Chapter 19: Hepatitis and Liver Disease Flashcards by Saina Karami

How is Hepatitis A transmitted?

fecal-oral route through improper hand washing after exposure to an infected person or via contaminated food/water

How well did you know this?

Not at all

Perfectly

How are Hep B and C transmitted?

contact with infectious blood or other body fluids

How well did you know this?

Not at all

Perfectly

Which type(s) of hepatitis has a vaccine?

Hep A and B

How well did you know this?

Not at all

Perfectly

First-line treatment for Hep A?

Supportive therapy

How well did you know this?

Not at all

Perfectly

First-line treatment for Hep B?

PEG-INF or NRTI (tenofovir or entecavir)

How well did you know this?

Not at all

Perfectly

First-line treatment for Hep C?

Treatment naiive: DAA combination (2-3 with different mechs)

Other: DAA combination + RBV or DAA combination + RBV + PEG-INF

DAA treatment lasts 8-12 weeks

How well did you know this?

Not at all

Perfectly

What is the purpose of ritonavir for HCV?

used to boost levels of HCV protease inhibitors used with it

How well did you know this?

Not at all

Perfectly

T/F: DAAs offer a cure for most patients with HCV?

True

How well did you know this?

Not at all

Perfectly

Which drug class ends in -privir?

NS3/4A Protease inhibitor (P for PI)

How well did you know this?

Not at all

Perfectly

Which drug class ends in -asvir?

N55A Replication Complex Inhibitor (A for N55A)

How well did you know this?

Not at all

Perfectly

Which drug class ends in -buvir?

N55B Polymerase Inhibitor (B for N55B)

How well did you know this?

Not at all

Perfectly

What do the protease inhibitors used for HIV and HCV have in common?

They are taken with food

Remember: PIG - Protease Inhibitors & Grub

How well did you know this?

Not at all

Perfectly

Boxed warning for all DAAs?

Risk of reactivating HBV

How well did you know this?

Not at all

Perfectly

Warning for sofosbuvir-containing regimens?

Serious symptomatic bradycardia has been reported when amiodarone is taken with sofosbuvir-containing regimen; do not use together

How well did you know this?

Not at all

Perfectly

Sofosbuvir/velpatasvir brand name?

Epclusa

How well did you know this?

Not at all

Perfectly

Glecaprevir/pibrentasvir brand name?

Mavyret

How well did you know this?

Not at all

Perfectly

How are the tablets in Viekira Pak taken?

2 tabs of paritaprevir/ritonavir/ombitasvir once daily in the morning and 1 dasabuvir tablet twice daily with meals

How well did you know this?

Not at all

Perfectly

T/F: Sofosbuvir monotherapy is NOT effective and NOT recommended?

True

How well did you know this?

Not at all

Perfectly

Which HCV drugs must you avoid or minimize acid suppressive therapy with during treatment?

Epclusa, Harvoni, & Vosevi

How well did you know this?

Not at all

Perfectly

Which HCV drugs are pan-genotypic (approved for all 6 HCV genotypes) for treatment naive?

Epclusa & Mavyret

How well did you know this?

Not at all

Perfectly

CI for paritaprevir/ritonavir/ombitasvir (Technivie) + dasabuvir (Viekira Pak)?

3A4 substrates or inducers & use with ethinyl estradiol, lovastatin & simvastatin

How well did you know this?

Not at all

Perfectly

Warnings for paritaprevir/ritonavir/ombitasvir (Technivie) + dasabuvir (Viekira Pak)?

Hepatic decompensation/failure in patients with cirrhosis, risk of increased LFTs, significant drug interaction potential

How well did you know this?

Not at all

Perfectly

CI for Elbasvir/grazoprevir (Zepatier)?

3A4 inducers

How well did you know this?

Not at all

Perfectly

Warnings for Elbasvir/grazoprevir (Zepatier)?

Risk of increased LFTs, significant drug interaction potential

How well did you know this?

Not at all

Perfectly

All DAAs are CI with strong ____?

inducers of 3A4 (e.g., carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, rifabutin, and St. John’s Wort)

____, ____ & ____ can decrease concentrations of ledipasvir and velpatasvir?

Antacids, H2RAs, PPIs

PPIs are not recommended for use with ____?

Epclusa

Do not use Harvoni with ____?

Stribild

T/F: Ribavirin CANNOT be used as monotherapy for HCV?

True - use in combo with other drugs (DAAs and/or interferon alfa)

Aerosolized ribavirin has been used for?

Respiratory syncytial virus (RSV)

Ribavirin boxed warnings?

Significant teratogenic effects; hemolytic anemia

Ribavirin CI?

pregnancy

Ribavirin side effects?

Hemolytic anemia

When should pregnancy be avoided with Ribavirin?

during therapy and 6 months after completion; need 2 reliable forms of contraceptives

Which form of INF-alfa prolongs the half-life, reducing the dose to once weekly?

Pegylated form

Interferon alfas are used for: Interferon betas are used for?

alfa: HBV, HCV, & some cancers ## Footnote beta: multiple sclerosis

INF-alfa boxed warnings?

can cause or exacerbate neuropsychiatric, autoimmune, ischemic or infectious disorders; if used with ribavirin, teratogenic/anemia risk

INF-alfa side effects?

CNS effects (fatigue, depression), GI upset, increased LFTs (5-10x ULN during treatment), myelpsuppression ## Footnote Flu-like syndrome (fever, chills, HA, malaise), pre-treat with APAP and an antihistamine

T/F: Interferon alfa CANNOT be used as monotherapy?

FALSE

What is the preferred treatment for HBV?

INF-alfa

MOA of NRTIs?

Inhibit HBV replication by inhibiting HBV polymerase resulting in DNA chain termination

What should be done before a patient can start on an NRTI for HBV?

All pts should be tested for HIV

Why must patients be tested for HIV before starting an NRTI?

Antivirals used for HBV can have activity against HIV and if a pt is co-infected with both HIV and HBV, it is important that the chosen therapy is appropriate for both viruses to minimize risk of HIB antiviral resistance

All HBV NRTIs should have a decreased dose or frequency with CrCl < ____ mL/min?

Boxed warnings for all NRTIs?

Lactic acidosis and severe hepatomegaly with steatosis, which can be fatal ## Footnote Exacerbations for HBV upon d/c

Tenofovir disoproxil brand name?

Viread ## Footnote remember - read dis

Tenofovir alafenamide brand name?

Vemlidy

Entecavir brand name?

Baraclutide

Lamivudine brand name?

Epivir HBV

Which NRTIs are the preferred therapy in HBV?

Tenofovir disoproxil ## Footnote Tenofovir alafenamide Entecavir

Which NRTI should be taken on an empty stomach?

Entecavir (Baraclutide) ## Footnote remember - empty and entecavir both start with E

Tenofovir disoproxil & Tenofovir alafenamide warnings?

renal toxicity and/or Fanconi syndrome, osteomalacia, and decreased bone mineral density

Tenofovir disoproxil side effects?

renal impairment, decreased bone mineral density

Tenofovir alafenamide side effects?

nausea ## Footnote Less renal and bone toxicity

Adefovir (Hepsera) boxed warnings?

Caution in pts with renal impairment or those at risk of renal toxicity (including concurrent nephrotoxic drugs or NSAIDs)

Lamivudine boxed warning?

Do not use Lamivudine HBV for treatment of HIV

Lamivudine side effects?

HA, N/V/D

Tenofovir disoproxil & tenofovir alafenamide should not be used with ____ due to increased risk of virologic failure and potential for increased side effects?

Adefovir ## Footnote remember this b/c they have the same ending of -fovir

Most common causes of cirrhosis?

Hepatitis C and alcohol consumption ## Footnote remember this b/c Hep C and cirrhosis

Clinical presentation of cirrhosis?

yellowed skin and yellowed whites of the eyes (jaundice)

Albumin levels in liver disease

Low

Total bilirubin levels in liver disease

High

PT levels in liver disease

High

Which type of liver disease is associated with ↑ AST/ALT?

Acute liver toxicity, including from drugs

Which type of liver disease is associated with ↑ AST/ALT, Alk Phos, Tbili, LDH, PT/INR and ↓ Albumin?

Chronic liver disease (e.g., cirrhosis)

Which type of liver disease is associated with ↑ AST > ↑ ALT (AST will be ~2x ALT) and ↑ GGT?

Alcoholic liver disease

Which type of liver disease is associated with ↑ ammonia?

Hepatic encephalopathy

Which type of liver disease is associated with ↑ Tbili?

Jaundice

In general, caution is advised when using hepatically cleared drugs in which Child Pugh class?

Class C (severe liver disease)

Which natural product is used for liver disease?

Milk Thistle

Which natural product is a known hepatotoxin?

Kava

Hepatotoxic drugs are typically d/c when the LFTs are > ___ xULN?

3 times ULN

Which class of drugs should be avoided in patients with cirrhosis because they can lead to decompensation, including bleeding?

NSAIDs

Key drugs that have a boxed warning for liver damage?

APAP, Amiodarone, Isoniazid, Ketoconazole (oral), MTX, Nefazodone, Nevirapine, NRTIs, PTU, Tipranavir, Valproic Acid

Alcoholic liver disease can include?

Fatty liver, alcoholic hepatitis, and chronic hepatitis

Chronic alcohol ingestion over a long period of time causes?

Steatosis or fatty liver

Which drugs are used for relapse in alcoholics?

Naltrexone, acamprosate and disulfuram

Which vitamin is used to prevent and treat Wernicke-Korsakoff syndrome in alcoholics?

Thiamine (Vitamin B1)

Portal hypertension can cause complications including the development and bleeding of?

Esophageal varices (enlarged veins in the lower part of the esophagus)

What are recommended first line treatments for bleeding varices?

Band ligation or sclerotherapy

Which drug is selective for the splanchnic vessels?

Octreotide

Which drug is non-selective for the splanchnic vessels?

Vasopressin

Which drug class should be added after resolution of variceal bleeding for secondary prevention?

Non-selective BB

Which non-selective BB are used for primary prevention of variceal bleeding?

Nadolol and propranolol

Nadolol brand name?

Corgard

The BB used for portal hypertension is titrated to the max tolerated dose with a target HR between ___ = ___ BPM and continued indefinitely.

55-60 BPM

What are symptoms of hepatic encephalopathy?

Musty odor of breath and/or urine, changes in thinking, confusion, forgetfulness, hand tremor (asterixis) ## Footnote Result from an accumulation of gut-derived nitrogenous substances in the blood such as ammonia.

Besides drug therapy, how is hepatic encephalopathy treated?

Reducing blood ammonia levels through the diet (limiting the amount of animal protein)

Which drug is first-line for both acute and chronic (prevention) therapy for hepatic encephalopathy?

Lactulose followed by rifaximin

Lactulose works by?

Converting ammonia products by intestinal bacteria to ammonium

Lactulose side effects?

Flatulence, diarrhea, dyspepsia, abdominal discomfort

Rifaximin brand name?

Xifaxan

Neomycin boxed warning?

Neurotoxicity

Neomycin SE?

GI upset

Metronidazole should not be used long term d/t?

Peripheral neuropathies

What is ascites?

Fluid accumulation within the peritoneal space

Patients with ascites d/t portal HTN should restrict ______?

Dietary sodium intake

Diuretic therapy for ascites can be initiated with either ______ monotherapy or with a combination of ____ and ____?

Spironolactone monotherapy ## Footnote Furosemide and spironolactone.

When Furosemide and spironolactone are used in combination for ascites, they should be titrated to a max weight loss of 0.5 kg/day with a ratio of ____ mg furosemide to ___ mg spironolactone to maintain K balance?

40 mg furosemide:100 mg spironolactone

Which antibiotic is used for Spontaneous bacterial peritonitis?

Ceftriaxone to target Streptococci and enteric Gram negative pathogens

Chapter 19: Hepatitis and Liver Disease Flashcards

(100 cards)