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can you provide rantionale with each answer, thank you Case 2: Hepatotoxicity in TB Treatment A 38-year-old male was recently diagnosed with active tuberculosis while incarcerated. He was started on standard four drug therapy. Baseline lab values were ALT (SGPT) 42 units/L and AST (SGOT) 63 units/L. He was released from jail and his care was transferred to the local health department where an assessment revealed a social history of previous alcohol and cocaine use, bipolar disorder, and homelessness. 1) What increases his risk of hepatotoxicity while taking TB medications? A. Alcohol use B. Cocaine use C. Bipolar disorder D. Homelessness The sputum results that were collected in jail were reported as pan-susceptible, he was tolerating medications well and EMB was discontinued. During his follow up visit the patient complained that he was not feeling well. 2) What are early signs and/or symptoms associated with hepatotoxicity? A. Abdominal tenderness, nausea, and fatigue B. Jaundice and dark urine C. Peripheral neuropathy and joint pain D. All of the above The nurse assessment further identified that he had bloating, nausea and fatigue. The patient admitted to drinking alcohol. 3) What should the local health department nurse do next? A. Draw labs that include LFTs. B. Do nothing, these are expected side effects of TB medications. C. Stop TB medications. D. Refer to a GI doctor His laboratory results revealed an increase in the ALT to 304 U/L and AST to 245 U/L. He was evaluated by the local health department provider, TB medications were stopped, he was instructed to return to the clinic for repeat labs, and he was re-educated to abstain from alcohol. 4) Which of the following statements is true of hepatotoxicity? A. Drug-induced hepatitis is the most frequent serious adverse reaction of the first-line drugs. B. Other causes of abnormal liver tests must be excluded before diagnosing drug-induced hepatitis. C. If LFTs are consistent with hepatotoxicity, all hepatotoxic drugs-must be stopped. D. All of the above 5) What is the best approach to continue TB treatment? A. A drug rechallenge should be initiated once the ALT returns to <2x the upper limit of normal. B. Restart all the TB medications once LFTs are normal. C. Discontinue TB treatment and have the patient follow-up every six months for symptoms of TB. D. Refer the patient to an alcohol rehabilitation center and restart all TB medications.

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