Liver disease

Question 1

which hepatitis dont have vaccine

Answer 1

HEP C

Question 2

which HEP is only acute

Answer 2

HEP A

Question 3

which HEP is fecal oral

Answer 3

HEP A

Question 4

which HEP is body fluid and blood

Answer 4

HEP B and C

Question 5

hep C treatment

Answer 5

2-3 direct acting antivirals with diff MOA for 8-12 weeks

Question 6

what are the protease inhibitors for HEP C

Answer 6

-Previr

Question 7

what are the replication complex inhibitors for HCV

Answer 7

-asvir
A for NS5A

Question 8

what are the polymerase inhibitors

Answer 8

-buvir
B for NS5B

Question 9

for DAA what is tested before starting

Answer 9

HBV

Question 10

Epclusa

Answer 10

Sofusbuvir-Velpatasivir
not a protease inhibitor - with or without food

• all 6 genotype, HCV HIV co infection

Question 11

mavyret

Answer 11

Glecaprevir/ pibrentasvir

*PI= with food
* all 6 genotypes, HIVHCV co infection, approved for 8 week therapy and also salvage therapy as well

Question 12

what are some interactions of DAAs

Answer 12

Acid suppresion
CYP3A4 inhibitors

Question 13

can ribavirin be used as monotherapy

Answer 13

NO

Question 14

IFNA can be used to treat with HEP

Answer 14

B and C
PEG INF lasts longer (3 times weekly)

Question 15

what is a mono-therapy approved for HEP B

Answer 15

INF A
Nucleoside reverse transferase inhibitors (NRTIs)

** test for HIV first so that therapy is chosen to cover both

Question 16

what are some NRTIs

Answer 16

preferred NRTI therapy includes:
TDF (Viread)
TAF (Vemlidy)
Entecavir (baraclude)
Lamivudine (EPIVIR) do not use in HIV results in HIV resistance)

**CRCL>50
** ribavirin can increase hepatic AE

Question 17

what is the most common cause of cirrhosis

Answer 17

alcohol and HEP C
increase in BILI rubin, PT INR, ALT and AST

Question 18

what are child class pugh levels

Answer 18

determines severity of Cirrhosis
Class A mild <7
class B 7-9 and
class C 10-15 severe

Question 19

what natural products can cause liver damage

Answer 19

Milk thistle is good
KAVA is bad

Question 20

DILI- drug induced liver injury

Answer 20

these drugs are stopped if AST >3 times
- tylenol
- amiodarone
- isoniazid
- ketoconazole
- MTX
- NNRTIs
- NRTIs
- Propylthiouracil
- valporic acid

Question 21

acute variceal bleed

Answer 21

increase in portal hypertension can be fatal
- blood products, mechanical ventilation, endoscopy
- medications include octreotide (sandostatin), vasoconstrictor selective
- vasopressin is non selective
- non selective BB- nadalol, propranolol, titrated to the max and used indefenitely

Question 22

what are some symptoms of hepatic encephalopathy

Answer 22

breath smell +urine
- confusion, fatigue, drowsiness
- accumulation of nitrogen in the blood

Question 23

what are the treatment options for hepatic encephalopathy

Answer 23

reducing ammonia levels- lactulose , 1st line
reduce protein intake
ABX- rifaximin- xifaxan q8 5-10 days , 2nd line
zinc supplement s

Question 24

ascities treatment

Answer 24

sodium restriction <2 grams
avoid sodium retention like bicarbs, NSAIDS
use diuretics unless na is <120- spironolactone mono or furosemide + spironolactone in a 4:10 ratio to balance potassium
paracentesis >5L requires addition of albumin 6-8g added per L removed after 5L