Liver 2 Flashcards by Reagan Blatz

What will be elevated with asymptomatic hepatitis (infection without disease?

AST and ALT

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Presentation of acute hepatitis

Flu-like symptoms
Abdominal pain
Jaundice
Scleral icterus
Pale stools
Dark urine

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What is acute fluminant hepatitis?

Rare, but may be fatal

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What is chronic persistant hepatitis?

Delayed recovery with minimal liver damage but failure to develop antibody (carrier state)

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What is chronic active hepatitis?

Progressive liver damage, failure to develop antibody, may be asymptomatic

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What type of virus is hepatitis A?

RNA virus

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How is hepatitis A transmitted?

Fecal-oral
- can occur from travel to countries with poor hygiene conditions - contaminated food or water

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What are the vaccines for hepatitis A?

Havrix
Avaxim
Vaqta
Twinrix

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Symptoms of hepatitis A

Fever, jaundice, scleral icterus
Hepatomegaly on physical exam

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What is the time from exposure to clinical manifestations for hepatitis A?

30 days (range 15-50)

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How long do hep A symptoms usually last?

~3 months

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Is hepatitis A chronic?

No - cured once you recover

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Treatment for hepatitis A virus?

Supportive
- healthy diet, rest, hydration, avoiding hepatotoxic drugs and alcohol

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Post exposure prophylaxis for hep A virus?

Hep A vaccine given within 14 days of exposure might help
Ig given ASAP if vaccine unavailable (purified antibodies from someone who is immune)

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What are the serologic markers of HAV?

IgG (immunity from vaccine or exposure)
IgM (indicates acute infection)

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What kind of virus id hep B virus?

DNA virus

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How is HBV transmitted?

Perinatal, sexual, blood (IVDU)

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What are the vaccines for HBV?

Twinrix (for A and B)
- antibody response decreases with age

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How many doses is the HBV vaccine?

3 doses

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How many doses for the HAV vaccine?

2 doses, 6 months apart

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Symptoms of HBV

~70% are asymptomatic
Jaundice
Dark urine
White stool
Abdominal pain
Fatigue, fever, chills, loss of appetite
Pruritis possible

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Is HBV chronic?

Depends on groups
90% in neonatal infection
25-50% children aged 1-5
10% in adults

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What can HBV lead to?

Cirrhosis (20-25%)
Hepatic carcinoma (5%)

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What are the serological markers of HBV?

HBsAg (HBV surface antigen): + indicates acute or chronic infection
Anti-HBs (antibody to HBV surface antigen): marker of HBV immunity
HBV-DNA: marker of viral replication - acute infection - used to monitor treatment for chronic HBV infection

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When do we treat HBV?

Active HBV infection (increased HBV-DNA & ALT; liver inflammation)

What is the treatment for HBV?

Interferon - peginterferon alfa-2a OR Nucleoside analogues - iamivudine - tenofovir, entecavir - adefovir

Is elimination the goal of HBV treatment?

Yes but its not always possible so permanent suppression is also the goal

Advantages to interferons (IFN) for HBV

Shorter course of therapy Absence of resistance A chance at full seroconversion

Disadvantages to interferons for HBV

Contraindicated in decompensated cirrhosis Subcutaneous injection Many side effects! 30% successful in developing immunity

Advantages of nucleoside analogues for HBV

Safer Fewer side effects Oral admin High response >90% but does not provide immunity (seroconversion)

Disadvantages of nucleoside analogues in HBV

Chronic therapy - seroconversion can take years and some may require treatment indefinitely Drug resistance Adjust in renal dysfunction

What is lamivudines (heptovir) place in therapy for HBV?

Main use: prohylaxis for those on immunosuppression - not DOC due to high resistance rates *was the first oral agent approved

What is adefovirs place in therapy for HBV?

Used as an add on in lamivudine resistance

What is tenofovirs place in therapy for HBV?

*DOC!! TAF and TDF are available but TAF produces higher levels in cells and can be administered at lower doses - MOST POTENT and low chance of resistance

What is entecavirs place in therapy for HBV?

*DOC!! Low rates of resistance

What are examples of combo therapy for HBV?

Lamivudine + tenofovir Tenofovir + entecavir

What type of virus if hepatitis c Virus (HCV)?

Single-stranded RNA virus

How is HCV transmitted?

Perinatal, sexual(very low), blood(common)

What is the vaccine for HCV?

There isn’t one available

How longe can HCV live off the body?

9 weeks

Symptoms of HCV

~70% are asymptomatic Jaundice Dark urine White stool Abdominal pain Fatigue, fever, chills, loss of appetite Pruritis possible

What can HCV lead to?

Chronic disease, cirrhosis, hepatocellular cancer

How long after exposure will you see clinical presentation with HCV?

Could be as late as 20-30 years post exposure

What % of HIV patients in SK are coinfected with HCV?

~70%

What are the most common genotypes of HCV?

Genotypes 1-6 1a, 1b, 2 and 3 are most common in Canada

What are the serological markers of HCV?

Anti-HCV (antibody to HCV): indicates acute or chronic infection *test remains positive for life Do this test next: HCV RNA by PCR: indicates virus replication; appears at start of acute infection - + indicates active virus ; - indicates no active infection

What was the traditional treatment for chronic HCV?

SVR 12 - sustained virological response is the goal Interferon and ribavirin in combo

What is ribavirin?

Nucleoside analogue Broad spectrum anti-viral

Common side effects for IFN based therapy for HCV

Flu-like symptoms Decreased blood counts Weight loss Anorexia Alopecia

What drugs have all been used for HCV treatment but aren’t as important anymore?

Boceprivir or telaprevir Simeprevir Sofosbuvir - no longer needed IFN injection

What does “previr” mean at the end of drug name?

It’s a protease inhibitor and cant be used in decompensated cirrhosis

What is in harvoni?

Ledipasvir & sofosbuvir

What genotypes can harvoni be used for?

HCV g1,4,5,6

Side effects of harvoni?

Mild to moderate in severity Fatigue Headache Insomnia Nausea

What DI does harvoni have?

Decreased absorption if administered with acid-suppressing drugs; with PPI

What is in zepatier?

Grazoprevir + elbasavir

What genotypes can zepatier be used for?

G1,4

What are the drugs in epclusa?

Sofosbuvir + velpatasvir

Which genotypes can epclusa be used for?

Pan-genotypic (used across all genotypes), some exceptions with g3

What DI does epclusa have??

Watch with acid suppressing drugs

What are the drugs in maviret?

Glecaprevir + pibrentasvir

Which genotypes can maviret be used for?

All genotypes 1,2,3,4,5,6

What drugs are in vosevi?

Sofosbuvir + velpatasvir + voxilaprevir

Which genotypes can vosevi be used for?

All genotypes 1,2,3,4,5,6 *used in treatment failures

Which drug has a cure rate (SVR) of 99-100%?

Epclusa

Which hepatitis c drugs need to be taken with food?

Maviret and vosevi

What are the two most common hepatitis c drugs?

Epclusa and maviret

Which hepatitis c drugs can not be used in decompensated cirrhosis?

Zepatier Maviret Vosevi

Which hepatitis c drug may be used in severe kidney failure (even dialysis)?

Maviret

How long is treatment for hep c typically?

8-12 weeks

What are the common drug interactions for epclusa?

Acid reducing agents Anti-arrhythmics Anticonvulsants Rifampin Antiretroviral Statins St. John’s wort

What are the common drug interactions for maviret?

Digoxin Anticonvulsants Anticoagulants Rifampin Antiretroviral Statins Immunosuppressants Oral contraceptives St. John’s wort

Differences between epclusa and maviret

Equally effective Epclusa: OD, no food requirement, 12 week therapy Maviret: TID, with food, 8,12, or 16 week therapy

Who should be tested for hepatitis c?

People born between 1945-75 (5x baseline risk) CDC suggest everyone over 18 at least once and during each pregnancy

What are the screening tests for hepatitis c?

Hepatitis C antibody. If positive: - hepatitis c antigen. If positive: -> hepatitis c RNA PCR (HCV RNA) - shows replication

What are the ending for the current hep c drugs?

“..previr” “..buvir” “..asvir”

What kind of virus is hepatitis D?

RNA virus, occurs simultaneously with HBV

Is there a vaccine for hepatitis D?

The hep B vaccine

What kind of virus is hepatitis E?

RNA virus

How is hepatitis E transmitted?

Fecal-oral -> contaminated water

Is there a vaccine for hepatitis E?

No but its like hep a and most people recover

Liver 2 Flashcards

(81 cards)