Week 205 - Hepatitis Flashcards

1
Q

What are the routes of hepatitis transmission?

A

Oral Faecal
Parenteral
Blood

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2
Q

Which hepatitis viruses are transmitted via the oral faecal route?

A

A & E

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3
Q

Which hepatitis viruses are transmitted via the parenteral route?

A

B & C, E (and D in the presence of B)

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4
Q

What are prodrome symptoms of hepatitis?

A

Flu like (anorexia, nausea, vomiting, fatigue, malaise, low-grade fever)

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5
Q

What viruses other than the hepatitis viruses, cause hepatitis?

A

Adenovirus, EBV, CMV, Herpes simplex

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6
Q

What is the incubation period of Hep E virus?

A

15-60 days (avg. 40)

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7
Q

What is the treatment available for HBV?

A
Peg interferon
Entecavir
Tenofovir
Lamivudine
Adebovir
Telbivudine
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8
Q

What are the hotspots of HBV?

A

Central + South Africa, China

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9
Q

What are the hotspots for HBC?

A

Egypt, Ukraine, Brazil

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10
Q

What are side-effects of Interferon?

A

Flu like symptoms (+ bone marrow suppression, thyroid dysfunction, exacerbation of autoimmune diseases)

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11
Q

What are side-effects of Ribavirin?

A

Teratogenic, haemolytic anaemia, skin rash, cough, insomnia

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12
Q

What are side-effects of Telaprevir?

A

Rash
DRESS (drug reaction with eosinophilia and systemic symptoms)
Bleeding PR

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13
Q

What are side-effects of Boceprevir?

A

Anaemia

Rash

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14
Q

Who’s at risk of HBC?

A

Recepients of clotting factors before 1987
IV drug users
Long term haemodyalisis pts

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15
Q

What is the natural history of HCV?

A

15% Resolve

85% ⇒ Chronic Infection (20% of these ⇒ cirrhosis)

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16
Q

What is the treatment available for HCV?

A

Peg interferon
Ribavirin
+/- telaprevir or boceprevir

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17
Q

Describe the route of a drug from the sinusoid to the hepatocytes

A

Sinusoids ⇒ drug passes through fenestrae in the endothelium
Through the space of Disse
In the hepatocytes the enzymes may convert them into more polar compounds

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18
Q

What is the phase I reaction (Drug Metabolism)?

A

Processing that creates/exposes functional groups (done my P450)

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19
Q

What is the phase II reaction (Drug Metabolism)?

A

Products are coupled with endogenous substrates such as glycine, acetic acid and sulphuric acid (conjugation)

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20
Q

Describe the first pass metabolism of Ethanol?

A

Ethanol ⇒ Acetaldehyde (Alcohol dehydrogenase)

Acetaldehyde ⇒ Acetyl CoA (acetylaladehyde dehydrogenase + NAD+)

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21
Q

What are the actions of alcohol?

A

Depressant
Inhibits NMDA receptors
Inhibition of neurotransmitter release
Enhancement of GABA transmission

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22
Q

What auto-antibodies would you look for in primary biliary cirrhosis?

A

anti-mitochondrial antibodies

23
Q

What auto-antibodies would you look for in autoimmune hepatitis?

A

Smooth muscle antibodies

24
Q

What auto-antibodies would you look for in primary sclerosing cholangitis?

A

Anti-nuclear cytoplasmic antibodies

25
Q

What are the characteristic features of Wilson’s Disease?

A

Kayser Fleischer rings
↑Copper
↓Ceruloplasmin

26
Q

How can you diagnose haemochromatosis?

A

↑Ferritin

Gene test for HFE gene

27
Q

What are the symptoms of haemochromatosis?

A
30-50 yrs
Weak, tired
Pain in joints, tummy
Hepatomegaly, liver cirrhosis
Bronzing of skin
Cardiomyopathy
28
Q

What comprises the portal triad?

A

Bile Duct
Portal Vein
Hepatic Artery

29
Q

What is the function of stellate cells in the liver?

A

Store fat + vit A
Produce collagen IV
Role in liver regeneration
Control blood flow through sinusoid

30
Q

List the causes of splenomegaly

A
Infection
Congestion (portal hypertension)
Haemolytic anaemia
Autoimmune (RA, SLE)
Haematological malignancy
Amyloid
Rare storage disorders
31
Q

What does prophylaxis for splenectomy consists of?

A

Pneumococcus, Meningococcus, Haemophilus

Prophylactic Penicillin V

32
Q

What is the definition of TOLERANCE?

A

Decreased response to the effects of a set drug concentration after continued use (compensatory homeostatic mechanisms)

33
Q

What is the definition of DEPENDENCE?

A

Need to take a drug to avoid withdrawal symptoms produced by compensatory homeostatic mechanisms

34
Q

What is the definition of ADDICTION?

A

Continued drug use despite known despite know adverse consequences

35
Q

What are treatments available for alcoholism?

A

Naltrexone + Nalmefene (opiod receptor antagonists)
Acamprosate (NMDA receptor antagonist)
Behavioural Therapy

36
Q

What is the basis of replacement therapy?

A

Replacing a fast acting drug with a slow one

37
Q

Name some psychostimulant drugs

A

amphetamines, methamphetamine, cocaine
Put dopamine transporter into reverse
MDMA (ecstasy), MMC (mephedrone)

38
Q

What is the neurobiology behind addiction?

A

VTA releases dopamine which goes to Nucleus Accumbens (via the mesolimbic dopamine system)

39
Q

What is the benzodiazepine used in alcohol withdrawal?

A

Chlordiazepoxide or Diazepam (Valium)

40
Q

What receptor does caffeine work on?

A

Adenosine (receptor antagonist)
Adenosine triggers sleep

Theophylline (tea) & theobromine (cocoa) have similar effects

41
Q

How does ketamine act?

A

NMDA receptor antagonism

Dissociative narcotic

42
Q

Name some Hallucinogens?

A

LSD, Psilocybin (magic mushrooms)

43
Q

How does acute intoxication with cannabis present?

A
Confusion
Depersonalization
Paranoid delusions
Hallucinations
Anxiety, Agitation
44
Q

Where is the CB1 receptor found?

A

In the brain - binds cannabis and endocannaobinoids

45
Q

Where is the CB2 receptor found?

A
Immune system (esp. B cells)
Also brain stem & cerebellum
46
Q

What is the net effect of CB1 receptor?

A

Local hyperpolarisation

47
Q

To what state in the mesolimbic system are schizophrenic symptoms attributed to?

A

Hyperdopaminergic state in the mesolimbic system

48
Q

What are Type A drug reactions?

A

Predictable, more common,mostly dose related

49
Q

What are Type B drug reactions?

A

Not predictable, less common + tend to be more severe

50
Q

What substances will go up in liver damage (relating only to what is stored in the liver)

A

↑CRP
↑α-1-antitrypsin
↑B12

51
Q

Which Hepatitis antigen is elevated in Acute HBV infection?

A

HBcAg

52
Q

Which Hepatitis antigen is elevated in Chronic HBV infection?

A

HBsAg

53
Q

Which Hepatitis antigen indicates replicative form of HBV infection?

A

HBeAg