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Clinical Pharmacy > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

How is hepatitis A and E transmitted?

A
  • transmitted by the fecal oral route
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2
Q

How is hepatitis B, C and delta spread?

A
  • parenteral transmission
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3
Q

___ hepatitis must have a co-infection with hepatitis B

A

delta

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4
Q

How is hep A transmitted?

A
  • fecal oral route
  • person to person
  • ingestion of contaminated food or water
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5
Q

What are the most common risk factors associated with hepatitis A?

A
  • international travellers
  • household or sexual contact with someone that has hep A
  • men who have sex with men
  • users of illegal drugs
  • patients with chronic liver disease
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6
Q

Incubation of hepatitis A is approx. how many days?

A
  • 28 days (ranges from 15-50)
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7
Q

Patients begin to shed the virus _______ after exposure

A

1-2 weeks

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8
Q

What is the progression of acute hepatitis?

A
  • starts with prodromal period: nonspecific flu-like symptoms (some may be mild) such as anorexia, fatigue, malaise
  • acute illness with abrupt onset of: anorexia, N/V, malaise, fever, headache, right upper quadrant abdominal pain
  • icteric hepatitis: dark urine, light coloured stools, worsening of systemic sx, pruritus
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9
Q

What is the progression in the levels of liver enzymes with a hepatitis A infection?

A
  • liver enzymes increase within the beginning few weeks of the infection, and peak around the 4th week – normalize by the 8th week
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10
Q

What are the symptoms likely experienced by children under 6 years old with HAV?

A

likely asymptomatic

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11
Q

What are the symptoms likely experiences by older children and adults?

A
  • most present with symptoms lasting under 2 months, 70% of adults experience jaundice
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12
Q

What are the symptoms likely experienced in adults that have an HAV infection?

A
  • peak viral shedding precedes GI symptoms in older adults
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13
Q

Is HAV a chronic infection?

A
  • no, it does not

- some patients can experience symptoms for up to 9 months

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14
Q

What are the potential complications of a HAV infection?

A
  • relapsing hepatitis
  • cholestatic hepatitis
  • fulminant hepatitis
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15
Q

The majority of patients have clinical resolution by _____, nearly all by _____

A

2 months

6 months

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16
Q

What is the treatment of an HAV infection?

A
  • there are none!
  • we do have prevention and prophylaxis available to us
  • we give a booster to ensure that we have prolonged immunity to hep A
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17
Q

What is the dosing of a hep A vaccine?

A
  • give an intramuscular infection with schedule of- 1 dose of HAV vaccine (primary immunization) with a booster dose 6-36 months later (timeframe is product dependent)
  • recommended for individuals over 6 months old for those at risk of the infection
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18
Q

What are the AE of HAV?

A
  • generally well tolerated
  • if a reaction does happen it is usually mild and transient soreness or redness at the injection site
  • less common: headache, irritability, malaise, fatigue, GI sx
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19
Q

When should the injection of Hep A not be given?

A
  • it should be postponed in the case of moderate to severe acute illness (minor illness with or without fever may receive the vaccine however)
20
Q

When is the human immune globulin recommended to be used instead of the hep A vaccine?

A
  • used as the post exposure immunoprophylactic option
  • recommended for infants under the age of 6 months, patients with contraindications to hep A vaccine or when hep A vaccine is not available
  • should be given in addition to the hep A vaccine in patients theatre immunocompromised or with chronic liver disease
  • may also be given in addition to hep A vaccine in susceptible adults, those over 60 years old and are household/close contacts of an individual with hep A
21
Q

What should be done for a patients that has come to you after being exposure if they come to you after 14 days?

A
  • efficacy is unknown if the immunization is given over 14 days after exposure, but efficacy is unknown if over 14 days since exposure (no recommendation after that time)
22
Q

What are the non-pharms that can be suggested for travellers to prevent HAV?

A
  1. safe food and water
    - waiting and drinking: boil it, cook it or peel it or leave it
    - eat foods that are hot and well cooked
    - avoid raw or undercooked meats and fish, including shellfish
    - drink water only if it has been boiled or disinfected
    - swimming an bathing- avoid swallowing water while bathing, showering or swimming
  2. frequent handwashing
    - soap and warm water for at least 20 seconds
    - alcohol based hand sanitizer if soap and water is not available
23
Q

How does transmission of hep B occur?

A
  • sexually
  • parenterally
  • perinatally
24
Q

Hep B virus remains stable in the environment for up to _____

A

7 days

25
Q

What are the risk factors of a hep B infection?

A
  • infants exposed during child birth
  • sexual contact
  • injection drug use
  • household contact of HBV positive patient
  • procedures with percutaneous exposure
  • one third of those with HBV have no identifiable risk factors
26
Q

What is the incubation period for HBV?

A
  • 60 to 90 days
27
Q

What percentage of infections are asymptomatic?

A
  • 50% of adults and 90% of children are asymptomatic
28
Q

When symptoms do happen in a hep B infection, what are they typically?

A
    • anorexia, abdominal pain, N/V, jaundice
29
Q

How long does the initial infection of HBV usually last?

A
  • may last up to 3 months
30
Q

Most people will have spontaneous clearing of HBV after _____

A

4-8 weeks

– there is some risk of becoming a chronic carrier however (higher in infants and those that are immunocompromized)

31
Q

Chronic carriers of hep B have an increased risk of developing what?

A
  • cirrhosis and hepatocellular carcinoma
32
Q

What is the dosing schedule for the vaccine of hep B?

A
  • an IM injection beginning with one dose of HbV vaccine (month 0), repeated at month 1 and month 6
33
Q

Has to be AT LEAST ____ months between the first dose and the last dose of hep B

A

4 months

34
Q

What are some of the AE that can be experienced after a HBV?

A
  • mild and transient reactions most common: irritability, headache, fatigue, pain and redness at the injection site
35
Q

What is the effect of giving hep B post-exposure?

A
  • provides 90% protection

- hep B immunoglobulin may help with increased protection by providing short term passive immunity

36
Q

Hep B post exposure prophylaxis should be offered to who?

A
  • infant or mother with acute or chronic hepatitis infection
  • percutaneous or mucosal exposure to: blood or bodily fluids that may contain hep B virus
  • sexual or household contacts of an individual with acute hepatitis B or is a chronic carrier
37
Q

Is alcohol safe to consume with hep B?

A
  • no, no alcohol is safe to consume with hep B
38
Q

What are some of the non-pharm suggestions to make to patients surrounding HBV prevention?

A
  • all chronic HBV patients should be educated to prevent rural transmission
  • sexual and household contacts require vaccination
  • chronic HBV patients need to prevent further liver damage, therefore must avoid alcohol and get immunized agains HAV
  • remind to consult with health care provider before using any new medications (rx and OTC) and natural health products
39
Q

What is the dosing for Twinrix?

A
  • dosing: intramusclar injection usually at month 0, 1 and 6 (rapid schedule is an option as well)
  • available as twinrix and twinrix junior
40
Q

What is the transmission of HCV?

A
  • bloodborne (exposure to contaminated needles/syringes, blood or blood products, procedures with blood exposure, being shaved if there is contaminated equipment)
  • sexual contact
  • perinatal transmission from mother to child
41
Q

What are the risk factors for HCV infection?

A
  • injection drug use
  • blood transfusion(historical, increased screening as of 1992 has decreased this risk)
  • healthcare associated transmission rates
  • high risk populations (prisoners, homeless)
42
Q

What is the clinical presentation of HCV?

A
  • 80% are asymptomatic
  • if symptoms: anorexia, abdominal pain, fatigue, nausea, dark urine, jaundice
  • up to 85% of those with an acute infection develop chronic HCV infection
  • 10-20% of chronically infected will develop severe liver disease
  • HCV is the major cause of cirrhosis and hepatocellular cancer, leading cause of needing a liver transplant in the US
  • — progression to end stage liver disease is slow, generally develops over 20 years after infection
43
Q

What is the treatment of HCV?

A
  • there are now oral regimens with durations of 6-12 weeks to 24-48 weeks
  • few AE
  • high cure rate (>90%)
  • genotype of hepatitis C virus will determine with therapy is most effective
44
Q

Is there any way to precent hep C?

A
  • no

- there is also no post exposure prophylaxis with it

45
Q

What are some of the non-pharm suggestions with treating hepatitis C?

A
  • chronic HCV patient- need to vaccinate against hepatitis A or B
  • lifestyle things:
  • – avoid alcohol
  • – eat a well balanced diet and routinely exercise
  • – avoid smoking
46
Q

What is things that can be done for prevention of HCV ?

A
  • avoid being blood, oral or semen donors
  • minimize blood or mucous exposure (avoid sharp razors, toothbrushes and cover open wounds)
  • if using illegal drugs, avoid sharing paraphernalia
  • – there is no vaccine available
  • – there is also no immunoglobulin option

Clinical Pharmacy (24 decks)

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