Hepatitis/Liver Disease Flashcards
(81 cards)
1
Q
Hep A is chronic or acute?
A
acute
2
Q
Transmission of HAV
A
fecal-oral
- improper handwashing
- contaminated food/water
3
Q
HAV symptoms are usually ____ and ____
A
mild and non-specific
4
Q
HBV and HCV are usually acute or chronic
A
BOTH!
acute illness that can lead to chronic infection, cirrhosis, cancer, liver failure, and death
5
Q
HBV/HCV transmission
A
infectious blood or body fluids
6
Q
Which hepatitis does NOT have a vaccine?
A
HCV
7
Q
HAV first line tx
A
supportive
8
Q
HBV first line tx
A
PEG-INF or NRTI (tenofovir or entecavir)
9
Q
HCV first line treatment naive
A
DAA (direct acting antivirals) combination
10
Q
How many HCV genotypes are there?
A
6
11
Q
What three things determine HCV therapy?
A
- genotype
- presence of cirrhosis
- treatment naive?
12
Q
What is a prefered HCV regimen?
A
2-3 DAAs with different mechanisms
13
Q
What is the prefered duration of HCV treatment?
A
8-12 weeks
14
Q
Ritonavir role in HCV treatment
A
dose not have action against HCV itself, but used to boost levels of HV protease inhibitors
15
Q
Interferon’s role in HCV
A
no recommended in combination therapy can be considered if DAAs are CI or too expensive
16
Q
Treatment options for treatment-naive patients without cirrhosis
A
glecaprevir/pibrentasvir
sofosbuvir/velpatasvir
17
Q
Three types of DAA mechanisms
A
- NS3/4A Protease inhibitor
- NS5A Replication Complex Inhibitor
- NS5B Polymerase Inhibitor
18
Q
list of Ns3/4A PIs
A
"-previr" P for PI glecaprevir grazoprevir paritaprevir voxilaprevir
19
Q
list of NS5A replication complex inhibitors
A
"-asvir" A for NS5A ledipasvir ombitasvir pibrentasvir velpatasvir
20
Q
list of NS5B Polymerase inhibitors
A
“-buvir” B for NS5B
dasabuvir
sofosbuvir
21
Q
Protease Inhibitors should be taken with or without food?
A
with food! PIG (PIs and Grub)
22
Q
What do patients need to be tested for before starting a DAA
A
HBV - risk of reactivating
23
Q
Sofosbuvir specific warnings
A
- do not take with amiodarone -> serious symptomatic bradycardia possilbe
- risk of hypoglycemia when used with insulin
24
Q
Side effects of DAAs
A
typically well tolerated
- HA, fatigue, diarrhea, nausea
25
What to monitor with DAAS
LFTs (bilirubin)
| HCV-RNA
26
Sovaldi
Sofosbuvir
400mg daily
*dispense in original packaging
27
Epclusa
Sofosbuvir/velpatasvir
1 tablet daily
*dispense in original packaging
avoid acid-suppressive therapy
28
Harvoni
sofosbuvir/ledipasvir
1 tablet daily
*dispense in original packaging
avoid acid-suppressive therapy
29
Vosevi
sofosbuvir/velpatasvir/voxilaprevir
*dispense in original packaging
avoid acid-suppressive therapy
30
Mavyret
glecaprevir/pibrentasvir
3 tablets daily
*Take with food (glecaprevir)
CI: mod-severe hepatic impairment or decompensation
31
Technivie
paritaprevir/ritonavir/ombitasvir
| *take with food (paritaprevir)
32
Viekira Pak
paritaprevir/ritonavir/ombitasvir+ dasabuvir
Tri - 2 tablets in the morning
dasabubvir - twice daily with meals
33
Zepatier
elbasvir/grazoprevir
34
Contraindication for Mavyret
mod-severe hepatic impairment or history of hepatic decompensation
35
Sofosbuvir monotherapy role
not effective/not recommended
36
Which drugs should be dispensed in original packaging?
Sovaldi, Epclusa, Harvoni, Vosevi
37
which drugs are approved for all 6 HCV genotypes (pan-genotypic)
Epclusa and Mavyret
38
Which drugs are approved for salvage therapy?
Vosevi and Mavyret
39
which drugs are approved for 8-week course of therapy?
Mavyret
40
which are approved for HCV/HIV co-infection
Epclusa, Harvoni, and Mavyret
41
which are approved for children 12 or older with certain genotypes
Sovaldi and Harvoni
42
Major warning with DAAs
LOTS OF DRUG INTERACTIONS
43
CI with strong ______ inducers
CYP3A4
| -carbamazepine, oxcarbazepine, phenobarb, phenytoin, rafampin, rifabutin, St. John's Wort
44
DAAs can increase the concentration of ______ leading to increased ________ risk
statins = increased MYOPATHY risk
45
Which drugs should Mavyret specifically not be used with
efavirenz
HIV PIs
ethinyl estradiol products
cyclosporine products
46
Which DAAs should not be used with PPIs
Epclusa
47
Ribavirin (RBV) MOA
inhibits replication of RNA and DNA viruses
48
RBV place in therapy
HCV in combo, never monotherapy
| aerosolized has been used in RSV
49
boxed warnings for RBV
- teratogenic effections
- not effective monotherapy
- hemolytic anima (can worsen cardiac disease)
50
CI with RBV
pregnancy
women of childbearing age without reliable contraceptive use
men with pregnant female partners
CrCl <50
didanosine concomitant use (hepatic failure)
51
what limits use of interferons
toxicities
| lab abnormalities
52
List of NRTIs used in HBV
```
TDF (Viread)
TAF (Vemlidy)
Entecavir (baraclude)
Adefovir
Lamivudine (Epivir HBV)
```
53
Which NRTIs should not be used with a HIV co-infection
lamivudine (Epivir), TAF, and TDF
| - lower dose for HBV could lead to resistance in HIV treatment)
54
Presentation of cirrhosis
jaundice, dark urine, pain in upper right quad of abdomen, loss of appetite
55
Which labs indicate acute liver toxicity due to drugs or otherwise
elevated AST ALT
56
which lab indicate chronic liver disease
increase ast/alt, alk phos, tbili, ldh, pt/inr
| decreased albumin
57
which lab indicates alcoholic liver disease
elevated ast about double the alt
| increased ggt
58
which lab indicateds hepatic encephalopathy
increased ammonia
59
normal range for ast/alt
10-40 u/L
60
increased alk phos and Tbili indicates cholestatic or hepatocellular liver disease?
cholestatic
| alt and ast = hepatocellular
61
increased alk phos, tbili, ast, and alt indicates what type of liver disease?
mixed!
62
primary treatment for drug-induced liver injury
Stop the drug!
63
When do we d/c a hepatotoxic drug?
when lfts are >3x upper limit of normal
64
Major hepatotoxic drugs
- APAP
- amiodarone
- isoniazid
- ketoconazole
- methotrexate
- nefazodone
- nevirapine
- NRTIs
- propylthiouracil
- tipranavir
- valproic acid
65
steatosis meaning
fatty liver
| reversible if offending agent stopped (alcohol)
66
Inpatient alcohol withdrawal treatment
bzds
67
Medications meant to prevent alcohol relapses
naltrexone
acamprosate
disulfiram
68
Why is thiamine used in alcoholics?
prevent/treat Wernicke-Korsakoff syndrome - encephalopathy
69
Recommended first line treatment for esophageal varices
band ligation
| sclerotherapy
70
Octreotide
selective vasoconstrictor for splanchnic vessels
| used in varices to stop/slow bleeding
71
Vasopressin
non-selective vasoconstrictor used in varices to stop/slow bleeding
72
Secondary prevention of variceal bleeding
Non-selective beta-blockers
| titrate to maximum tolerated dose
73
side effects of octreotide
bradycardia, cholelithiasis, biliary sludge
74
Which beta blockers are non-selective
nadolol
| propranolol
75
how to beta-blockers prevent variceal bleeding
reduce portal pressure by decreasing CO and decreasing splanchnic blood flow via vasoconstriction
76
What causes symptoms of hepatic encephalopathy
accumulation of ammonia
77
symptoms of hepatic encephalopathy
musty odor of breath, changes in thinking, confusion, forgetfulness, asterixis
78
drug therapy for hepatic encephalopathy
lactulose
| antibiotics like rafaximin
79
how does lactulose work
first line therapy for encephalopathy and prevetion
| converts ammonia produced by intestinal bacteria to ammonium which cannot diffuse into the blood due to not being polar.
80
How do antibiotics help hepatic encephalopathy
decrease ammonia production by inhibitions activity of urease producing bacteria
81
lactulose treatment dosing
30-45 mL every hour until bowel movement then 30-45 mL 3-4 times daily titrated to produce 2-3 soft bowel movements dialy
