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NAPLEX review 2024 RXPrep Book > Renal & Liver Disease: Hepatitis & Liver Disease > Flashcards

Renal & Liver Disease: Hepatitis & Liver Disease Flashcards

1
Q

What is Hepatitis?

A

Inflammation of the liver

Can be caused by Hepatitis virus, alc, other drugs, and other viruses

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2
Q

Hep A info

A

usually, acute, self limiting illness

due to improper hand hygiene, transmission via fecal-oral route from eating dirty food or contact w/ person

generally mild symptoms

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3
Q

Hep B & Hep C info

A

can cause acute illness but can lead to chronic infection & cirrhosis of liver, liver cancer, liver failure and death

transmission through blood and body fluids

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4
Q

Who is Hep B vaccination recommended for?

A

all adults

Preg women should be screened for HBV/HCV w/ each pregnancy

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5
Q

Which Hep virus doesnt have a vaccine?

A

Hep C

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6
Q

Drug treatments for Hep C

A

direct acting antivirals (DAAs) for about 8-12 weeks

Ribavirin can be added

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7
Q

PIG (DAAs acronym)

A

Protease Inhibitors & Grub = Take with food

** Exception Zepatier and fosamprenavir**

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8
Q

For treatment-naive patients without cirrhosis, recommended regimens for HCV are….

A

Glecaprevir/pibrentasvir (Mavyret)
Sofosbuvir/velpatasvir (Epclusa)

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9
Q

Info for all DAAs

A

Boxed warning: can reactivate HBV, test everyone

Warning: sofosbuvir regimens, dont use w/ amiodarone d/t serious bradycardia

SE: Well-tolerated

Monitoring: LFTs, HCV-RNA

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10
Q

Which DAAs approved for all 6 HCV genotypes for treatment naive patients

A

Epclusa
Mavyret (approved for 8 wk course)

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11
Q

Glecaprevir/pibrentasvir (Mavyret) info

A

Dose: TID w/ food

CI: hepatic impairment (Child Pugh B/C), using strong CYP3A4 inducers, ethinyl estradiol products

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12
Q

List of DAAs

A

glecaprevir/pibrentasvir (Mavyret)
Sofosbuvir/velpatasvir (Epclusa)
Sofosbuvir/ledipasvir (Harvoni)
Sofosbuvir/velpatasvir/voxilaprevir (Vosevi)
Sofosbuvir (Sovaldi) - mono therapy not recommended
Elbasvir/ grazoprevir (Zepatier)

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13
Q

Which DAA need to be dispensed in original container?

A

Sovaldi
Epclusa
Harvoni
Vosevi

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14
Q

Which DAA should be avoided with acid suppressive therapy?

A

Epclusa
Harvoni
Vosevi

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15
Q

Special info about Elbasvir/grazoprevir (Zepatier)

A

CI: Child Pugh B/C, use w/ strong CYP3A4 inducer

Warnings: increase LFTs, sig drug interaction

** Screen for NS5A polymorphism or HCV 1a genotype **

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16
Q

Mavyret drug interactions

A

Avoid strong inducers of CYP3A4, ethinyl estradiol products, lovastatin, simvastatin

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17
Q

Epclusa, Harvoni, Vosevi drug interactions

A

Antacids, H2RAs, PPIs

Separate antacids by 4 hours
Take H2RAs same time or 12hrs separated
PPIs not recommended

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18
Q

Ribavirin info

A

Can be used in HCV combo therapy but not as mono therapy

Boxed Warning: Sig Teratogenic effects

CI: pregnancy, & those who may become pregant

SE: Hemolytic anemia

** Avoid pregnancy during & 6 months after therapy, have to use 2 types of birthcontrol during and 6 months after **

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19
Q

Drugs that can be used as mono therapy for HBV?

A

NRTIs (Nucleosides/tide reverse transcriptase inhibitors)

Patients should be tested for HIV prior to starting, if both HBV & HIV then therapy should be appropriate for both

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20
Q

All HBV NRTIs info

A

Dose: Dc dose or frequency if Crcl < 50 except Vemlidy

Box warning: lactic acidosis & severe hepatomegaly, exacerbation of HBV once D/c’d, can cause HIV resistance

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21
Q

Preferred NRTI therapy for HBV

A

TDF (Viread)
TAF (Vemlidy) - dont use Crcl < 25
Entecavir (Baraclude) - txm naive 0.5, Lamivudien resistant 1mg (take empty stomach)

22
Q

TDF & TAF info

A

Warnings: Renal toxicity, Fanconi syndrome, dec bones density

SE TDF: Renal impairment, dec bone density
SE TAF: Better tolerated, less renal/bone toxicity than TDF

Keep both in original containers

23
Q

Entecavir (Baraclude) info

A

SE: peripheral edema, incr LFT/SCr

** Food reduces AUC 15-20%, take empty stomach or 2 hrs before meal **

24
Q

Lamivudine (Epivir HBV) info

A

Dose: Daily for HBV, 150 BID or 300 QD if also HIV

Boxed warning: dont use for HIV**

SE: HA/N/V/D

25
Q

Adefovir (Hepsera)

A

Boxed warning: Caution pts w/ renal impairment, at risk of renal injury or using NSAIDs/nephrotoxic drugs

26
Q

Tenofovir formulations should not be used with….

A

adefovir

27
Q

What is approved as mono therapy for chronic HBV?

A

PEG-INF-alfa

use limited due to toxicities and lab abnormalities

28
Q

PEG-INF-alfa info

A

Dosing: SC weekly

Boxed warning: neuropsychiatric, autoimmune, ischemic/infectious disorders, teratogenic/anemia risk if used w/ ribavirin

CI: autoimmune hep, decomp liver disease, infants/neonates

SE: CNS effects, GI upset, Inc LFTs, myelosuppresion, flu-like symptoms (pretreat w/ Tylenol)

29
Q

What is cirrhosis?

A

advanced fibrosis, scarring, of the liver

usually irreversible and due to Hep C or alcohol

30
Q

Clinical presentation of liver cirrhosis?

A

Yellow skin and yellowed whites of the eyes, dark urine

31
Q

How is cirrhosis diagnosed?

A

Liver biopsy is definitive

Inc ALT/AST, dec albumin, inc Tbili, inc PT, inc INR can be signs

32
Q

Liver disease classifications

A

hepatocellular = inc AST/ALT
cholestatic = inc Alk Phos and Tbili
Mixed = inc AST/ALT/Alk Phos and Tbili

33
Q

How to asses severity of liver disease?

A

Child- Pugh classification

MELD for end-stage liver disease

34
Q

When are hepatotoxic drugs discontinued due to risk of drug-induced liver injury?

A

LFTs > 3 ULN

35
Q

Which pain med should be avoided in patients with cirrhosis?

A

NSAIDs

36
Q

Drugs with boxed warning for liver damage

A

Tylenol ( > 4mg/day)
Amiodarone
Isoniazid
Ketoconazole
Methotrexate
Nefazodone
Nevirapine
NRTIs
Propylthiouracil
Valproic Acid

37
Q

Treatment for Alcohol-associated liver disease?

A

Stop drinking
Benzo for all withdrawal
Naltrexone/Disulfram/acomprosate prevent relapse
Rehab and support groups

Thiamine = used to prevent Wernicke-Korsakoff Syndrome, caused by lack of Vitamin B1

38
Q

Portal hypertension can lead to….

A

esophageal varices, acute vatical bleeding can be fatal

39
Q

Txm for bleeding Esophageal varices

A

1st line: Band ligation or sclerotherapy

Vasoconstrictive meds:
Octreotide: selective for splanchnic vessels
Vasopressin: non-selective

pts should get 7 days abx (ceftriaxone or quinolone)

40
Q

Octreotide (Sandostatin) info

A

Dose: Bolus IV 25-100mcg, then continuous 25-50mcg for 2-4 days

SE: Bradycardia, cholelithiasis, biliary sludge

41
Q

Vasopressin (Vasostrict) info

A

Antidiuretic hormone analog

42
Q

Beta blockers that are used for primary and secondary prevention of variceal bleeding

A

Nadolol
propranolol

titrated to max dose w/ HR 55-60 BPM

Carvedilol also used for primary prevention

43
Q

Nadolol (Cogard) & Propranolol (Inderal) variceal prevention info

A

Boxed warning: Dont stop abruptly, taper dose if dec

Warnings: pts w/ diabetes, can mask hypoglycemia**, caution Asthma/COPD patients, caution Raynaud’s

SE: Bradycardia, fatigue, hypotension, dizziness, depression, impotence

Monitor: if HR dec below 55, BP

** Propranolol has high lipid solubility, crosses BBB and has more CNS effects**

44
Q

Carvedilol (Coreg) info

A

Same as other BB

CI: severe hepatic impairment

** Take w/ food to dec absorption and risk of orthostatic hypotension **

45
Q

Hepatic Encephalopathy symptoms

A

Musty odor of breath/urine
changes in thinking, confusion, forgetfulness
hand tremor
sluggish movements

46
Q

TXM of Hepatic encephalopathy

A

Reduce blood ammonia levels through diet, 1.2-1.5g/kg protein (animal < veg/dairy)

47
Q

Drug txm for Hepatic encephalopathy

A

1st line: Lactulose
2nd line: ABX - Rifaximin

48
Q

Lactulose Hepatic encephalopathy info

A

SE: Farting, Diarrhea, abd discomfort, dyspepsia

Monitor: Mental status, bowel movements, ammonia lvls

49
Q

ABX for Hepatic encephalopathy info

A

Rifaximin
Dose: txm (off label) approved prevention

Neomycin:
Boxed warning: Neuotoxicity
SE: GI upset

50
Q

All patients with cirrhosis and ascites should be considered for….

A

liver transplant

51
Q

Diuretic therapy for ascites

A

Spironolactone mono therapy
Combo furosemide/spironolactone (40mg furosemide/ 100mg spironolactone ratio)

52
Q

Spontaneous Bacterial Peritonitis

A

acute infection of ascitic fluid

Txm: ceftriaxone 5-7 days, can add albumin, if survive then give secondary prevention of cipro/bactrim

NAPLEX review 2024 RXPrep Book (67 decks)

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