced prednisone 20 mg/day and ciprofloxacin 1g/day. He was discharged on the third day of admission after clinical and laboratorial improvement. Currently, he is asymptomatic and in use of azathioprine 150 mg/day.

Acetaminophen-Induced Acute Liver Failure

Acetaminophen (AAP) is an antipyretic and analgesic agent, which is sold under many brand names including Tylenol. Although AAP rarely induces hepatotoxicity by an idiosyncratic mechanism, it is one of intrinsic hepatotoxins with a narrow therapeutic window. The overdose of AAP is the single most common cause of acute liver failure in the United States. In Korea, recent increase of working parents adds to the cause of overlooking children's AAP intoxication. Therapeutic dose of AAP is mostly converted to an inactive compound in the liver by conjugation with sulfate and glucuronide, with a small fraction (less than 5%) metabolized via the cytochrome P-450(CYP) system. The CYP enzymes oxidize AAP to produce a highly reactive metabolite: N-acetyl-p-benzoquinone imine (NAPQI), which is detoxified in the liver by conjugation with hepatic glutathione (GSH). In case of AAP overdose a large amount of NAPQI depletes hepatic glutathione. Then the excess NAPQI binds to hepatocellular proteins, initiating cell death. The toxicity of AAP may be enhanced by agents that either increase the production of NAPQI or reduce the supply of GSH. N-acetylcysteine(NAC) replenishes hepatic GSH, thereby detoxifying NAPQI. Early administration of NAC minimizes the hepatotoxicity. In general the survival rate from AAP-induced acute liver failure has been increased with the use of NAC and liver transplantation.

Study on the idiosyncrasy oforganic chemistry textbook for traditional Chinese medicine organic chemistry / 中华医学教育探索杂志

The Organic Chemistry textbook for traditional Chinese medicine should be connected with this speciality and possese its own characteristic. First,the content in textbook should be chosen according to this specility,so that some outlying teaching content irrelevant to the speciality can be deleted but some correlated content be added to the textbook. Secondly,a lot of examples from traditional Chinese medicine should be inserted in the textbook,especially at "Classification and nomenclature","Important compounds"and"Exercise".

Herbal Preparation-induced Liver Injury / 대한소화기학회지

Recently the use of herbal preparations as remedies for various medical conditions, has been rapidly increasing in Korea. In our previous study, 38.9% of patients with chronic liver disease were found to use some sorts of herbal preparations. They believe herbal preparations are safe although the ingredients has never been rigorously substantiated. Toxicities of certain herbal preparations are caused by their contaminants and adulterated ingredients or concurrently used conventional drugs rather than specific components of the herbal preparations. Furthermore, in most instances, multiple herbal ingredients are used by the prescribers of oriental medicine. All of these conditions frequently impose diagnostic difficulties. There are myriads of plant-derived hepatotoxic substances which may or may not cause liver injury in individuals. The severity of liver injury depends largely on the toxicity of the substance, the amount of exposure and the individual's susceptibility. These toxic substances cause liver injury not only through the mechanism of intrinsic hepatotoxicity but also through the idiosyncrasy as in conventional drug-induced injury. Therefore, theoretically, it is possible to apply pre-existing CAMs (Causality Assessment Methods) to the assessment of causality in cases with diagnostic difficulties.