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Therapeutics P3 Spring > exam 4 lecture 6 > Flashcards

exam 4 lecture 6 Flashcards

(45 cards)

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1
Q

What type of viruses are hepatitis

A

RNA viruses (except HBV, which is DNA virus)

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2
Q

Name the main transmission, perinatal transmission and common risk factors for all hepatitis types

A

HAV- main transmission- fecal
perinatal transmission- no
Most common risk factor- direct contact with someone with HAV

HBV- main transmission- blood sexual, perinatal- yes,
most common risk factor- Born to infected mother

HCV- main transmission- blood
Perinatal transmission- yes
Most common risk factor- inj drug use

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3
Q

Which hepatitis are chronic

A

B and C

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4
Q

What is the course of infection of hep A, B and C

A

A- acute then resolved
B- acute then chronic sometimes
C- acute, then usually chronic

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5
Q

Which hepatitis is not curable

A

B

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6
Q

Which hep do we have no vaccines towards

A

C

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7
Q

How is Hep A diagnosed

A

requires detection of IgM anti HAV or HAV RNA in serum or stool

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8
Q

How many HAV doses are given for newborns? WHat type of vaccine is it (pregnancy)? When should post exposure prophylaxis be recommended

A

Two doses given at 0 and 6-12 months

Inactivated vaccine- safe in pregnancy

Post exposure prophylaxis should be given ASAP after exposure (within 2 wks)

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9
Q

How is hep B spread?

A

sex
injected drug
mother to child
contact with blood or open sores
needle
Razors or toothbrush

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10
Q

What are the 3 triple panel test constituents

A
  1. hep B surface antigen (HBsAg)
  2. Antibody to hepatitis B surface antigen (anti HBs)
  3. Antibody to hep B core antigen (anti- HBc)
  4. Immunoglobulin M class of antibody to hepatitis B core antigen (IgM anti HBc)
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11
Q

What questions do each of the triplepanel test of hep B tell us

A

Hep B surface antigen- Is patient infectious
antibody to hep B surface antigen- is patinet immune
Antibody of hep B core antigen- has the patient been exposed to virus

IgM anti HBc- has atient been recently exposed to virus

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12
Q

What does it men if HBsAg is positive but IGM anti HBc is negative? IgM anti HBC positive?

A

HBsAg positive/IgM anti HBc negative- chronic infection

IgM anti HBc positive- acute infection

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13
Q

What does anti-HBs positive/ anti HBc positive mean? Anti HBc negative?

A

anti-HBs positive/ anti HBc positive- resolved infection

Anti HBc negative- immune from prior vaccination

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14
Q

Management of acute infection of HBV

A

no tx
supportive care

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15
Q

goals of therapy of HBV tx

A

achieve sustained suppression of HBV replication

Remission of liver disease

Prevent cirrhosis, hepatic fx and HCC

Functional cure- HBsAg loss with or without anti- HBe gain- is attainable

virological cure not yet positive

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16
Q

What labs do we look at to see what phase of hepatitis a person is in

A

Liver panel

HBeAg

HBV DNA PCR

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17
Q

What phase of chronic HBV has Normal ALT but elevated HBV DNA?

Normal ALT but low/undetectable HBV DNA

A

normal ALT- elevated HBV- e+ Immune tolerant

Normal ALT- low undetectable HBV- e- inactive (carrier)

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18
Q

What phase of chronic HBV would a person be in if they had elevated ALT with elevated HBV DNA

A

e + Immune active or e- immune reactivation

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19
Q

What phase of chronic HBV is elevated ALT, elevated HBV DNA and low albumin/ low platelet going to be in?

Study These Flashcards
A

e= cirrhosis or e- cirrhosis

20
Q

define cirrhosis

Study These Flashcards
A

low albumin, low platelets

21
Q

ALT upper limit of normal for men and women

Study These Flashcards
A

35 for men

25 for women

22
Q

is hep B nucleoside analog txtemporary or lifelong

23
Q

How do we decide tx eligibility of HBV

Study These Flashcards
A

DNA >2000 IU/ml (viral load)

ALT>2xULN
or
cirrhosis

24
Q

When should we treat for e+ immune active/reactive

Study These Flashcards
A

e+ immune active- treat if ALT > 2x ULN, HBV DNA >20,000

e- immune reactivation treat indefinitely if ALT > 2x ULN, HBV DNA > 2000

25
when shoud we treat for e cirrhosis
e+ Cirrhosis- tx indefinitely if HBV DNA > 2000 e- cirrhosis- treat indefinitely if HBV DNA >2,000 otherwise nonitor
26
What is first line for HBV
tenofovir (TDF or TAF) entecavir
27
side effects after treating HBV
potential ALT flared on withdrawal
28
side effects for TAF, TDF and entecavir? Monitoring for each?
TAF- lactic scidosis, monitor lactic acid levels Entecavir- lactic acidosis ; monitor lactic acid levels if clinical concern test for HIV before tx initiation TDF- nephropathy, lactic acidosis, osteomalacia. Monitor Crcl baseling, bone density if hx of fracture
29
all doses have to be adjusted with renal dysfunction in HBV tx with TAF, TDF and entecavir
yes
30
What to monitor for HBV patients
monitor ALT 3-6 months and e antigen 6-12 months follow up every 3-6 months after therapy initiated
31
if we stop HBV therapy, how often should we monitor patients
every 3 months for at least 1 year
32
Who should receive HCC surveillance every 6 months (even if on tx)
All HBsAG + patients with cirrhosis and high risk non cirrhotics
33
What are some high risk cirrhotics that need to be monitored every 6 months
Asian or black men over 40, asian women a=over 50 and those with 1st degree relatives with HCC
34
HCV what percent develop chronic infection? What is chronic infection defined as? What percent of people with chronic HCV develop cirrhosis
>50% with acute HCV develop chronic infection Defined as persistently detectable HCV RNA for >6 months 5-25% of poeple with chronic HCV develop cirrhosis over 10-20 yrs
35
diagnostic test of HCV
HCV RNA
36
goal of therapy for HCV
Obtain virological cure by achieving a sustained virologic response. HCV RNA undetectable 12 wks after cessation of tx prevent complications (cirrhosis and death)
37
fundamental principles of HCV tx (what is used, is recent or active drug use contraindication?, warning when using these agents?)
combination therapy of direct acting antivirals (DAAs), prevents emergence of drug resistance not contraindicated all DAAs carry warning of HEP B reactivation
38
name the DAAs used in HCV
NS3/4A protease inhibitors NS5B polymerase inhibitors NS5A replication complex inhibitors
39
how can we identify the NS3/4A protease inhibitors
-pravir (protease) grazopravir
40
What is something to note about grazopravir
ALT needs to be checked at 8 wks dx if 5 x ULN (upper limit of normal) LFTs need to be checked too
41
how to recognize NS5B polymerase inhibitors
-buvir sofosbuvir
42
Sofosbuvir side effects, dose adjustments in hepatic impairement?
fatigue and headache dose adjustment not needed in hepatic impairement (needed in protease inhibitors)
43
name NS5A replication complex inhibitors
Elbasvir (asvir) velpatasvir
44
what is a pre treatment lab needed before elbasvir
genotype 1a patients must screen for presence of resistance associated substitutions (RASs)
45
What is pre treatment lab needed for velpatasvir
genotype 3 patients must screen for Y93H

Therapeutics P3 Spring (33 decks)

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