Pharm - hepatitis and jaundice

Question 1

What list of meds can cause drug induced liver injury

Answer 1

acetaminophen
anesthetics
NSAIDs
antimicrobials
antifungals
HIV antiretroviral therapy
oral hypoglycemics
lipid lowering agents

Question 2

What is R value

Answer 2

ALT/ULN ALT
DIVIDED BY
ALP/ULN ALP

Question 3

What is hepatocellular R

Answer 3

R >= 5
more severe prognosis

Question 4

What is mixed R

Answer 4

R = 2-5
More prone to chronic disease

Question 5

What is cholestatic R

Answer 5

R <= 2
more prone to chronic disease

Question 6

What predicts prognosis with acetaminophen OD

Answer 6

Rumack-Matthew nomogram
Kings College criteria

Question 7

What is the initial management for acetaminophen OD

Answer 7

gastric emptying via lavage
activated charcoal within 4 hours ingestion

Question 8

What is the specific antidote for acetaminophen OD

Answer 8

Mucomyst (N-acetyl-cysteine)

Question 9

What antimicrobials can cause drug induced hepatitis

Answer 9

beta lactams
beta lactamase inhibitors

Question 10

What oral hypoglycemic is assoc with cholestatic injury pattern

Answer 10

Glimepiride

Question 11

What lipid lowering agents may cause drug induced hepatitis

Answer 11

statins
ezetimibe

Question 12

What differentiates acute viral hepatitis from chronic viral hepatitis?

Answer 12

greater or less than 6 months
A is only acute

Question 13

Describe hep A

Answer 13

acute, self-limited
person to person via fecal oral route or ingestion of contaminated food or water
assoc with poor sanitation

Question 14

Hep A clinical presentation

Answer 14

incubation period 28 days
symptoms may or may not be present

Question 15

What labs indicated hep A

Answer 15

elevated aminotransferases
detection of IgM antibody to HAV

Question 16

How to manage hep A

Answer 16

no treatment
supportive
avoid hepatotoxic substances

Question 17

How to prevent hep A

Answer 17

hand washing
Havrix and Vaqta vaccines
combo vax Twinrix (HAV and HBV)
Immunoglobulin dose

Question 18

When to give Havrix

Answer 18

0, then 6-12 months

Question 19

When to give VAQTA

Answer 19

0, then 6-18 months

Question 20

Who is recommended to get Hep A vax

Answer 20

all children older than 1
Increased infection risk
-MSM
-injection & non-injection drugs
-occupational risks

Question 21

Postexposure prophylaxis for HAV

Answer 21

if vaxxed, nothing
no vax - vaccine or immunoglobulin as soon as possible within 2 weeks

Question 22

When is immunoglobulin preferred for HAV postexposure prophylaxis rather than vax?

Answer 22

<12 months
Immunocompromised
Chronic liver disease

Question 23

What is the same between Hep B and Hep C

Answer 23

transmitted by blood
targets liver
acute or chronic

Question 24

What is different between Hep B and Hep C

Answer 24

DNA vs RNA virus
vaccine with 3 injections vs no vax
treat with NRTIs vs NSSA inhibitor, protease inhibitor, polymerase inhibitor

Question 25

What does HBsAg (surface antigen) tell you?

Answer 25

live active virus/active Hep infection

Question 26

What does HBeAG identify?

Answer 26

active replication of HBV

Question 27

What does Anti-HBc (core antigen) indicate?

Answer 27

active virus present or was present but cleared by the immune system

Question 28

What does IgM anti-HBs tell you?

Answer 28

acute phase of infection

Question 29

What does IgG anti-HBs tell you?

Answer 29

immunity from clearing infection or from immunization

Question 30

What will be positive if patient is immune to hep B due to infection and NOT the immunization?

Answer 30

anti-HBc

Question 31

What is the only positive lab if patient is immune to HBV due to immunization?

Answer 31

Anti-HBs

Question 32

What classification is used for hepatitis B?

Answer 32

child turcotte pugh classification

Question 33

What is the common co-infection with HBV?

Answer 33

HIV or HCV

Question 34

What class and specific med is hep B treatment

Answer 34

Nucleoside analog class NRTI - nucleoside reverse transcriptase inhibitors

Question 35

What are some treatment considerations for hep B treatment?

Answer 35

1. After clearance treat another 6 months 2. Renal dose (dose reductions) 3. If treatment is stopped prematurely or abruptly severe acute worsening of liver function may occur

Question 36

What is interferon based therapy for Hep B

Answer 36

Peg-IFN-2a (pegasys) subQ

Question 37

What are adverse effects of Pegasys

Answer 37

fatigue autoimmune disorders

Question 38

What patients are ineligible for Pegasys therapy

Answer 38

Baseline neutrophil count <1500 Platelet count <90,000 Hgb < 10

Question 39

What are nucleos(t)ide analogs for hep B treatment?

Answer 39

Adefovir Entecavir Lamivudine Tenofovir (also for HIV)

Question 40

When should Adefovir not be used and why

Answer 40

HIV concomitant infection because if HIV untreated can cause resistance

Question 41

What is recommended for hep B prevention testing

Answer 41

HBsAG testing immunization offered to all individuals testing seronegative

Question 42

Who is recommended to get Hep B vax

Answer 42

multiple sexual partners MSM IVDU HIV + patients End stage renal disease Workers at high risk of occupational exposure

Question 43

What are the single antigen formations of HBV vax

Answer 43

Recombivax HB Engerix-B

Question 44

What is a combination HBV vax

Answer 44

Twinrix (HBsAg and HAV)

Question 45

What vaccines for HBV for children?

Answer 45

comvax pediarix

Question 46

When is serologic testing for immunity recommended?

Answer 46

advised in situations of known status indicating clinical management -health care workers -HIV infections -immunosuppressed patients

Question 47

What determines the efficacy of postexposure prophylaxis?

Answer 47

how quickly the vaccine is administered -within 7 days for needle stick -within 14 days for sexual exposure

Question 48

What should be done for perinatal exposure

Answer 48

if born to a HBsAg + mother give HBV vaccine and HBIG within 12-24 hours after birth

Question 49

What should be given if exposed to source with HBsAg positive

Answer 49

completed vaccine series - give booster dose

Question 50

What should be given to unvaccinated individuals when exposed?

Answer 50

HBIG and begin vaccine series within 24 hours postexposure

Question 51

What are the risk exposures for Hep C that indicate screening/testing

Answer 51

hemodialysis - long term Needle stick (health care workers) Newborn of HCV + mother M/M unprotected sex

Question 52

What is the goal of Anti-HCV therapy

Answer 52

Virologic cure continuous absence of detectable HCV RNA at least 12 weeks after completion of therapy

Question 53

What are the clinical benefits of hep C treatment

Answer 53

reduced complication development improved quality of life reduce all-cause mortality

Question 54

What factor improves outcomes of Hep C treatment

Answer 54

early initiation

Question 55

What is common co infection with hep C

Answer 55

HIV or HBV

Question 56

What are the protease inhibitors used to treat Hep C

Answer 56

Grazoprevir Paritaprevir Ritonavir Voxilaprevir Glecaprevir

Question 57

MOA with protease inhibitors

Answer 57

inhibit cleavage of HCV-encoded polyprotein

Question 58

What are NS5B RNA polymerase inhibitors used to treat Hep C and MOA

Answer 58

Dasabuvir Sofosbuvir Inhibits NS5B RNA-dependent RNA polymerase activity

Question 59

What are the NS5A inhibitors used to treat Hep C and MOA

Answer 59

Daclatasvir Elbasvir Ledipasvir Ombitasvir Veltpatasvir Pibrentasvir Binds to the N-terminus on domain 1 of the HCV

Question 60

What to note about sofosbuvir+Velpatasvir (Epsula)

Answer 60

covers all genotypes (1-6)

Question 61

What to note about Glecaprevir + Pibrentasvir (Mavyret)

Answer 61

Covers all genotypes (1-6) Protease + NS5A inhibitor

Question 62

What to note about Anti-HCV therapy concerns

Answer 62

Treating HCV can lead to reactivation of HBV Important to obtain adequate history and screening!

Question 63

What is an Anti-HCV therapy

Answer 63

PEG-IFN-2 (Pegasys) + ribavirin

Question 64

Is there a vaccine for Hep C prevention

Answer 64

No