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NAPLEx > Hepatitis and liver disease > Flashcards

Hepatitis and liver disease Flashcards

1
Q

Hep A

A

Acute
fecal-oral
vaccine yes
1st tx is supportive

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2
Q

Hep B

A

acute and chronic
blood, body fluid
vaccine yes
1st tx- PEG-INF or NRT (tenofovir or entacavir)

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3
Q

Hep C

A

acute and chronic
blood, body fluid
vaccine no
1st tx- treatment-naive: DAA combo

other: DAA combo + RBV or/w PEG-INF

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4
Q

Interferon

A

not recommended but could play a role DAA to expensive

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5
Q

ritonavir

A

not active for HCV, generally used as a boost to PI

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6
Q

NS3/4A
Protease Inhibitors

A

-previr
P for PI

ex: glecaprevir, grazoprevir, paritaprevir, voxilaprevir

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7
Q

NS5A
Replication Complex Inhibitors

A

-asvir
A for NS5A

ex: elbasvir, ledipasvir, ombitasvir, pibrentasvir, velpatasvir

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8
Q

NS5B
Polymerase inhibitors

A

-buvir
B for NS5B

ex: dasabuvir, sofosbuvir

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9
Q

PIG

A

protease inhibitor & Grub
Take With Food
except Zepatier- w/o regard to food, fosamprenavir oral suspension w/o food

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10
Q

All DAAs

A
  • risk of reactivation HBV, test all pt for HBV before starting
  • sofsobuvir- regimens do not use amiodarone! serious bradycardia
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11
Q

Glecaprevir/pibrentasvir

A

Mavyret
w/food
- contra in child-pugh B or C
- do not use with efavirenz or HIV protease inhibitors (atazanavir, darunavir, lopinavir, ritonavir), or Ethinyl estradiol contain products

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12
Q

Sofosbuvir/velpatasvir

A

epclusa

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13
Q

protect from moister

A

savaldi, epclusa, harvoni, vosevi
because it contains sofosbuvir that needs to be protected from most. these are combo drugs with sofosbuvir

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14
Q

pan-genotypic

A

approved for all 6 HCV geno types for patient- naive pts.
Epclusa and Mavyret

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15
Q

8 week course for select pts

A

Mavyret

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16
Q

salvage therapy (in failed previous therapy)

A

Vosevi and Mayvret (select pts)

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17
Q

sofosbuvir/velpatasvir/voxilaprevir

A

Vosevi

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18
Q

sofosbuvir

A

sovaldi
monotherapy not effective

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19
Q

DAA Drug interaction

A

-contra for strong cyp inducers… carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, rifabutin, st. johns worst.

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20
Q

Sofosburvir/ledipasvir

A

Harvoni

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21
Q

Harvoni, Epclusa and Vosevi
DI

A

antacids, H2RAs, and PPI, can decrease concentration
- antacids separate by 4 hrs
- PPI not recommended with Epclusa

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22
Q

Paritaprevir/ritonavir/ombitasvir +dasaburvir

A

Viekira Pak
contra with- strong cyp3A4 inducers, ethylin estradiol-containing products,

23
Q

Elbasvir/grazoprevir

A

Zepatier
Do not use with efavirenz or HIV PIs

24
Q

Ribavirin

A

can be used for HCV in combo
- teratogenic
- not effective monotherapy
- hemolytic anemia
- avoid male and female prego, till past 6 months after therapy

25
Q

interferon
alfa

A

HBV, HCV and some cancer

26
Q

interferon
beta

A

Multiple sclerosis

27
Q

interferon alfa-2b
pegylated 2a
pegylated 2b

A

Intron A 3 times weekly
Pegasys and pegintron weekly

boxed warning, neuropsych, autoimmune, infection

SE: flu like symptom, myelosuppression, CNS (fatigue, depression)

28
Q

All HBV NRTS

A

CrCl<50
decrease dose or fequency

lactic acidosis, hepatomeglay with steatosis
exacerbation of HBV

29
Q

interferon alfa

A

approved as monotherapy for HBV

30
Q

Viread

A

Tenofovir Disoproxil fumarate TDF
300mg daily
preferred therapy
renal tox, Fanconi syndrome, osteomalacia and decrease bone mineral density

keep in original container

  • HBV NRTS
31
Q

Vemlidy

A

Tenofovir alafenamide TAF
25mg w/food
CrCL< 15 is not recommended
preferred therapy
renal tox, Fanconi syndrome, osteomalacia and decrease bone mineral density

keep in original container
- HBV NRTS

32
Q

Baraclude

A

Entecavir
preferred therapy
take on empty stomach
- HBV NRTS

33
Q

Epivir HBV

A

Lamivudine
done not use in HIV pts, lower dose of lamivudine
- HBV NRTS

34
Q

Adefovir

A

Hepsera
renal tox, avoid use with nephrotoxic drugs like NSAIDS
- HBV NRTS

35
Q
  • HBV NRTS DI
A

tenofovir formulations avoid use with adefovir
bactrim can increase lamivudine levels

36
Q

ALT and AST range

A

10-40 units/L

37
Q

acute liver tox from drugs

A

increased ALT/AST

38
Q

chronic liver disease (cirrhosis)

A

Increased ALT/AST, ALK Phos, LDH, PT/INR
Decreased albumin

39
Q

alcoholic liver disease

A

increased AST>ALT (double), increased gamma-glutamyl transpeptidase (CGT

40
Q

hepatic encephalopathy

A

increased ammonia

41
Q

jaundice

A

increased Tbili

42
Q

Child-pugh classification system

A

scores from 0-15,
class a mild <7
class b moderate - 7-9
class c severe - 10-15

43
Q

food hepatotoxic

A

kava, comfrey, and flavocoxid

people use milk thistle extract to help tx Hep C… not real data, could contra with meds

44
Q

stop hepatotoxic drugs when

A

> 3 times upper limit of normal so >150 (AST or ALT)

45
Q

key drugs that damage liver

A

Acetaminophen
amiodarone
isoniazide
ketaconazole (oral)
methotrexate
Nafazodone
Nevirapine
NRTIs
propylthiouracil
valporic acid

46
Q

wernicke-korsakoff syndrome

A

thiamine is used to prevent, brain damage due to lack of vitamin B1

47
Q

Octreotide … use

A

selective for splanchnic vessels where other vasopressins are non-selective
for bleeding varices

48
Q

Octreotide

A

Sandostatin
IV
SE: bradycardia, cholelithiasis, biliary sludge

49
Q

non-selective BB for portal hypertension

A

Nadolol (corgard)
propranolol (inderal)

50
Q

Hepatic encephalopathy

A

accumulation of gut-derived nitrogenous substances in the blood

lactulose first line
rifaximin second line
zinc may be helpful

51
Q

Lactulose

A

enulose, constulose
SE: flatulence, diarrhea, dyspepsia, abdominal pain
monitor bowel moment and ammonia

  • Hepatic encephalopathy
52
Q

rifaximin

A

xifaxan

53
Q

ascities

A

fluid accumulation within the peritoneal space,

diuretic therapy,
spironolactone monotherapy or with combo of furosemide and spironolactone (ratio 40 to 100)

furosemide itself is not enough

54
Q

spontaneous bacterial peritonitis infection

A

ceftriaxone

NAPLEx (75 decks)

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