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PHA 550 > Hepatitis A and B > Flashcards

Hepatitis A and B Flashcards

1
Q

Hepatitis A: treatment

A

supportive care

  • immune globulin
  • handwashing hygiene

** NO role for antiviral agents in tx

infection confers lifeline immunity

prevention w/ vaccination preferred

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2
Q

Hepatitis A: HAVRIX vaccine (number of doses, schedule, age)

A 
2 doses (0, 6-12mo)
1-18yo and 19+yo
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3
Q

Hepatitis A: VAQTA vaccine (number of doses, schedule, age)

A 
2 doses (0, 6-18mo)
1-18yo and 19+yo
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4
Q

Hepatitis A: TWINRIX vaccine (number of doses, schedule, age)

A 
3 doses (0, 1, 6mo)
18+yo - ADULTS ONLY
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5
Q

Hepatitis A: vaccine: accelerated schedule (vaccines included, age, doses, schedule)

A

combination of HepA and HepB vaccine + 20mcg of HepB surface antigen

4 doses (0, 7d, 21-30d, 12+mo)
18+yo - ADULTS ONLY
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6
Q

Hepatitis A Vaccine: ADEs

A

soreness and warmth at injection site
HA
malaise
pain (arthralgias, myalgias)

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7
Q

In which patient population is efficacy of the HepA vaccine decreased?

A

HIV pts w/ CD4 <200

coinfected HIV/HCV pts

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8
Q

HepA: When can you administer PREEXPOSURE prophylaxis?

What is the exception?

A

vaccine can be given regardless of departure dates to endemic areas

Exception:
give both Ig and vaccine if traveling w/in 2 weeks
-older pts
-IM
-hx of chronic liver dz
-hx of other chronic medical condition

**Ig gives passive coverage while we wait for the active coverage of the vaccine

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9
Q

HepA: What are the options for POSTEXPOSURE prophylaxis?

A

either the vaccine or Ig

vaccine preferred w/ recent HAV exposure

vaccine brands are interchangeable for booster shots

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10
Q

What is an advantage and disadvantage of POSTEXPOSURE prophylaxis with the hepatitis A vaccine?

A

advantage: active immunity

disadvantage: uncertain efficacy in patients:
>40yo
w/ underlying conditions

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11
Q

HepA: When do patients not need Ig prophylaxis (pre or post exposure)?

A

pts who have received at least 1 dose of HAV vaccine at least 1 mo prior to exposure

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12
Q

HepA: When is Ig treatment indicated?

A

when the vaccine is not an option:

  • <12mo or >40yrs
  • IM
  • chronic liver dz
  • underlying medical conditions
  • vaccine contraindicated
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13
Q

Does immunoglobulin confer active or passive immunity?

A

passive

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14
Q

What is an ADE reported w/ HepA Ig treatment?

A

anaphylaxis in pts w/ IgA deficiency

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15
Q

What are the 2 categories of dosing for HepA Ig therapy?

A
  • postexposure prophylaxis, short term preexposure (<3mo)

- long term preexposure (=5mo)

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16
Q

Where is HepA Ig administered?

A

24+mo: deltoid, gluteal muscle

<24mo: anterolateral thigh muscle

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17
Q

What does a loss of HBsAg confer?

A

loss of HBsAg –> development of HBsAG antibody –> confers immunity and clearance

18
Q

What does a loss of HBeAg confer?

A

loss of HBeAg –> development of HBeAg antibody –> confers infection resolved

19
Q

What is the sign of chronic HBV?

A

detectable HBsAg for more than 6mo

20
Q

Is Hepatitis B curable?

A

No

infections can be controlled

cure is not possible bc HBV template is integrated into the host genome

21
Q

Hepatitis B: Treatment: Acute Supportive

A

immune globulin (IVIG) - acute exposure

22
Q

Hepatitis B: Treatment: Prevention

A

vaccine (0, 1, 6mo)

  • Engerix-B®
  • Recombivax HB®

serology markers anti-HBsAg only

23
Q

Hepatitis B: Treatment: Chronic Management

A

interferons

antivirals

24
Q

When can you administer a combination vaccine for HepB?

A

combo vaccine should NOT be used for birth (0) dose for HepB

may be used to complete the course after 6+ weeks of age (1, 6)

eg: HepB w/ DTaP,HIB

25
Q

What determines the newborn first dose?

A

the HBsAg status of the mother

26
Q

When is the first dose for an infant with an HBsAg NEGATIVE mother?

A

first dose: at birth/before discharge

27
Q

When is the first dose for an infant with an HBsAg POSITIVE mother?

A

first dose: w/in first 12hrs of life

(even if premature, regardless of birth weight)

administer Ig at the same time (different site)

28
Q

When is the first dose for an infant with an HBsAg UNKNOWN mother?

A

first dose: w/in 12hrs of birth

29
Q

What condition requires serologic testing and potential revaccination for HepB?

A

renal impairment (vaccine dialyzes off)

serologic testing: 1-2mo after final dose, annually

**no hepatic adjustment needed for hepatic impairment

30
Q

When should patients be revaccinated for HepB?

A

antiHBs concentrations <10mIU/mL

revaccinated w/ 3 doses of vaccine

31
Q

Hepatitis B Vaccine: contraindications, ADEs, interactions

A

hypersensitivity (yeast, HepB vaccine, component of formulation)

syncope (maybe w/ visual disturbances, weakness, tonic clonic movements)

dermatologic (ANGIOEDEMA, petechiae, pruritus, rash, urticaria)

IM: may diminish therapeutic effect of vaccines

32
Q

What is the POSTEXPOSURE treatment for HepB? What is the timespan for action?

A

post exposure w/in 7d

HepB immune globulin (HBIG)

follow w/ HBV

33
Q

What is the treatment for chronic HepB?

A

PEG-INF alpha (immunomodulating agent)

antivirals (Entecovir, Tenofovir)

HAV vaccination

34
Q

Long term therapy for HepB can develop resistance. Resistance develops to which agents most common and least common?

A

MC: lamivudine, telbivudine

LC: tenofovir

35
Q

What additional recommendations would you give to a patient w/ HepB?

A

vaccinate sexual and household contacts

avoid alcohol

milk thistle
(not with antivirals)
(can protect/restore liver hepatocytes)

36
Q

What diagnostic information is used to determine if a patient can be observed/monitored or needs pharmacologic intervention for HepB?

A

ALT
=2: observe/monitor
>2: pharmacologic tx

for pts w/ cirrhosis: also look at HBV DNA

37
Q

HepB: Entecavir: ADEs

A

HA
fatigue
upper abdominal pain
lactic acidosis

38
Q

HepB: Tenofovir disoproxil: ADEs

A 
nausea
diarrhea
abdominal pain
dizziness
fatigue
nephropathy
lactic acidosis
39
Q

HepB: Pegylated Interferon alfa 2a: ADEs

A 
flu like sx
fatigue
mood disturbances (DEPRESSION)
cytopenias
autoimmune disorders
40
Q

What indicates a positive response to HBV therapy? (biochemical, histologic, virologic)

A

biochemical: normalization of ALT
histologic: dec histology activity
virologic: undetectable HBV DNA, loss of HBeAg

PHA 550 (26 decks)

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