During an outpatient clinic follow-up appointment, a client with multiple sclerosis (MS) has lab tests completed. The results show elevated levels of aspartate aminotransferase (AST), serum glutamic-oxaloacetic transaminase (SGOT), alanine aminotransferase (ALT), serum glutamic-pyruvic transaminase (SGPT), and alkaline phosphatase (ALP). What is the priority concern for the nurse?
A) Adverse response to Avonex
B) Adverse response to Aubagio
C) Flare-up due to demyelination
D) Adverse response to bisacodyl
E) Damage from viral infection
Answer: A, B
AST, SGOT, ALT, SGPT and ALP are liver enzymes that are monitored to detect adverse response to the medications Avonex and Aubagio. Flare-ups due to demyelination do not cause liver enzymes to increase. Bisacodyl is a stool softener used for constipation in MS and does not cause liver enzymes to elevate. Incomplete evidence links viral infection to the risk of MS. There is no reason to attribute elevated liver enzymes to viral exposure.
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