Exam 5 - Hepatitis Flashcards Preview

Therapeutics V Spring 2019 (P3 Spring) > Exam 5 - Hepatitis > Flashcards

Flashcards in Exam 5 - Hepatitis Deck (92):
1

what are the 3 main hepatitis viruses we learned about?

Hep A (HAV)
Hep B (HBV)
Hep C (HCV)

2

what does hepatotrophic mean?

systemic infection that primarily affect the liver

3

the hepatitis viruses are all RNA --- except _____ is a DNA virus

Hep B

4

HAV, HBV, or HCV:
which one(s) will produce a chronic infection

B and C

5

HAV, HBV, or HCV:
which one(s) have immunizations to prevent them

A and B has immunizations

6

HAV, HBV, or HCV:
which one's source is feces

A

7

HAV, HBV, or HCV:
which one(s) has a high risk via sexual transmission

A and B
(not impossible with C tho)

8

HAV, HBV, or HCV:
which one(s) has primary prevention that includes handwashing

A (why handwashing signs in bathrooms of restaurants)

9

HAV, HBV, or HCV:
which one(s) has high risk via IV drug use

B and C

10

HAV, HBV, or HCV:
which one has a high occupational risk

B

11

HAV, HBV, or HCV:
which one(s) is usually acute and then resolves

A

12

Risk Groups for HAV:
-traveling to where???
-men who _________
-users of _______
-people with _________ disorders
-people working w/ ________________

-traveling to areas with high/med rates of HAV infection
-men who have sex with men
-users of illegal drugs
-people with clotting factor disorders
-people working w/ nonhuman primates susceptible to this infection

13

People that should get HAV vaccine:
-All children starting at age _____
-Children/adolescents aged 2-18 who ______
- people with ________ disease
- people with ________ disorders
- men who have sex with men
- illegal drug users

-age 1
-who live in area with high incidence of HAV
(or people who travel to places with high/intermed rates of HAV)
-chronic liver disease
- clotting factor disorders

14

what are the Hep A vaccines that are available?

Havrix
Vaqta
Twinrix (A and B combo)

15

Hep A vaccines? inactiavted or live vaccine?

inactivated--- ok in pregnancy

16

Routine vaccination is not needed for what people for Hep A?

food service workers
sewage workers
health care workers
children < 12 months old (bc vaccine not approved for them)
child care attendees

17

HAV, HBV, or HCV:
which one is classified as a picornavirus?

A

18

HAV, HBV, or HCV:
classified as hepadnavirus?

B!!
B is only one that is DNA based (DNA in the name..)

19

Is this a way that Hep B an be transmitted?
food/water

no

20

Is this a way that Hep B an be transmitted?
injection drug use

yes

21

Is this a way that Hep B an be transmitted?
breastfeeding

no (unlike HIV)

22

Is this a way that Hep B an be transmitted?
mother-child transmission

yes

23

Is this a way that Hep B an be transmitted?
sharing razors/toothbrushes

yes

24

HBV Serologic Markers:
what does HBsAg stand for?

hepatitis B surface antigen

25

HBV Serologic Markers:
what does HBsAg mean clinically?

it is marker of presence of ongoing infection
if + result = pt is INFECTIOUS
if - result = pt is NOT infectious

26

HBV Serologic Markers:
what does anti-HBs stand for?

antibody to hepatitis B surface antigen

27

HBV Serologic Markers:
what does anti-HBs mean clinically?

marker of IMMUNITY
if + result = patient is IMMUNE
if - result = pt is not immune

28

HBV Serologic Markers:
what does HBcAg stand for

hepatitis B core antigen

29

HBV Serologic Markers:
what does HBcAg mean clinically?

it isnt used clinically....
no free HBcAg circulates in the blood

30

HBV Serologic Markers:
what does Total anti-HBc stand for

antibody to hepatitis B core antigen

31

HBV Serologic Markers:
what does total anti-HBc mean clinically?

marker of exposure to the infection/actually virus
if + = pt has been exposed to the virus

32

HBV Serologic Markers:
what does IgM anti-HBc stand for?

immunoglobulin M class of antibody to hepatitis B core antigen

33

HBV Serologic Markers:
what does IgM anti-HBc mean clinically?

marker of ACUTE/recent acquired infection
if + result = pt been exposed to virus within past 6 mos

34

HBV Serologic Markers:
what does HBeAg and anti-HBe stand for

hepatitis B e antigen and
antibody to the hep B e antigen

35

HBV Serologic Markers:
what does HBeAg and anti-HBe mean clinically?

relates to the virus if it is actively replicating or has it stopped

36

what HBV Serologic Marker's result lets you know that the person has been exposed to the virus?

total anti-HBc (anitbody to hepatitis B core antigen)

37

what HBV Serologic Marker lets you see that the patient has been recently/past 6 mos exposed to the virus

IgM anti-HBc

38

what HBV Serologic Marker says that the patient is infectious?

HBsAg
(hepatitis B surface antigen)

39

what HBV Serologic Marker lets you know that the patient is immune?

anti-HBs
(antibody to hepatitis b surface antigen)

40

what HBV Serologic Marker lets you distinguish if the patient is immune due to disease or vaccination

none!!
anti-HBs lets you know if they are immune ... no test to distinguish how the patient is immune

41

Goals of Therapy for HBV:
-Achieve sustained suppression of _______
-remission of ________
-prevent what 3 things?

- HBV replication
- liver disease
- prevent cirrhosis, hepatic failure, and HCC (hepatic carcinoma)

42

Fundamental Principles of Treatment for HBV:
Initiate treatment when HBV DNA >/= _________ or >/= ___________ because it is associated with increased risk of cirrhosis and HCC

> 2,000 IU/mL
OR
> 10,000 copies/mL

43

Fundamental Principles of Treatment for HBV:
What is the ULN (upper limit of normal) for ALT?

Males: 35 U/L
Females: 25 U/L

44

Fundamental Principles of Treatment for HBV:
Patients with _________ and all patients with _______ need to be treated INDEFINITELY

e- immune reactivation
and
all pts with cirrhosis

45

Fundamental Principles of Treatment for HBV:
For e+ patients: treatment should be continued for at least __________
(want loss of HBeAg and want gain of anti-HBe or at least HBsAg loss)

12 months

46

Fundamental Principles of Treatment for HBV:
what is his "2 outta 3 rule aint bad" rule mean??

need 2/3 criteria for treatment:
MUST have HBV DNA > 2000 IU/mL
and then need just ONE of the following
ALT > 2 x ULN
or Cirrhosis present

47

what are the 4 first line agents possible for HBV?

peginterferon alfa 2a
TDF (tenofovir disoproxil fumarate)
TAF (tenofovir alafenamide)
Entecavir

48

which first line agent of HBV is used given SQ and given 48 weeks

peginterferon alfa 2a

49

which first line agent of HBV must be taken on an empty stomach

entecavir

50

what are the contraindications for peginterferon use?

Hx of psychosis
Severe depression
Neutropenia/thrombocytopenia
Symptomatic heart disease
decompensated liver disease
uncontrolled seizures

51

which first line agent of HBV has a dose adjustment if lamivudine exposure has happened

Entecavir

52

How do you dose adjust Entecavir if the patient has had lamivudine before?

pt gets double the dose (normally is 0.5 mg daily if naive --- but if lamivduine given before, give 1 mg PO daily)

53

what is another reason you would double the dose of Entecavir (other than lamivudine)

if decompensated cirrhosis

54

ADEs from peginterferon

flu like sxs
fatigue
mood disturbances
cytopenia
autoimmune disorders
anorexia

55

Monitoring for peginterferon

CBC Q month to Q 3 months
TSH Q3 months
Clinical monitoring for autoimmune, ischemic, neuropsychiatric, and infectious complications

56

Monitoring for Entecavir

Lactic acid levels (only concerned in decompensated cirrhosis)

also test for HIV before treatment initiation

57

ADEs of TDF?

Nephropathy
Fanconi syndrome
Osteomalacia
Lactic acidosis

58

Monitoring for TDF and TAF

CrCl (at least baseline and other times too)
Bone density study
Check phosphate, urine glucose, and protein at least annually if renal impairment risk
test for HIV before treatment initiation


TAF is the same as above but no bone density scan needed...

59

what is fanconi syndrome?

rare disorder of kidney tubule function that results in excess amounts of glucose, bicarbonate, phosphates (phosphorus salts), uric acid, potassium, and certain amino acids being excreted in the urine.

60

ADE of Lamivudine and thus what monitoring??

Pancreatitis --- check amylase if Sxs present
Lactic acidosis --- check lactic acid levels

test for HIV before treatment

61

what HBV drugs need renal adjustment if renal insufficiency?

nucleoside analogs
(TDF, TAF, and Entecavir)

62

For pts on HBV therapy:
check HBV DNA levels (viral load) how often?

check Q 3 months until undetectable then check Q3-6 months

63

what 3 things do you look at to put a patient in a Clinical phase of chronic HBV?

Look at E antigen, ALTs, and Cirrhosis

64

what question does HBeAg answer?

answers if virus is ACTIVELY replication

65

what question does anti-HBe answer?

has the virus recently stopped replicating?

66

Treating Pregnant women with HBV:
want to minimize perinatal transmission:
thus begin at weeks _______ of gestation

28 - 32

67

Treating Pregnant women with HBV:
treat pregnant women with HBV DNA > ________ IU/mL with __________

200,000!!!!
give TDF
(other options not studied)

68

HAV, HBV, or HCV:
which one is a flavivrus

C

69

HCV:
is differentiated into _____ different genotypes
___ and ___ are the two most common in the US

6;
1a and 1b

70

Chronic HCV infection is defined as what?

persistently detectable HCV RNA >/= 6 months

71

Goals of Therapy: HCV?

obtain virological CURE by achieving a SVR (sustained virological response) aka
HCV RNA is undetectable 12 weeks after cessation of treatment

also prevent cirrhosis, HCC, and death

72

Treatment for HCV is recommended for who?

everybody!!! unless the person is gonna die within the year (due to non liver issues)

73

all DAAs carry what black box warning?

Hep B reactivation

74

Hep B reactivation appears to be correlated with ________ before HCV treatment

HBsAg positivity

75

what are the 3 main DAA classes for HCV

NS3/N4A protease inhibitors
NS5B polymerase inhibitors
NS5A replication/assembly complex inhibitors

76

what DAA drug class ends with -previr

N3A/N4A PRotease inhibitors

77

what DAA drug class ends with -asvir

NS5A replication/assembly complex inhibitors

78

what DAA drug class ends with -buvir

NS5B polymerase inhibitors

79

which DAA drug class will have nucleoside analogs

NS5B polymerase inhibitors

80

which DAA drug class is a potent CYP3A4 inhibitor

N3A/N4A Protease inhibitors/-previr

81

which N3A/N4A Protease inhibitor/-previr needs to have ALT checked at 8 weeks and discontinue if ALTs are too high

grazoprevir

82

Discontinue grazoprevir when?

if ALTs are 5 x the ULN

83

which DAA drug class is well tolerated (have very vague side effects.. HA/Nausea etc)

N3A/N4A Protease inhibitors/-previr

84

which DAA drug class has pangenotypic coverage

NS5B polymerase inhibitors/-buvirs

85

what drug means you should avoid amiodarone coadministration due to risk of symptomatic bradycardia

sofosbuvir

86

which NS5A replication/assembly complex inhibitor is affected by pH (and how is it affected)

ledipasvir
(antacids/high pH = DECREASED absorption/solubility)
aka separate from antacids

87

which NS5A replication/assembly complex inhibitor is metabolized by CYP3A4 (will dose adjust if coadministered if strong inhibitors or inducer)

daclatasvir

88

which NS5A replication/assembly complex inhibitor do you need to needs to test for RAV (resistance associated variants) presence

elbasvir

89

what do you do if RAV (resistance associated variants) is present when giving elbasvir

treat for 16 weeks and add ribavirin

90

Normally HCV treatment is for how long?

12 weeks

91

Counseling for preventing spread of Hep C

dont share toothbrushes/shaving equipemnt
cover bleeding wounds
do not use illicit drugs/dont share needles at least
do not donate blood, organs, tissues, semen

92

test for what prior to using velpatasvir and do what with results?

if genotype 3/compensated cirrhotic pt --- check for Y93H variant --- if present GIVE and ribavirin