NR 506 Week 1
Running head: NR 506 WEEK 6 PART 2
NR 506 Week 6 part 2
Lee Arthur
Chamberlain
Advanced Pahrm
NR 508
Dr. Landry
, NR 506 Week 6 part 2
Greeting Professor and Class,
As stated in the previous case study we need to continue to monitor Jonathan, he has
returned to the clinic with the following lab results:
He returns to your clinic for follow-up blood work, and four values catch your attention:
AST 430 U/L
ALT 535 U/L
Bilirubin 41 mg/dl
BG 60 mg/dl
He admits to a history of moderate-to-high alcohol intake (>12 drinks/week for >10
years). He is slightly febrile (99.7°F) and has abdominal tenderness. He also admits to taking
several, different over-the-counter pain relievers of different brands daily and continuously to
combat the pain in his knee, in addition to his prescription(s) in Part One. You decide to run a
toxicology lab, and it reveals a blood acetaminophen concentration of 58 µg/mL.
Given the above information I believe he is suffering from Tylenol induced Hepatoxicity.
According to (Gong et al., 2014) an acute or cumulative overdose of Tylenol can cause severe
liver injury that can lead to liver failure. As found on (Epocrates, 2017) the therapeutic blood
level for acetaminophen is 10-20 µg/mL. At therapeutic doses, AAP is primarily detoxified by
glucuronidation and sulfation with a small fraction metabolized by cytochrome P-450-dependent
mixed function oxidase system to a highly reactive N-acetyl-p-benzo-quinonemine (NAPQ1)
metabolite. The metabolite reacts with glutathione (GSH) spontaneously or is catalyzed by
glutathione-S-transferases to form a GSH-adduct which is mainly excreted into bile through
Running head: NR 506 WEEK 6 PART 2
NR 506 Week 6 part 2
Lee Arthur
Chamberlain
Advanced Pahrm
NR 508
Dr. Landry
, NR 506 Week 6 part 2
Greeting Professor and Class,
As stated in the previous case study we need to continue to monitor Jonathan, he has
returned to the clinic with the following lab results:
He returns to your clinic for follow-up blood work, and four values catch your attention:
AST 430 U/L
ALT 535 U/L
Bilirubin 41 mg/dl
BG 60 mg/dl
He admits to a history of moderate-to-high alcohol intake (>12 drinks/week for >10
years). He is slightly febrile (99.7°F) and has abdominal tenderness. He also admits to taking
several, different over-the-counter pain relievers of different brands daily and continuously to
combat the pain in his knee, in addition to his prescription(s) in Part One. You decide to run a
toxicology lab, and it reveals a blood acetaminophen concentration of 58 µg/mL.
Given the above information I believe he is suffering from Tylenol induced Hepatoxicity.
According to (Gong et al., 2014) an acute or cumulative overdose of Tylenol can cause severe
liver injury that can lead to liver failure. As found on (Epocrates, 2017) the therapeutic blood
level for acetaminophen is 10-20 µg/mL. At therapeutic doses, AAP is primarily detoxified by
glucuronidation and sulfation with a small fraction metabolized by cytochrome P-450-dependent
mixed function oxidase system to a highly reactive N-acetyl-p-benzo-quinonemine (NAPQ1)
metabolite. The metabolite reacts with glutathione (GSH) spontaneously or is catalyzed by
glutathione-S-transferases to form a GSH-adduct which is mainly excreted into bile through
