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Therapy: year 3 > Viral Hep > Flashcards

Viral Hep Flashcards

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1
Q

Jaundice and increas serum ATL are part of whihc hep

A

acute

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2
Q

liver cirrhosis and complications of ESLD are part of whihc hep

A

chronic

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3
Q

whihc hep has no treament?

A

a

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4
Q

whihc hep can u be immunized for

A

hep a and b

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5
Q

whihc hep has transmission via percutanoues, sexual and perinatal

A

B and D

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6
Q

whihc hep has a dna virus

A

B

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7
Q

whihc hep has insidious onset verusus sudden

A

B, C, D

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8
Q

whihc hep has a chornic conponent/whihc has the largest chronic conpentent?

A

B, C, D

C (70-80%), B (9-10% inaudlts, 90% in children), D

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9
Q

antigen and antibody for HAV

A

Antigen: hep a virus
Antibody: hep A antibody ( Anti-HAV)

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10
Q

antigen and antibody for HBV

A

Antigen: HBsAb, HBcAg, HBeAg (surface core envelop)
Antibody: anti-HBs, anti-HBc (IgM- acute infection, IgG- chronic or recovery) , anti-HBe

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11
Q

whihc antigen is not measure for hep b

A

core

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12
Q

antigen and antibody for HCV

A

Antigen: HCV

Antibody: anti-HCV

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13
Q

following percutaneous needle injury what are you likely to get?

A

HIV, HCV, HBV

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14
Q

whihc hep can be cured?

A

C

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15
Q

Timeline of incubation, symptoms, infectivity and resoltion for hep A

A

Incubates: 28 days
Symptoms: children can be asymptomatic
infectivity: 2 weeks before symx
resolution: 2 months (up to 6 months)

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16
Q

how does perinatal transmission occur and how should we treat it? What can mom do to prevnt it

A

mother is HBsAg positive at time of delivery

TX: HBIg and hep b vax to child within 12 hours of delivery and revax at 1 and 6 months ( reduces transimmison from 90% to 10%)

prvention: in third trimester mother can take nucleotide to reduce viremia (TDF)

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17
Q

HBV post-exposure if HBsAg positive, known non-responder

A

IG and initiate vx series

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18
Q

HBV post-exposure if HBsAg positive, and antibody response unknown

A

test exposed person for anti-HHs, if inadequate response treat as non-responder

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19
Q

clinical progression of Hep b

A

acute - chronic - cirrhosis (liver failure - decompensated, or liver cancer) - liver transplant and death

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20
Q

HBsAg: negative
Anti-HBc: negative
Anti-HBs: negative

A

susceptible to virus

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21
Q

HBsAg: negative
Anti-HBc: Positive
Anti-HBs: positive

A

immune due to natural infection

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22
Q

HBsAg: negative
Anti-HBc: negative
Anti-HBs: positive

A

immune due to hep b vax

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23
Q

HBsAg: pos
Anti-HBc: pos
IgM anti-HBc: pos
Anti-HBs: negative

A

acutely infected

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24
Q

HBsAg: pos
Anti-HBc: pos
IgM anti-HBc: neg
Anti-HBs: negative

A

chronically infected

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25
can hep b be cured?
not cured but controlled
26
duration of hep infection?
over 6 months
27
non-param for hep B and c
- reudce weight if BMI >30 - control sugars in DM - reduce hepatoxins (alcohol, acetaminophen, herbal products) - avoid NSADIS - reduce risk of transmission cover scrapes and cuts and bleach staidn
28
hep b: if Alt is normal
no tx, unless signifianct disease suspected
29
hep B : if alt is elevated and HBV DNA is 10 000- 10 000 000
consider pegiterferon or nuclos(t)ide analogues (entecavir, TDF, TAF), goals suppress HBe seroconversion
30
hep B : if alt is fluctuates and HBV DNA is 10 000- 10 000 000
nuclos(t)ide analohgues (entecavir, TDF and TAF) lifelong
31
hep B : if alt is elevated and HBV DNA is >100
nucleos(t)ide analog plus HBIg
32
Interferon when best to use and for long long?
low effeicay when DNA is high and low AST, can be used when DNA is low however more serious effects only works for 24-48 weeks, consider therpay for 16-48 weeks
33
oral nucelosides inhibtiors used when, for how long, resistance and different types
- longterm suppressive therapy - consider d/c after 12 months Peginterferon : 180 mcg sq once weekly entecavir : 0.5 mg Po daily: treamnt naive OR 1mg PO once daily : lamivudine resistance TDF : 300 mg PO daily TAF : 25 mg PO daily
34
hep B if treament naive:
Tenofovir or entecavir ( high genetic barrier to resistance ) - lamivudone - reisitance easier but can use entecavir then
35
If hep B and HIV co-infection
TDF and 3TC (emtricitabine) - if we d/c this it can cause flare up and decompensation
36
s/E /CI of Peginterferon
CI: - major depressive order - autoimmune - cardiac - decompensated cirrhosis uncontrolled seizure disorder
37
S/E entecavir
take on empty stomach
38
TDF caution point
don't use in renal insufficiency
39
TAF caution point
can be used in patients with renal insufficiency until CrCl ,< 15 mL/min
40
hep b monitoring
HBV DNA - q 3-6 months until undetable ALT: q 3 mo nths serology - surface, and envelope for q 6months on tx and d/c12-18 after treament
41
hep C risk factors
sexual activity : MSM, STI
42
Hep C testing
check if anti-HCV first then HCV RNA
43
hep c clinical progression
acute - chronic - cirrhosis - HCC transplant and death
44
what's defined as a cure for hep C
undetecable viral load
45
hep c tretament options
DAAs for 8-12 weeks +/- ribavirin (added for treament expected or decomp liver)
46
hep c tx for treatment experienced or decompensated cirrhosis
+/- ribavirin (added for treament expected or decomp liver)
47
first line for hep c
alsways 2 DAAs
48
the two DAA regimens
epclusa - sofosubuvir and velpatasvir maviret - glecaprevir and pilbentasvir
49
epclusa duration/ special diet?
12 weeks - no speial diets
50
maviret duration/ special diet?
8 weeks - taken with food
51
who is eleigible for simplfied tretament
adults with chornic hep c , who do not have cirrhosis, and no previous hep c trtemant
52
epclusa - sofosbuvir/velpatatsvir drug class
NS5A inhib
53
epclusa - sofosbuvir/velpatatsvir AE
fatigue and headache
54
maviret - glecaprevir /pibrentasvir drug class
GLE: NS3/4a portetase inhibitor and pib:NS5A inhib
55
maviret - glecaprevir /pibrentasvir AE
Fatigue, headche, diaarrhea, nausea, prurirtus
56
DI with epclusa
Statins PPI H2RA Anatcids Amiodarone HIV - Efavirenz, TDF
57
DI with maviret
Statin Ethinyl estradiol PPI HIV - Efavirenze, draunavir/lopinavir/ritonavir, rilpivirine
58
HCV therpay caution points
HBV can be reactivated
59
when should protease inhibtors be avoided?
such as maviret - ajundice, hepatic decomp, ascites, esophageal varicela hemorahge, hepatic encephalophathy
60
moniotrng and lab values need to be checked before starting theroay
HCV RNA, LFT, SCr, CBC HCV ressitance testing HBV (HBsAg)
61
efficacy tetsing
HCV RNA 12 weeks after completemnt of therpay
62
If hep B coinfection what shoudl we do
give them hep b therpy fro 12 weeks

Therapy: year 3 (14 decks)

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