Which of the following drug classes has the potential to be hepatotoxic according to the listed mnemonics?

• A. Beta-lactams
• B. Thiazides
• C. NRTIs
• D. Fibrates

Answer: (C)

NRTIs, or nucleoside reverse transcriptase inhibitors, have a well-documented potential for hepatotoxicity, making them a significant concern in clinical practice. This drug class is primarily used in the treatment of HIV and includes medications such as zidovudine, lamivudine, and tenofovir. The risk of liver damage comes from various mechanisms, including direct hepatotoxic effects and the potential for causing lactic acidosis, which can lead to hepatomegaly and steatosis.

In contrast, while beta-lactams, thiazides, and fibrates can have their own side effects and potential toxicity, they are not primarily associated with hepatotoxicity to the same extent as NRTIs. For example, beta-lactams typically have a good safety profile in terms of liver function, thiazides are more known for causing electrolyte imbalances, and fibrates can impact liver enzymes but are not primarily recognized for severe hepatotoxic effects. This distinction highlights why NRTIs are identified as having a higher risk for liver damage compared to the other drug classes listed.