QLexNursing

🔹 Ketoconazole inhibits adrenal steroid synthesis by blocking CYP450 enzymes, making it effective in Cushing’s disease, but it carries a high risk of hepatotoxicity.

🔹 Baseline liver function tests (LFTs) are required before starting therapy, with frequent monitoring during initiation and after dose increases to detect early liver injury.

🔹 Hepatotoxicity from ketoconazole can be severe and potentially fatal, sometimes occurring early in therapy, even at standard doses.

🔹 Prompt identification of elevated transaminases allows timely dose adjustment or discontinuation to prevent acute liver failure.

🔹 Because of this risk, LFT monitoring is the most critical safety strategy when managing patients on ketoconazole.

❌ Why the other options are less important

❌ ECG monitoring for QT prolongation only

🔹 QT prolongation is a concern, but it is not the primary or most critical monitoring priority compared with hepatotoxicity.

❌ Cortisol monitoring every 4–6 hours

🔹 Cortisol levels should be monitored periodically, but such frequent checks are unnecessary and not the main safety concern.

❌ Regular potassium checks

🔹 Electrolyte monitoring may be useful, but potassium abnormalities are less common and less dangerous than liver toxicity.