American Board of Internal Medicine (ABIM) Certification Practice Exam

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Which toxicity may occur as a side effect of leflunomide?

Fatigue
Headache
Aminotransaminase elevations
Nausea

The correct answer is: Aminotransaminase elevations

Leflunomide is a medication commonly used in the treatment of rheumatoid arthritis and other autoimmune diseases, and it is known for its mechanism of action, which involves the inhibition of pyrimidine synthesis, leading to immunosuppression. One of the notable side effects associated with leflunomide is the elevation of aminotransferases, which are enzymes found in the liver. This elevation reflects liver toxicity, and it is important for clinicians to monitor liver function in patients receiving this medication. The risk of aminotransferase elevations is significant enough that liver function tests are recommended before and during therapy with leflunomide. While other side effects such as fatigue, headache, and nausea can occur with various medications, the specific association of aminotransferase elevations with leflunomide is a well-documented and relevant concern in clinical practice. Monitoring these levels helps prevent potential liver damage and allows for timely intervention if elevations are observed.