Hepatitis/Liver Disease Flashcards by Kappa Epsilon Pi Chapter

How is Hep A contracted?

poor hand washing – food/water (fecal -oral)

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how is Hep B and C contracted?

transmission of infectious blood or other bodily fluids

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Hep A or B or C?

can cause acute illness AND lead to chronic infection as well (cirrhosis, liver cancer, failure)

B and C

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Hep A or B or C?

acute infection only

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Hep A or B or C?

has a vaccine available for it

A and B

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Hep A or B or C?

treatment consists of just supportive care

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Hep A or B or C?

treatment consists of PEG-INF or NRTI

Hep B

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Hep A or B or C?

treatment consists of DAA (direct acting antivirals)

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Preferred Hep C treatment:
(if tx naive and no cirrhosis)
consists of ___#___ of direct acticg antivirals with DIFFERENT mechanisms for usually ______ weeks

2 - 3;
12 weeks (8 weeks in some regimens)

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______ is used in some Hep C regimens but it is only used for a boost of HCV protease inhibitors

ritonavir

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T or F:

DAAs can actually lead to a cure of Hep C

true

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DAA (direct acting antiviral) drugs and MOA:

NS3/A4 Protease inhibitor: what is their name clue?

-Previr

P for protease

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DAA (direct acting antiviral) drugs and MOA:

NS5A replication complex inhibitor: what is their name clue?

-Asvir

A for NS5A

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DAA (direct acting antiviral) drugs and MOA:

NS5B replication complex inhibitor: what is their name clue?

-Buvir

B vor NS5B

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T or F: the following are an appropriate combination

dasabuvir and sofosbuvir

FALSE — they are from the same drug class and should not be used together

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T or F: the following are an appropriate combination

daclatasvir + sofosbuvir

TRUE — they are from different drug classes

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the HIV and Hep C protease inhibitors have what following counseling point in common?

take with food

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boxed warning for ALL DAA’s?

risk of reactivating HBV

test all patients for HBV prior to starting DAA

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warning for sofosbuvir containing regimens?

contaminant amiodarone has led to serious symptomatic bradycardia!!

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Generics for Harvoni?

sofosbuvir and ledipasvir

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Generics for Epclusa

sofosbuvir and velpatasivr

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for the combination paritaprevir/ritonavir/ombitasvir (+/- dasabuvir) product:
what are the two biggest warnings?

hepatic decompensation/hepatic failure with cirrhosis / increased LFTs (esp with ethinyl estradiol)
significant drug interactions (ritonavir portion!)

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All DAAs are contraindicated with _________

CYP 3A4 INDUCERS

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Harvoni, Epclusa, and Vosevi:

all must avoid _______ therapy and can decrease concentrations of ledipasvir and velpatasvir

Acid supression

separate from antacids for 4 hours,
for H2RAs: take at same time or separate by 12 hours
PPI use not recommended (may differ per various products)

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Dasabuvir is a substrate of _____

CYP2C8

Technivie and Viekira are substrates/inhibitors of ______

CYP3A4/PGP

With Technivie and Viekira products: ______ containing medications must be stopped

ethinyl estradiol

Ribavarin (RBV) is an antiviral used in HCV: as monotherapy or in combo

combo only!

What dosage form of ribavarin may e used for RSV

aerosolized ribavarin

Ribavarin: | avoid in _______ patients due to _____ effects and even at least _______ after end of therapy

pregnant; teratogenic effects (even avoid pregnancy in female partners to male patients under treatment) even for at least 6 months of stopping

what other drug (that is not a direct antiviral) can be used for treatment of HCV but is not used a lot because of hella toxicities and lab abnormalities

interferon alpha

Interferon Alpha: | boxed warnings: can cause or exacerbate what things?

neuropsychiatric, autoimmune, ischemic, or infectious disorders

Ribavarin and Interferon alpha can cause ______ anemia

hemolytic

``` Side effects of interferon alpha: ____ effects ____ upset increased _______ ______ syndrome ```

CNS effects (fatigue/depression) GI upset increased LFTs Flu like syndrome (pre treat with APAP and antihistamine)

T or F: | interferon alpha can be used as monotherapy for HBV

true

what antiviral drug class is used for HBV?

NRTIs (tenofovir disoproxil fumurate and alafenamide!!) (also lamivudine, entacavir are used)

Generic for Viread and vimlidy

Viread: tenofovir DF Vimlidy: tenofovir ala

Epivir HBV comes in tablet and oral solution --- are they interchangeable?

Cirrhosis = advanced fibrosis/scarring -- most common 2 causes in US are ?

alcohol | Hep C

Common objective criteria/lab values to look at for evaluating the cirrhosis?

- AST/ALT (liver enzymes) - Albumin - total bilirubin - prothrombin

If cirrhosis is present, the lab will be elevated or decreased? ALT and AST

elevated | higher = more acute/active

If cirrhosis is present, the lab will be elevated or decreased? albumin

decreased

If cirrhosis is present, the lab will be elevated or decreased? bilirubin

increased

If cirrhosis is present, the lab will be elevated or decreased? PT/prothrombin

increased

to rank the severity of liver disease _____ classification is used

child pugh

what natural product is thought to be good for liver detox (alcohol, Hep B or C)

milk thistle

Drug induced liver injury: | step 1) STOP THE DRUG -- done normally when LFTs are > _____ times the upper limit of normal

3 (aka 150)

what are the key drugs that can liver damage

``` APAP isoniazid ketoconazole methotrexate nevirapine NRTIs Propylthiouracil Tipranavir Valproic acid Nefazodone ```

what does steatosis mean

fatty liver

alcohol liver disease can include what 3 diff types of liver issues?

fatty liver alcoholic hepatitis chronic hepatitis

Treatment of alcoholic liver disease: 1st part of treatment is obvs alcohol cessation 2nd: treatment programs may use _____ for acute withdrawl (inpatient) or ______ is used for outpatient

benzodiazepines; anticonvulsants

Treatment of alcoholic liver disease: | what drugs are used to prevent relapses

naltrexone acamprosate disulfiram

Treatment of alcoholic liver disease: | _______ is used to prevent and treat ________ syndrome

thiamine (vit B1); | wernicke-korsakoff

what are the main complications with liver disease/ cirrhosis?

-portal HTN/variceal bleeding -hepatic encphalopathy -ascites -spontaneous bacterial peritonitis (and hepatorenal syndrome)

the variceal bleeding typically occurs where?

esophagus

Variceal bleeding can be fatal: | 1st line therapy includes: _______ or _______

band ligation (put a band around the vessel) or sclerotherapy (inject something to make the vessel close)

what medications can be injected to vasoconstrict the GI circulation (to fix variceal bleed)

- ocreotide (selective option) | - vasopressin (non-selective option)

__________ should be added after resolution of variceal bleeding for SECONDARY prevention

non selective beta blockers | ex: nadolol or propranolol

vasopression is a _______ _____ analog

antidiuretic hormone analog

``` Hepatic Encephalopathy (HE): sxs include what? ```

- changes in thinking/confusion/forgetfulness - musty odor of breath - asterixis (hand tremor)

``` Hepatic Encephalopathy (HE): Symptoms of this occur by accumulation of ___________ in the blood (like ______) ```

gut derived nitrogenous substances (ammonia)

what drugs are used to decrease ammonia levels for Hepatic Encephalopathy (HE)?

lactulose and antibiotics (rifaximin or neomycin)

Hepatic Encephalopathy (HE): 1st line tx is _______; works by converting ammonia to ______ 2nd line is _______

1st: lactulose 2nd: Rifaximin

Ascites is fluid accumulation in the ________

peritoneal space

For patients with ascites: | dietary ________ intake should be restricted

sodium

Treating Ascites: _______ monotherapy is ok ________ + _______ is ok _________ monotherapy is ineffective

spironolactone alone is ok spironolactone + furosemide is ok furosemide alone is NOT ok

Treating Ascites: | Need a ratio of ____ mg furosemide to ____ mg spironolactone to maintain potassium balance

40 mg furos | 100 mg spiro

A patient with ______ and ______ should be considered for liver transplantation

cirrhosis; ascites

Spontaneous bacterial peritonitis (SBP): | acute infection of ascitic fluid ---- treat with _____

ceftriaxone | may add on albumin and patient will get a prophylactic abx after

Hepatitis/Liver Disease Flashcards

(69 cards)