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Hepatitis and Liver Disease > Hepatitis & Liver Disease > Flashcards

Hepatitis & Liver Disease Flashcards

(59 cards)

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1
Q

Transmission of Hep A

A

Fecal - Oral

Self-limiting

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2
Q

Transmission of Hep B

A

Blood - Blood

Not curable

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3
Q

Transmission of Hep C

A

Blood - Blood

Curable

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4
Q

First line treatment for Hep B

A

PEG-INF (pegylated interferon)

or

NRTI (tenofovir or entecavir)

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5
Q

First line treatment for Hep C

A

Treatment naive: DAA (Direct acting antivirals) combo

DAA combo + RBV (Ribavirin)

or

DAA combo + RBV + PEG-INF

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6
Q

Ritonavir MOA

A

***Not active for HCV

But is used to Boost levels of HCV Protesase Inhibitors used with it

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7
Q

NS3/4A Protease Inhibitors name clue

A

-previr

P for Protease Inhibitor

Grazoprevir
Paritaprevir
Simeprevir
Voxilaprevir

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8
Q

NS5A replication complex inhibitor name clue

A

-asvir

A for NS5A

Daclatasvir
Ledipasvir
Ombitasvir
Pibrentasvir
Velpatasvir
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9
Q

NS5B Polymerase Inhibitor name clue

A

-buvir

B for NS5B

Dasabuvir
Sofosbuvir

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10
Q

DAAs + statins

A

Increase concentration of statin and risk of myopathy

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11
Q

Interferon Alpha is used to treat what

A

HBV

HCV

Some cancers

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12
Q

Interferon Beta is used to treat?

A

Multiple sclerosis

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13
Q

MOA of NRTIs in HBV

A

Inhibit HBV replication by inhibiting HBV polymerase resulting in DNA chain termination

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14
Q

NRTI stands for?

A

Nucleoside/tide reverse transcriptase inhibitors

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15
Q

Prior to starting HBV therapy what should be checked

A

Test for HIV b/c antivirals used for HBV can have activity against HIV and if a patient is co-infected with both HIV and HBV it is important that the chosen therapy is appropriate for both viruses to minimize risk of HIV antiviral resistance

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16
Q

List NRTIs for HBV (4)

A

Tenofovir

  • disoproxil fumarate
  • alafenamide

Entecavir

Adefovir

Lamivudine

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17
Q

CrCl dose adjustment for all HBV NRTIs

A

CrCl < 50 mL/min

decrease dose or frequency

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18
Q

BBW for all HBV NRTIs (3)

A

Lactic acidosis

Severe hepatomegaly with steatosis

Exacerbations of HBV on discontinuation

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19
Q

DDI: Ribavirin + NRTI

A

Lactic acidosis

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20
Q

DDI: Lamivudine + SMX/TMP

A

SMX/TMP increases Lamivudine levels

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21
Q

Define Cirrhosis

A

Advanced fibrosis (scarring) of the liver that usually irreversible

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22
Q

Normal range for AST and ALT

A

10 - 40 units/L

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23
Q

Specific lab abnormality for acute liver toxicity, including from drugs

A

Elevated AST and/or ALT

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24
Q

Specific lab abnormality for chronic liver disease

Study These Flashcards
A

Elevated:

AST/ALT
Alk phos
Tbili
LDH
PT/INR

Decreased:
Albumin

25
Specific lab abnormality for alcoholic liver disease
Elevated AST > Elevated ALT ***AST double ALT Elevated Gamma-glutamul transpeptidase (GGT)
26
Specific lab abnormality for Hepatic Encephalopathy
Elevated Ammonia
27
Child Pugh Scores class interpretation (A,B,C)
Class A (mild disease) Score < 7 Class B (mod disease) Score 7 - 9 Class C (severe disease) Score 10 - 15
28
Meld (model for end-stage liver disease); | What do higher numbers indicate
0-40 higher numbers indicate greater risk of death within 3 months
29
Key Drugs with boxed warning for liver damage
``` APAP Ketoconazole MTX NRTIs VPA ```
30
What 3 drugs are used for ETOH relapse
Naltreoxne Acamprosate Disulfiram
31
Purpose of Thiamine for alcoholics
To treat Wenicke-Korsakoff syndrome, a condition that cause brain damage due to lack of vitamin B1
32
Define Esophageal Varices and 1 cause
Enlarged veins in the lower part of the esophagus cause: portal HTN
33
Treatment for bleeding Varices (2)
Band ligation (band around the vessel) Sclerotherapy (injecting a solution into the vessel to make it collapse and close)
34
Drugs that can help vasoconstrictor the splanchnic (GI) circulation
Octreotide: selective for splanchnic vessels Vasopressin: non-selective
35
Which two ABX are options for prophylaxis in patients with a Variceal bleed for up to 7 days
Ceftriaxone Quinolone
36
Secondary prevention of Variceal bleeding
Non-selective beta-blocker: - Nadolol - Propranolol
37
MOA of BB in variceal bleeding prevention
- Decreases cardiac output via beta 1 | - Decreased splanchnic blood flow by vasoconstriction via beta 2
38
Major caution with using non-selective BB
- Asthma - Severe COPD - PAD - Raynaud's
39
S&S of Hepatic Encephalopathy
- Musty order of breath and/or urine - Changes in thinking/confusion/forgetfulness - Asterexis (hand tremor)
40
Cause of hepatic encephalopathy
Accumulation of gut-derived nitrogenous substances in the blood such as ammonia glutamate. These are normally cleared by the liver, but when the liver isn't working blood is shunted through collateral vessels that empty directly into the circulation instead.
41
What lifestyle modification needs addressed in Hepatic Encephalopathy?
Restrict daily Protein intake to 1 - 1.5 g/kg
42
First line and second line tx for acute and chronic Hepatic Encephalopathy
Lactulose Rifaximin
43
Lactulose MOA
Convert ammonia produced by bacteria to ammonium, which is polar and therefore cannot readily diffuse into the blood
44
What two ABX are used to inhibit the activity of urease-producing bacteria which decreases the ammonia
Neomycin Metornidazole
45
Define Ascites
Fluid accumulation within the peritoneal space
46
Ascites can lead to what 2 conditions
SBP: spontaneous bacterial peritonitis HRS: hepatorenal syndrome
47
Treatment for Ascites due to Portal HTN
- Diet restriction of Na to <2 g/day - Avoid Na-retaining medications (NSAIDS) - Diuretics to increase fluid loss
48
Which diuretic therapy is preferred for ascites
Spironolactone monotherapy Spironolactone + Furosemide - ratio of S:F 100 mg: 40 mg - to maintain potassium balance
49
Define SBP
Acute infection of the ascitic fluid
50
What two organisms are a concern in SBP
Streptococci Enteric gram ( - ) pathogens
51
What ABX to treat SBP
Ceftriaxone
52
Second line treatment of SBP
Cipro or SMX/TMP
53
Define HRS
Development of renal failure in patients with advanced cirrhosis. It is the result of renal vasoconstriction, mediated by activation of the RAAS and the SNS through a feedback mechanism known as Hepatorenal Reflex
54
Treatment of HRS (3)
- Albumin - Octreotide (Sandrostatin) - Midodrine
55
Harvoni generic
Sofosbuvir/Ledipasvir
56
Epclusa generic
Sofosbuvir/Velpatasvir
57
Mavyret generic
Glecaprevir/Pibretasvir
58
Viekira Pak, Viekira XR generic
Paritaprevir/Ritonavir/Ombitasvir + dasabuvir
59
DAA (Direct acting antivirals) combo recommendation
2 to 3 agents for different MOA

Hepatitis and Liver Disease (1 decks)

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