Chapter 19: Hepatitis & Liver Disease Flashcards
(96 cards)
1
Q
What does hepatitis mean?
A
Inflammation of the liver
2
Q
What is the primary route of transmission for Hepatitis A virus (HAV)?
A
Fecal-oral route
3
Q
What kind of illness does Hepatitis A virus (HAV) usually cause?
A
Acute, self-limiting illness
4
Q
What can Hepatitis B virus (HBV) and Hepatitis C virus (HCV) increase?
A
AST/ALT levels
5
Q
What are some symptoms of Hepatitis B virus (HBV) and Hepatitis C virus (HCV)?
A
Jaundice, right upper quadrant pain, dark urine
6
Q
What serious conditions can chronic infection from HBV or HCV lead to?
A
Cirrhosis, liver cancer, liver failure, death
7
Q
How is Hepatitis B virus (HBV) and Hepatitis C virus (HCV) transmitted?
A
Contact with infectious blood or other body fluids
8
Q
Is there a vaccine available for Hepatitis A?
A
Yes
9
Q
Is there a vaccine available for Hepatitis B?
A
Yes
10
Q
Is there a vaccine available for Hepatitis C?
A
No
11
Q
What do preferred HCV regimens typically consist of?
A
2 - 3 direct-acting antivirals (DAAs) with different mechanisms
12
Q
How long do preferred HCV regimens usually last?
A
8 - 12 weeks
13
Q
List NS3/4A Protease Inhibitors
A
- Glecaprevir
- Grazoprevir
- Voxilaprevir
14
Q
List NS5A Replication Complex Inhibitors
A
- Elbasvir
- Ledipasvir
- Pibrentasvir
- Velpatasvir
15
Q
List NS5B Polymerase Inhibitors
A
Sofosbuvir
16
Q
First line HCV treatment?
A
- Mavyret
- Epclusa
17
Q
Mavyret generic combo?
A
Glecaprevir/pibrentasvir
18
Q
Epclusa generic combo
A
Sofosbuvir/velpatasvir
19
Q
DAAs boxed warning
A
Risk of reactivating HBV; test all patients for HBV before starting a DAA
20
Q
What should not be used with sofosbuvir-containing regimens?
A
Amiodarone due to symptomatic bradycardia
21
Q
What is an important patient counseling with Mavyret?
A
Take with food
22
Q
Is Sofosbuvir monotherapy effective?
A
No, Sofosbuvir monotherapy is not effective and not recommended.
23
Q
How should Direct-Acting Antivirals (DAAs) be dispensed?
A
DAAs should be dispensed in the original container.
24
Q
What should be avoided or minimized when using DAAs?
A
Acid-suppressive therapy should be avoided or minimized.
25
What are some examples of strong inducers of CYP3A4 that are contraindicated with DAAS?
Carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, rifabutin, St. John's wort
26
What should Mavyret not be used with?
Strong inducers of CYP3A4, ethinyl estradiol-containing products, lovastatin, simvastatin
27
What effect can antacids, H2RAs, and PPIs have on ledipasvir and velpatasvir?
They can decrease concentrations of ledipasvir and velpatasvir
28
Are PPIs recommended with Epclusa?
No, PPIs are not recommended with Epclusa
29
When is Ribavirin gets added to DAA therapy?
Ribavirin is added to DAA therapy in patients who do not achieve a sustained virologic response or cure with first line DAAs or in those whose disease is complicated by cirrhosis.
30
Ribavirin boxed warning
* Significant teratogenic effects
* not effective for monotherapy of HCV;
* hemolytic anemia
31
Ribavirin contraindicated in ____
Pregnancy
32
What is the primary precaution for females regarding Ribavirin therapy?
Avoid pregnancy during therapy and 6 months after completion
33
What should all patients be tested for before starting HBV therapy?
HIV
34
Why is it important to choose appropriate therapy for patients co-infected with HIV and HBV?
To minimize risk of HIV antiviral resistance
35
What is the CrCl cut of when using HBV NRTIs?
CrCl < 50 mL/min: Reduce dose or frequency
36
What are boxed warnings associated with HBV NRTIs?
* Lactic acidosis
* Severe hepatomegaly with steatosis
* Exacerbations of HBV after D/c
37
List 3 preferred first line NRTIs for HBV
1. Tenofovir disoproxil
fumarate, TDF (Viread)
2. Tenofovir alafenamide, TAF (Vemlidy)
3. Entecavir (Baraclude)
38
Tenofovir disoproxil
fumarate, TDF
Viread
39
Tenofovir alafenamide,
Vemlidy
40
Entecavir
Baraclude
41
Warnings associated with tenofovir-products (TDF & TAF)
* Renal toxicity (Fanconi syndrome),
* osteomalacia and decrease bone mineral density
42
How should Entecavir (Baraclude) be taken?
Take on empty stomach
43
What is the pegylated form of interferon alfa approved for?
Treatment of chronic HBV
44
What is the benefit of adding polyethylene glycol to interferon alfa?
Prolongs the half-life and reduces dosing to once weekly
45
What is the administration route and frequency of pegylated interferon-alfa-2a (Pegasys)?
SC injection once weekly for 48 weeks
46
What type of warning is associated with pegylated interferon-alfa-2a?
Boxed warning for neuropsychiatric, autoimmune, ischemic or infectious disorders
47
What are some common side effects of pegylated interferon-alfa-2a?
CNS effects, gastrointestinal upset, increased LFTs, myelosuppression, flu-like syndrome
48
What is the recommended pre-treatment for flu-like syndrome caused by pegylated interferon-alfa-2a?
Acetaminophen and an antihistamine
49
What is the duration of treatment with pegylated interferon-alfa-2a?
48 weeks
50
What is the increase in LFTs during treatment with pegylated interferon-alfa-2a?
5-10 x ULN
51
What is cirrhosis?
Advanced fibrosis (scarring) of the liver that is usually irreversible.
52
What are the complications of cirrhosis?
Complications include:
* Portal hypertension
* Gastroesophageal varices
* Ascites
* Hepatic encephalopathy
53
What are the symptoms of cirrhosis?
Symptoms include yellowed skin and yellowed whites of the eyes (jaundice).
54
What do AST and ALT stand for?
* Aspartate aminotransferase (AST)
* Alanine aminotransferase (ALT).
55
What liver function test abnormalities are associated with acute liver toxicity?
Increase in AST and ALT.
56
What liver function test abnormalities are associated with chronic liver disease like cirrhosis?
Increase in AST, ALT, Alk Phos, Tbili, LDH, PT/INR and decrease in Albumin.
57
What are the test results for alcoholic liver disease?
Increase in AST > Increase in ALT (AST will be about double the ALT) and Increase in gamma-glutamyl transpeptidase (GGT).
58
What is the test result for hepatic encephalopathy?
Increase in Ammonia.
59
What is the test result for jaundice?
Increase in Tbili.
60
What is the liver disease classifications system?
Child pugh
61
List drugs with a boxed warning for liver damage
* Acetaminophen
* Amiodarone
* Bosentan
* Isoniazid
* Ketoconazole
* Leflunomide/terifluno
* Methotrexate
* Nefazodone
* Nevirapine
* Propylthiouracil
* Valproic acid
* Zidovudine
62
What natural product is used for liver disease?
Milk Thistle
63
What natural product is a known hepatotoxin?
Kava
64
What is the term for fatty liver caused by chronic alcohol ingestion?
Steatosis
65
What causes steatosis in the liver?
Fat deposition in the hepatocytes
66
What is the most important part of ALD treatment?
Alcohol cessation
67
What medications are primarily used for alcohol withdrawal in inpatient treatment programs?
Benzodiazepines
68
Which medication is known as Vivitrol?
Naltrexone
69
Name medications used to prevent relapses in ALD treatment.
* Naltrexone
* Acamprosate
* Disulfiram
70
What role does thiamine play in ALD treatment?
Prevents and treats Wernicke-Korsakoff syndrome
71
What is a key component of supportive care in the management of acute variceal bleeding?
Blood transfusion, IV fluids, Mechanical ventilation
72
What is used for Splanchnic (GI) vasoconstriction in the management of acute variceal bleeding?
IV octreotide (Sandostatin)
73
What are some adverse effects of IV octreotide?
Decrease HR, cholelithiasis, biliary sludge
74
Which antimicrobial therapy is used to prevent spontaneous bacterial peritonitis in acute variceal bleeding?
Ceftriaxone
75
What are two endoscopic evaluation techniques used in the management of acute variceal bleeding?
Band ligation, Sclerotherapy
76
What are the non-selective beta-blockers used for primary and secondary prevention of variceal bleeding?
Nadolol and propranolol
77
What is the target heart rate (HR) for patients on non-selective beta-blockers?
55 - 60 BPM
78
What is hepatic encephalopathy (HE)?
HE is caused by acute or chronic hepatic insufficiency. Hepatic encephalopathy results from the liver's inability to clear toxins from the blood.
79
What are the symptoms of hepatic encephalopathy?
Symptoms include:
* Musty odor of breath and/or urine
* Changes in thinking
* Confusion
* Forgetfulness
* Flapping hand tremor (asterixis)
80
What causes the symptoms of hepatic encephalopathy?
The symptoms result from an accumulation of gut-derived nitrogenous substances in the blood, such as ammonia and glutamate.
81
What are the main treatment strategies for hepatic encephalopathy?
Treatment includes:
* Identifying and treating precipitating factors
* Reducing blood ammonia levels through diet and drug therapy
82
What is the first-line drug therapy for hepatic encephalopathy?
Lactulose is first line for both acute and chronic therapy.
83
How does lactulose work in treating hepatic encephalopathy?
Lactulose converts ammonia produced by intestinal bacteria to ammonium, enhancing diffusion of ammonia into the colon for excretion.
84
What are the side effects of lactulose?
Side effects include:
* Flatulence
* Diarrhea
* Dyspepsia
* Abdominal discomfort
* Dehydration
* Hypernatremia
* Hypokalemia
85
Rifaximin
Xifaxan
86
What are the boxed warnings associated with neomycin?
Neurotoxicity (hearing loss, vertigo, ataxia)
87
What is ascites?
Fluid accumulation within the peritoneal space
88
What dietary restriction should patients with ascites due to portal hypertension follow?
Restrict dietary sodium intake to < 2 grams/day
89
What medications should be avoided in patients with ascites?
Sodium-retaining medications, including NSAIDs
90
What diuretics can be initiated for ascites?
* Spironolactone monotherapy
* spironolactone + furosemide
91
What is the recommended ratio of furosemide to spironolactone when used in combination?
40 mg furosemide to 100 mg spironolactone
92
What procedure is needed in severe cases of ascites?
Abdominal paracentesis
93
What is spontaneous bacterial peritonitis (SBP)?
An acute infection of the ascitic fluid
94
What is the recommended treatment for SBP?
Ceftriaxone (or equivalent) for 5 - 7 days
95
What can improve survival in patients with SBP?
Addition of albumin (1.5 grams/kg on day 1 and 1 gram/kg on day 3)
96
What should patients who have survived SBP receive for secondary prophylaxis?
Oral ciprofloxacin or sulfamethoxazole/trimethoprim
