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Spring 2025 Therapeutics V > Exam 4: Viral Hepatitis > Flashcards

Exam 4: Viral Hepatitis Flashcards

(72 cards)

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1
Q

What is hepatitis?

A

Inflammation of the liver

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2
Q

What are the 3 most common viruses that cause viral hepatitis? (note there are 5 total)

A

Hepatitis A virus
Hepatitis B virus
Hepatitis C virus

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3
Q

What type of virus is hepatitis?

A

RNA

*except HBV is DNA

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4
Q

Which forms of hepatitis can cause a chronic infection?

A

HBV
HCV

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5
Q

What is the main route of transmission for HAV?

A

Fecal-Oral

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6
Q

What are the main routes of transmission for HBV?

A

Blood
Sexual

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7
Q

What is the main route of transmission for HCV?

A

Blood

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8
Q

What is the most common risk factor for getting HAV?

A

Direct contact with someone with HAV

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9
Q

What is the most common risk factor for getting HBV?

A

Born to infected mother

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10
Q

What is the most common risk factor for getting HCV?

A

Injection drug use

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11
Q

The vaccine against which form of hepatitis is recommended at birth?

A

HBV

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12
Q

Which form of hepatitis does not require chronic treatment?

A

HAV

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13
Q

Chronic treatment of which hepatitis form is CURATIVE?

A

HCV

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14
Q

Chronic treatment of which hepatitis form is NOT CURATIVE?

A

HBV

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15
Q

What is the only form of hepatitis without a vaccine available?

A

HCV

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16
Q

What are the 2 methods for diagnosing HAV?

A

Presence of IgM anti-HAV in the serum

Presence oh HAV RNA in the serum/stool

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17
Q

Which antibody is responsible for providing lifelong immunity to HAV?

A

IgG anti-HAV

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18
Q

How do we assess immunity to HAV?

A

Total anti-HAV present

(Measure both IgG and IgM)

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19
Q

How do we treat HAV infection?

A

We don’t!

-Supportive care

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20
Q

When should the HAV vaccine typically be given?

A

2 dose series:
0 months and 6-12 months

Post-exposure prophylactic vaccine should be given ASAP after exposure
-in people >12 months old
*Give IM immune globulin if < 12 mo old
*Give both immune globulin and vaccine if >40 years old with increased risk

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21
Q

True or False: The HAV vaccine is safe in pregnancy

A

True

(it is an inactivated vaccine)

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22
Q

What side effect is unique to HAV?

A

diarrhea

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23
Q

Who should be screened for HBV?

A

Adults age 18 and older at least once in their lifetime using a triple panel test

Screen for HBsAg during each pregnancy

Test people at ongoing risk periodically

Test anyone who requests to be tested

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24
Q

What 3 markers are tested in an HBV triple panel test?

A

Hepatitis B Surface Antigen (HBsAg)

Antibody to hepatitis B surface antigen (anti-HBs)

Antibody to hepatitis B core antigen (Total anti-HBc)

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25
Which marker of HBV tells us if the patient is infectious or not?
Hepatitis B Surface Antigen (HBsAg)
26
Which marker of HBV tells us if the patient is immune or not?
Antibody to hepatitis B surface antigen
27
Which marker of HBV tells us if the patient has been exposed to the HBV virus?
Antibody to hepatitis B core antigen
28
If all 3 HBV markers in a triple panel come back negative, and the patient is susceptible but never infected, what do we do?
Offer HepB vaccine
29
If in an HBV triple panel, HBsAg is negative, anti-HBs is positive, and anti-HBc is positive, what does this mean and what do we do?
Resolved infection Counsel about HBV reactivation risk
30
If in an HBV triple panel, HBsAg is negative, anti-HBs is positive, and anti-HBc is negative, what does this mean and what do we do?
Patient has immunity from a prior vaccination (if documented) If not vaccinates, complete the vaccine series
31
If in an HBV triple panel, HBsAg is positive, anti-HBs is negative, anti-HBc is positive, and IGM anti-HBc is positive, what does this mean and what do we do?
Acute infection Link to hepatitis B care
32
If in an HBV triple panel, HBsAg is positive, anti-HBs is negative, anti-HBc is positive, and IgM anti-HBc is negative, what does this mean and what do we do?
Chronic infection Link to hepatitis B care
33
How do we treat an acute HBV infection?
No treatment Supportive care
34
When do we use medication therapy to treat HBV?
Chronic infection
35
What 3 tests do we do on a patient with chronic HBV to figure out what phase they are in?
Liver panel HBeAg HBV DNA PCR
36
What is the clinical threshold that HBV DNA must be above in order to treat for HBV?
>/= 2000 IU/mL (>/= 10,000 copies/mL)
37
ALT is normally elevated in HBV infection, what is the upper limit of normal for men and women?
Men: 35 U/L Women: 25 U/L
38
Do we use monotherapy or combination therapy for HBV treatment?
Monotherapy *combination therapy has not shown higher efficacy
39
How long does nucleoside analog therapy typically last for HBV?
Indefinite
40
What requirements must be met with HBV infection to me eligible for treatment?
HBV DNA > 2000 IU/mL + ALT > 2xULN or Cirrhosis
41
If a patient has the e+ Immune-active phase of chronic HBV, what criteria must they meet to be given treatment?
ALT > 2xULN HBV DNA > 20,000 IU/mL ***
42
What are the first-line nucleoside analogs used for HBV treatment?
Tenofovir (TDF) 300 mg po daily Tenofovir alafenamide 25 mg po daily *this tends to be reserved 2nd line* Entecavir -use 0.5 mg po daily in nucleoside naive patients -use 1 mg po daily in nucleoside-experienced patients
43
What are the other agents that can be used for HBV besides the 1st line treatment?
Nucleoside analogs: -Lamivudine -Adefovir -Telbivudine Cytokine -not in US
44
What side effects are we worried about with Tenofovir Disoproxil Fumarate?
*Nephropathy Fanconi syndrome Osteomalacia Lactic acidosis
45
What side effect are we worried about with all 3 of the first-line nucleoside analogs for HBV? (entecavir, tenofovir disoproxil fumarate, tenofovir alafenamide)
Lactic acidosis
46
Who has a higher risk for HBV reactivation/flares?
Patients who test positive for both anti-HBc and HBsAg
47
What is the treatment for HBV in pregnant women?
Beginning at week 28-32 of gestation, treat pregnant women who have HBV DNA > 200,000 IU/mL with tenofovir DF *note: only use tenofovir DF, no other forms/drugs
48
What treatment is frequently used for HBV/ HIV coinfection?
Emtricitabine + Tenofovir
49
When is the HBV vaccine typically administered and how many doses?
3 doses at: 0, 1, and 6 months old
50
Hepatitis C is divided into what categories?
7 major genotypes (1-7) then, further classified into 67 subtypes (a, b, c, etc)
51
What are the most common types of HCV in the us?
1a and 1b
52
What are the 2nd most common genotypes of HCV?
2 and 3
53
How is HCV spread?
Repeated percutaneous exposures to infected blood
54
What is considered a chronic HCV infection?
Persistently detectable HCV RNA for >/= 6 months
55
How do we diagnose HCV infection?
Presence of HCV RNA
56
Who should be screened for HCV?
All US adults Pregnant women during every pregnancy
57
What is the goal of HCV therapy?
Obtain a virological cure by achieving sustained virological response (SVR) SVR= HCV RNA is undetectable 12 weeks after cessation of treatment
58
Who should receive treatment for HCV?
All people with chronic HCV -except those with short life expectancies (<12 mo)
59
Should we use combination therapy in HCV treatment?
Yes, it prevents resistance
60
All Direct Acting Antivirals (DAAs) used in HCV treatment have what black box warning?
Risk of Hepatitis B reactivation
61
What are the NS3/4A Protease Inhibitors that can be used in HCV treatment?
*Grazoprevir 100 mg po daily or with/without food Glecaprevir Voxilaprevir
62
What is an important clinical pearl about Grazoprevir therapy?
Patients should have ALT checked at 8 weeks, discontinue if >5xULN
63
What are the NS5B Polymerase Inhibitors used for HCV treatment?
"buvir" = NS5B Sofosbuvir (no hepatic dose adjustment) *this is the only one left
64
What are the NS5A replication complex inhibitors used for HCV treatment?
"asvir"= NS5A Ledipasvir Elbasvir Velpatasvir Pibrentasvir
65
What is an important clinical pearl regarding Elbasvir use in HCV?
Prior to use in patients with an HCV genotype 1a, an NS5A genotype must be performed to screen for the presence of resistance-associated substitutions (RASs) at baseline Presence of any substitutions at codons: 28, 30, 31, or 93 requires extended 16 week course + ribavirin
66
What is an important clinical pearl for Velpatasvir use in HCV treatment?
Prior to use, in compensated cirrhotic patients with HCV genotype 3, an NS5A genotype must be performed to screen for the presence of the Y93H substitution -presence requires adding ribavirin or voxilaprevir
67
What are the FDA Approved combinations for HCV treatment?
Elbasvir + Grasoprevir Pibrntasvir + Glecaprevir Velpatasvir + Sofosbuvir + Voxilaprevir 2nd line Ledipasvir + Sofosbuvir Velpatasvir + Sofosbuvir
68
Which combination product is 3 tablets daily taken with food?
Pibrentasvir + Glecaprevir
69
What are the most common side effects of ribavirin?
*Hemolytic anemia *Teratogenic
70
Who is ribavirin contraindicated in?
CrCl <50
71
How long does HCV therapy last?
12 weeks
72
Which regimen is a predominantly 8 week course?
Pibrentasvir + Glecaprevir

Spring 2025 Therapeutics V (41 decks)

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