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Year2 GI Exam I > Hepatitis Tx I > Flashcards

Hepatitis Tx I Flashcards

1
Q

Agents for Hep B virus

A 
peginterferon alfa
adefovir
entecavir
lamivudine
telbivudine
tenofovir
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2
Q

agents for Hep C virus

A 
pegintergeron alfa
ribavirin
simeprevir
sofosbuvie
protease inhibitors: roceprevir and telaprevir
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3
Q

how to confirm hep virus

A

serologic tests

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4
Q

which hep virus is DNA

A

hep B

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5
Q

Hep C is transmitted most commonly

A

injection drug users

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6
Q

serologic test for HepAvirus

A

IgM Ab

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7
Q

Tx HepA

A

prevention and prophylaxis
Ig for pre and post exposure prophylaxis
vaccination preferred

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8
Q

Sx HepB

A

fever, anorexia, nausea, vomtiing, jaundice, dark urine, pale stools, abnominal pain

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9
Q

serologic tests for Hep B

A

HBsAg- active infection
antiHBs- recovery or immunity, successful vaccination
antiHBc- previous or ongoing infection
IgM antiHBc delineates recent infection in past 6 mo
HBeAg viral replication
HBeAb clearing virus

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10
Q

What serologic levels will be increased in acute infection HBV

A

HBsAg, antiHBc IgM antiHBc

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11
Q

what serologic levels will be increased in chronically infected HBV

A

HBsAg, antiHBc

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12
Q

patient had Hep B virus and cleared

what will titers show

A

antiHBc and anti HBs

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13
Q

is HBV curable

A

no

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14
Q

goals of therapy for HBV

A

suppress replication
prevent complications
seroconvert HBeAg to Ab
reduce need for liver transplantation

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15
Q

when to Tx HBV

A

risk of liver related morbidity and mortality is foreseeable

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16
Q

non-pharm management for HBV

A

vaccinate sexual and household contacts
avoid alcohol
vaccinate HAV

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17
Q

first vaccine against major human cancer, HCC

A

HBV vaccine

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18
Q

msot common blood borne pathogen

A

hep C

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19
Q

85% hep c develop what

A

chronic HCV so increased risk cirrhosis, HCC and end stage liver failure

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20
Q

chronic Sx HCV

A

fatigue, RUQ pain, nausea, poor appetite

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21
Q

goals of HCV therapy

A

eradicate virus

absent RNA for 6 mo

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22
Q

Indications for HCV Tx

A

all patients with evidence of chronic HCV in prev 6 mo

untreated patients with HCV

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23
Q

patients not to Tx HCV in

A

decompensated liver disease or Hx of severe uncontrolled psychiatric disorder

24
Q

factors associated with favorable Tx response for HCV Tx

A

HCV genotype 2 or 3
absence cirrhosis
low preTx HCV RNA level

25
Q

pros and cons of Interferon alfa

A

pros: finite duration, no resistance, responses durable
cons: side effects, not used in patients with decompensated disease

26
Q

MOA interferon alfa

A

inhibits viral penetration, translation, transcription, protein processing, maturation and release
enhanced phagocytic activity

27
Q

how is peginterferon administered? why?

A

subcutaneoulsy because slower clearance

have to adjust for renal impairement

28
Q

adverse effects interferon alfa

A

flu like illness (resolves with cont Tx)

transient inc in hepatic enzymes

29
Q

adverse effects chronic Tx interferon alfa

A

neurotoxicity with chronic Tx with myelosuppression and profound fatigue, weight loss, rash, cough, myalgia, alopecia, tinnitus, reversible hearing loss, retinopathy, penumonitis

30
Q

contraindications interferon alfa

A

hepatic decompensation, autoimmune disease, Hx cardiac arrhythmia, pregnancy

31
Q

cautions for using interferon alfa

A

psychiatric disease, epilepsy, thyroid disease, ischemic cardiac disease, severe renal insufficiency, cytopenia

32
Q

Therapeutic uses interferon alfa

A

chronic HBV and HCV

33
Q

drug drug interactions interferon alfa

A

may increase levels of theophylline and methadone

not recommended with didanosine(inc hepatic failure) or zidoyudine (exacerbate cytopenias)

34
Q

MOA nucleoside/nucleotide analogs

A

interfere viral replication

35
Q

what are pros and cons to nucleoside analogs vs interferon

A

PO administration that is better tolerated and higher response rate, can be used chronic therapy or htose with liver disease
cons: sustained response limited after discontinuation
resistance, peripheral neuropathy, lactic acidosis and hepatic steatosis

36
Q

what are the nucleoside/tide analogs

A

adefovir and dipivoxil
entecavir
lamivudine

37
Q

MOA adefovir dipivoxil

A

inhibit HBV DNA polymerase, chain termination after incorporation into viral DNA

38
Q

adverse effects adefovir dipivoxil

A

HA, diarrhea, abdominal pain, potential nephrotoxicity

39
Q

therapeutic use adefovir and dipivoxil

A

wide range DNA RNA viruses like HBV HIV and herpes

not rec as first line HBV

40
Q

R to adefovir dipivoxil

A

adefovir-R rt233 HBV mutatns

no cross R with lamivudine

41
Q

MOA entecavir

A

inhibits DNA polymerase (base priming, reverse transcriptase and DNA synthesis)

42
Q

what to tell patient if on entecavir

A

take on empty stomach

43
Q

adverse effects entecavir

A

HA, dzziness, nausea

44
Q

Therapeutic use entecavir

A

first line HBV

45
Q

MOA lamivudine

A

inhibits DNA polymerase, competes for incoporation into viral DNA, causes chain termination

46
Q

adverse effects lamivudine

A

excellent safety profile
can have HA nausea and dizziness
if HIV patient inc risk pancreatitis

47
Q

what analog can you use in pregnant woman

A

lamivudine

48
Q

Therapeutic use lamivudine

A

HIV Tx
rapildy suppress HBV not rec as 1st line b/c resistance
cross R with entecavir

49
Q

MOA telbivudine

A

inhibits DNA polymerase (competitive) causes chain termination

50
Q

adverse effects telbivudine

A

fatigue, HA, abdominal pain, increased creatine kinase levels, nausea, vomiting

51
Q

contraindications telbivudine

A

avoid with interferon alfa b/c peripheral neuropathy

52
Q

therapeutic use telbivudine

A

rapidly suppresses HBV and causes HBeAg seroconversion
not rec as 1st line b/c Resistance
cross R with lamivudine

53
Q

MOA tenofovir

A

competitvely inhibits DNA polymerase, chain termination

54
Q

adverse effects tenofovir

A

nausea, diarrhea, vomiting, decreased bone mineral density (give Ca and vit D supp)

55
Q

therapeutic use tenofovir

A

first line HBV
HIV Tx
resistance rare

Year2 GI Exam I (18 decks)

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