hepatitis Flashcards

Question

Tenofovir alafenamide (TAF)

Answer 1

-phosphonamide prodrug of tenofovir -adenosine nucleotide analog inhibits HBV DNA replication Dose -adults >18yo: 25 mg with food -avoid in crcl < 15mL.min AE -HBV exacerbation if abruptly dc -HA, ab pain, cough, backache, fatigue -less BMD and nephrotoxicity vs TDF metabolism: carboxyesterase hydrolysis, p-gp and BCRP (substrate)

Answer 2

Emtricitabine, lamivudine, TDF and TAF initial fix dose combination -TDF/ Emtricitabine -TDF/lamivudine -TAF/ Emtricitabine

Answer 3

nucleus(t)ide - no cirrhosis: 12 months -cirhossis: indefinite peg-IFN-a: 48 weeks

Answer 4

HAV+ HBV (IM) -TWINRIX HBV (IM) -ENGERIX-B -RECOMBIVAX HB HEPLISAV-B

Answer 5

-one-time, routine, opt out for >18 yo -one time <18 yo if you if risky, activities, exposure, or conditions or circumstances -routine prenatal care w each pregnancy -Periodically if if risky, activities, exposure, or conditions or circumstances -Annually: IVDU, HIV+, MSM unprotected sex, and MSM taking PrEP

Answer 6

target specific nonstructural (NS) protein for HCV leading to disruption in viral replication and infection

Answer 7

Indication (age ≥ 3 y/o) * GT1,4,5,6w/o cirrhosiso r w/compensated cirrhosis *GT1 decompensated cirrhosis +RBV *GT1 or 4 liver transplant recipient w/o cirrhosis or w/compensated cirrhosis + RBV *DDIs * P-gp inducers * Amiodarone (bradycardia) * Antacids: separate by 4 hrs ** H2RAs: simultaneously w/or 12 hrs apart; avoid comparable doses > famotidine 40 mg PO BID * *PPIs: simultaneously w/fasting conditions; avoid comparable doses > omeprazole 20 mg po daily

Answer 8

Indication (age ≥ 3 y/o) * GT 1-6 w/o cirrhosis or w/ compensated cirrhosis (RBV-free) or w/decompensated cirrhosis + RBV DDIs * P-gp,CYP2B6,2C8,3A4inhibitorsand inducers * Amiodarone(bradycardia) * Antacids:separateby4hrs *H2RAs:simultaneouslyw/or12hrsapart; avoid comparable doses > famotidine 40 mg PO BID * PPIs: not recommended; if needed, take Epclusa w/food & 4 hrs before omeprazole 20 mg po daily

Answer 9

Indication (≥ 12 y/o & ≥ 30 kg) * GT1or4 *In combination w/ RBV if NS5A mutations and/or IFN, RBV, or PI-tx experienced) *NS5A resistance test before tx forGT 1a Contraindications *Moderate or severe hepatic impairment (CTPBorC) *Strong CYP3A inducers, OATP1B1/3 inhibitors *Contraindications to RBV apply DDIs * CYP3A4, P-gp, OATP1B1/3 inducers and inhibitors

Answer 10

Indication (≥ 3 y/o) *GT 1-6 w/o cirrhosis or w/ compensated cirrhosis *GT1previously tx w/ NS5A inhibitoror NS3/4A protease inhibitor (not both) Contraindications * Moderate-severehepaticimpairment (CTP Class B or C) *H/Opriorhepaticdecompensation *Coadministration w/ atazanavir and rifampin DDIs *Pgp,BCRP,OATP1B1/1B3,3A4,1A2, UGT1A1 inducers and inhibitors

Answer 11

GT 1-6: Mavyret® (glecaprevir/pibrentasvir) 300 mg/120 mg w/food x 8 wks -OR- GT 1-6: Epclusa® (velpatasvir/sofosbuvir) 100 mg/400 mg x 12 wks

Answer 12

Check HCV VL and LFTs ≥ 12 wks following completion to confirm virologic cure (SVR) and transaminase normalization counsel risk reduction and test for HCV VL annually and w/e elevated AST,ALT, or bilirubin avoid excess ETOH

Answer 13

GT 1-6: Mavyret® (glecaprevir/pibrentasvir) 300 mg/120 mg w/food x 8 wks -OR- GT 1-6: Epclusa® (velpatasvir/sofosbuvir) 100 mg/400 mg x 12 wks *GT3 if baseline NS5A resistance mutation negative

Answer 14

* Check HCV RNA and LFTs ≥ 12 wks upon completion to confirm virologic cure (SVR) and transaminase normalization * Assessment for other causes of liver dx if elevated transaminase levels after achieving SVR * U/S surveillance for HCC (w/ or w/o AFP testing) Q6mo. * Upper endoscopic surveillance for esophageal varices associated-portal hypertensive bleeding * Counsel if ongoing risk for HCV infection (i.e., IVDU or MSM engaging in unprotected sex) about risk reduction and test for HCV VL annually and whenever elevated ALT, AST, or bilirubin * Advise to abstain from ETOH use

Answer 15

* Check HCV RNA and LFTs ≥ 12 wks or later following completion of therapy to confirm virologic cure (SVR) and transaminase normalization * If initial HCV tx fails to achieve SVR then evaluate for retreatment by a specialist * U/S surveillance for HCC (w/ or w/o AFP testing) Q6mo * Assess HCV disease progression Q6-12 mo. w/ hepatic function panel, CBC, and INR * Advise to abstain from ETOH

Answer 16

* Suffer more liver-related M&M, nonhepatic organ dysfunction, and overall mortality vs HCV-monoinfected pts * Despite potent ARVs, HIV independently associated w/advanced liver fibrosis and cirrhosis * Prioritize tx for providers, pts and payers * Monitor liver dx progression if HCV tx delayed * Efficacy and ADEs similar to HCV monoinfection

Answer 17

* No vaccine available * Avoid sharing dental or shaving equipment * Cover bleeding wounds * Avoid use of illicit drugs and recommend substance abuse tx * For those who continue with IVDU * Avoid reusing or sharing syringes, needles, water, cotton * Use new sterile syringes and filters, and disinfected cookers * Clean injection site w/new alcohol swab * Discard syringes and needles after single use in safe, puncture-proof container * Avoid blood donation if HCV-infected * Use barrier protection to prevent sexual transmission * Mix 1 part household bleach: 9 parts water to clean contaminated household surfaces with visible blood. Wear gloves.

hepatitis Flashcards

(41 cards)