exam 4 - viral hepatitis

Question 1

what are the modes of transmission of hepatitis

Answer 1

fecal-oral
blood
sexual

Question 2

what are the risk factors of hepatitis

Answer 2

A - direct contact
B - born to mother
C - injection drug use

Question 3

prevention of hepatitis

Answer 3

vaccine

Question 4

what forms of hepatitis have the potential for chronic infection

Answer 4

Hep B and Hep C

Question 5

what does an all neg test for hep b mean

Answer 5

susceptible, never infected

Question 6

what does
HBsAg: neg
anti-HBs: pos
anti-HBc: pos

Answer 6

resolved infection

Question 7

what does
HBsAg: neg
anti-HBs: pos
anti-HBc: neg

Answer 7

immune from prior vaccine

Question 8

what does
HBsAg: pos
anti-HBs: neg
anti-HBc: pos
IgM anti-HBc: pos

Answer 8

acute infection

Question 9

what does
HBsAg: pos
anti-HBs: neg
anti-HBc: pos
IgM anti-HBc: neg

Answer 9

chronic infection

Question 10

what does
HBsAg: neg
anti-HBs: neg
anti-HBc: pos

Answer 10

unclear result; either resolved, false positive, occult infx, infx w/ mutant strain

Question 11

goals of chronic hep b management

Answer 11

achieve suppression
remission of liver disease
prevent liver complications
functional or virologic cure

Question 12

what are the fundamental principles of hep b treatment

Answer 12

HBV DNA < 2000
indefinite duration of nucleoside analog therapy
(e- indef; e+ at least 12 months)

Question 13

goals of therapy for hep c

Answer 13

obtain virologic cure
prevent complications & death

Question 14

fundamental principles of hep c treatment

Answer 14

-all oral regimens
-combo prevents drug resistance
-treatment recommended for all chronic HCV
-DAAs for outpatient (risk of hepb activation)

Question 15

what is the upper limit of normal for ALT for females

Answer 15

25 U/L

Question 16

what is the upper limit of normal for ALT for males

Answer 16

35 U/L

Question 17

classify:
normal ALT
elevated HBV DNA (++++)

Answer 17

e+ immune tolerant

Question 18

classify:
normal ALT
low/undetectable HBV DNA (+/-)

Answer 18

e- inactive (carrier)

Question 19

classify:
elevated ALT
elevated HBV DNA (+++)

Answer 19

e+ immune active or e- immune reactivation

Question 20

what are the first line NAs for hepB

Answer 20

Tenofovir
Tenofovir alafenamide
entecavir

Question 21

what are the first line cytokines for hepB

Answer 21

peginterferon alfa 2a

Question 22

side effects of tenofovir alafenamide

Answer 22

lactic acidosis

Question 23

monitoring of tenofovir alafenamide

Answer 23

LA levels
SCr
HIV

Question 24

side effects of tenofovir

Answer 24

nephropathy
fanconi syndrome
osteomalacia
lactic acidosis

Question 25

monitoring for tenofovir

Answer 25

CrCl at baseline renal function

Question 26

entecavir AEs

Answer 26

lactic acidosis

Question 27

entecavir monitoring

Answer 27

LA levels HIV status

Question 28

peg-IFN-2a AEs

Answer 28

flu like mood disturbance autoimmune anorexia

Question 29

peg-IFN monitoring

Answer 29

CBC montly-3months TSH complications

Question 30

for immune tolerant HBV patients what should be monitored

Answer 30

ALT q3-6 months and eAg q6-12 months

Question 31

for e- inactive HBV, what should be monitored

Answer 31

ALT every 6-12 months

Question 32

for patients on HBV therapy, what should be monitored

Answer 32

HBV DNA levels every 3 months

Question 33

if therapy is stopped for HBV patients, what should be monitored

Answer 33

recurrent viremia, ALT flares, decompensation

Question 34

for all HBsAg + patients with cirrhosis, what should be monitored

Answer 34

HCC surveillance every 6 months

Question 35

what are the drug classes for HCV

Answer 35

NS3/4A protease inhibitors NS5B polymerase inhibitors NS5A replication complex inhibitors

Question 36

what are the NS3/4A inhibitors

Answer 36

"previr" peritaprevir grazoprevir glecaprevir voxilaprevir

Question 37

nsb5 inhibitors

Answer 37

"buvir" sofosbuvir dasabuvir

Question 38

what are the NS5A inhibitors

Answer 38

"asvir" ledipasvir elbasvir velpatasvir pibrentasvir

Question 39

what are the hepatitis guidelines

Answer 39

hcvguidelines.org

Question 40

what is the pre-treatment testing for velpatasvir

Answer 40

NS5A genotype must be tested for the Y93H sub

Question 41

what is the pre-treatment for elbasvir

Answer 41

NS5A genotype must be screened for RAS substitutions

Question 42

what should be monitored for grazoprevir

Answer 42

ALT checked at 8 weeks dc if >5xULN