Viral hepatitis and Drug Induced Liver disease Flashcards by Edward Brauer

What is inflammation of liver caused by immune respnse called

Acute Viral Hepatitis

How well did you know this?

Not at all

Perfectly

What are some symptoms of Acute Viral Hepatitis?

Fatigue, mild fever, nausea, vomiting, diarrhea, anorexia, abdominal pain, dark urine, jaundince

How well did you know this?

Not at all

Perfectly

What is Fulminant hepatitis?

Encephalopathy, coagulapathy, cerebral edema and mutliple organ failure (end line of sudden liver inflammation)

How well did you know this?

Not at all

Perfectly

Inflammation of the liver and persistently abnormal liver enzymes for at least ____ months is known as ________.

6 months; chronic viral hepatitis

How well did you know this?

Not at all

Perfectly

If you have chronic viral hepatitis what are you at risk for involving the liver?

Cirrhosis of the liver and liver cancer

How well did you know this?

Not at all

Perfectly

What are some complications of cirrhosis?

portal hypertension, ascites, encephalopathy, variceal bleed, spontaneious bacterial peritonitis, Liver cancer

How well did you know this?

Not at all

Perfectly

What is the target organ of injury of hepatitis A virus?

Liver

How well did you know this?

Not at all

Perfectly

Who has the highest rates of infection of Hep A and why?

Children, fecal oral route

How well did you know this?

Not at all

Perfectly

Is hep A self-limiting or fulminant?

self limiting, only 2% become

How well did you know this?

Not at all

Perfectly

Can hep A cause chronic infection?

How well did you know this?

Not at all

Perfectly

What are some risk factors of hep A?

international travel, sexual/household contaction/ homosexual activity, food or waterborne outbreaks, injection drug use

How well did you know this?

Not at all

Perfectly

Does acute hepatitis A have descrete onset of symptoms or does it take a long time?

Discrete

How well did you know this?

Not at all

Perfectly

Is there a vaccine for Hep A?

Yes

How well did you know this?

Not at all

Perfectly

What is the post exposure tx for Hep A?

Immune Globulin

How well did you know this?

Not at all

Perfectly

How soon after infection must immune globulin be given for Hep A? What is the dose and route?

14 days; IM into deltoid or gluteal muscle and its 0.02ml/kg

How well did you know this?

Not at all

Perfectly

What is the pre-exposure dose for short and long term?

Short-term: 1-2 months - 0.02ml/kg

long-term: 3-5 months - 0.06ml/kg

How well did you know this?

Not at all

Perfectly

What type of virus is Hep B?

Double strand DNA

How well did you know this?

Not at all

Perfectly

What are some risk factors for hep B

IVDA, multiple sex partners, inamtes, pregnancy, MSM, high HBV rates, receiving dialysis

How well did you know this?

Not at all

Perfectly

What is the tx of hep B for an acute infection?

Supportive therapy

How well did you know this?

Not at all

Perfectly

What is the tx for HBV infection for chronic infection?

I LATTE Interferon, Lamivudine, Adefovir, Telbivudine, Tenofovir, Entacavir

How well did you know this?

Not at all

Perfectly

What is the end line tx for HBV?

Liver Transplant

How well did you know this?

Not at all

Perfectly

What drug tx for HBV is SQ?

IFN

How well did you know this?

Not at all

Perfectly

What two drugs are well tolerated side effects?

Lamivudine and Entecavir

How well did you know this?

Not at all

Perfectly

What are some benefits of IFN?

no resistance, urable response

How well did you know this?

Not at all

Perfectly

What are some negatives of IFN?

many side effects, CI in decompensated liver disease

What is the side effect profile for Lamivudine?

Low

What are some benefits and negatives of Lamivudine?

low cost, well tolerated; | negatives: High resistance

What is a side effect of Adefovir

potential renal toxicity

What is the benefit of Adefovir?

effective when lamivudine resistnace

What are some negatives of Adefovir?

Renal toxicity, slower supporesion

What is the cost like on Adefovir?

Intermediate

What are some side effects of Telbivudine?

Myopathy

What are some benefits of Telbivudine?

More effective than Lamivudine

What are some negatives of Telbivudine?

limited long term, not effective for Lam resistance

What are some side effects of Tenofovir?

dec bone mineral dnsity, renal toxicity

What are some benefits of Tenofovir?

more effective than Adefovir, effective for Lam resistance

What are some negatives of Tenofovir

Decreased bone mineral density and renal toxicity

What are some side effects of Entecavir?

well-tolerated

What are some benefits of Entecavir?

Dec resistance, dec side effects, effective when Lamivudine resistnace

What are some negatives?

limited long term data, high cost

What are the two with renal toxicity?

Adefovir and Tenofovir

What is one side effect of Telbivudine?

Myopathy

What is used for Hep B prevention?

Vaccines: Recombivax HB, Engerix-B, Twinrix (Combination of HAV and HBV)

What populations are indicated for Hep B vaccines

all newborns and adolescents, Healthcare workers, Hemodyalsis pts, increased risk due to sexual practices, post-exposure prophylaxis

What is Hepatitis B Immune Globulin (HBIG) indicated for? What are some brand names?

HepaGamB HyperHEP B S/D Nabi-HB Indicated for passive immunity post exposure prophylaxis and prevention of viral recurrence after liver transplantation

When a pt has muscle pain and renal problems and has tried Lamivudine what anti-viral would you try?

Entecavir

What does all the vaccines have at the end of their name? What about the immune globulin how do you tell those?

X, Its HHN (first letters of all them)

What type of information is in the HCV?

RNA

What is the leading cause of cirrhosis HCC and liver transplantiation?

HCV

What are the three biggest reasons for HCV?

IV Drug Use, Sexual, Tranfusion

What must you do before you tx HCV?

genotype the virus

What is the gold standard of tx for Genotype 1?

pegylated IFN + ribavirin + protease inhibitor

What is the gold standard of tx for Genotype 2,3,4?

peglyated IFN + ribavirin

What are the different types of pegylated interferons?

alfa-2a (pegasys) | alfa-2b (peg-Intron)

What are the two protease inhibitors used for HCV genotype 1 infections?

Telaprevir, boceprevir

What is the end stage of HCV infection?

Liver transplantation

What are some predictors of response?

HCV genotype, baseline viral load, race

What is the dosage and frequency for Pegylated IFNs for HCV infection?

Dosed once weekly: 2a (pegasys) - 180mcg | 2b (peg-intron) - weight based

How long to you tx?

based on genotype

What are some adverse effects of Pegylated IFNs?

Fever, chills, HA, myalgia, fatigue, rash, alopcia, retinopath, bone marrow suppression, N/D/V, depression, thyroid disorder

Is Ribavirin effective as monotherapy?

What is the preg category of Ribabirin?

How many forms of contraception should you use when using Rivavirin?

2 non-estrogen forms

What are some side effects of Ribavirin?

hemolytic anemia (reduce dose), nasal stuffiness, sinusitis, cough, pruritis and rash and fatigue

What is the dose of ribavirin?

depends on genotype and pt weight, reduce dose if hemolytic anemia presents

What type of HCV is protease inhibitors for?

Genotype 1

Is it effective as monotherpay?

no, must be used with Peg-interferon + Ribavirin

What CYP does protease inhibitors act on?

CYP3A4

Regimen and duration of tx based on prior _______. Can you select for resistance in viral infections?

Tx status; yes

What are the two protease inhibitors?

Telaprevir and boceprevir

Can Telaprevir or Boceprevir be used in tx naive, prior relapsers, prior partial or null responders?

Yes

What are the differences in side effects of the two protease inhibitors?

Telaprevir: Rash, pruritis, anemia: BBW of Serious Skin reactions Boceprevir: anemia, neutropenia, thrombocytopenia

What is the difference in dose of the Protease inhibitors?

Telaprevir: 750mg PO TID Boceprevir: 300mg PO TID

What is the duration of Tx for genotype 1 HCV?

Peg-interon + Ribavirin + PI = depends onf prior tx Peg-INF + Ribavirin = 12 months Peg-INF = 12 months

What is the duration of Tx for genotype 2,3,

Peg-INF + Ribavirin = 6 months | Peg-INF = 12 months

Stop after ____ months of no virologic response

6 months

Early virologic response at ___ and ___ wks predictive of therapy success

4wks and 12 wks

Contraindications to HCV tx?

Pregnancy and 6 months after cessation of therapy, decompensated cirrhosis, uncontrolled depression, active alcohol use or drug abuse, severe leukopeia or thrombocytopenia, uncontrolled thyroid disease, autoimmune disease

What pts does HDV occur in?

HBV pts

Can HBV-HDV be more severe than HBV alone?

Yes

How does you contract HDV?

IVDA or sexual contact

How do you get HEV?

enterically transmitted hepatitis

Is there tx or prevention for HEV?

What is the transmission route of HEV?

fecal oral route

How do you manage DILD?

Stop the offending agent

What is the most common cause of acute liver failure?

DILD

WHere is AST found?

Liver and Heart

Where is ALT found?

Liver

Where is AP found?

liver and bone

Where is GGT found

liver and several other organs

What are some acute hepatitis indications or labs?

Jaundice Serum bilirubin >2x ULN Serum ALT > 3x ULN (upper limit of normal)

Who is at risk for DILD?

older pts; chronic ingestions of alcohol and acetaminophen and other liver toxic drugs; female gender, familial predispostition

What is the difference between idiosyncratic and intrinsic depatotoxic drug reactions?

Unpredictable vs predictable

Does Acetaminophen have intrinsic hepatotoxicity?

yes (big large single toxic dose)

Which drug has an onset of symptoms as soon as hours to days?

ACetaminophen

How do you diagnose DILD?

rule out other causes of liver injury, examine medication time line

Can you rechallenge someone if they had liver disease?

Yes if u are uncertain about etiology or the medication is essential to well-being of pt

What type of liver damage will be okay to rechallenge a pt in and which will be bad?

Cholestatic is okay but hepatocellular is bad

What is the tx of DILD?

supportive care, remove agent, antidote/protectant, corticosteroids, Ursodiol and referrel for liver transplantation

What is the antidote for APAP overdose?

N-acetylcysteine

What is the toxic dose of APAP in adults and children?

10-15g or 150mg/kg in children leads to hepatic necrosis

How does APAP liver toxicity occur?

APAP metabolized to N-acetyl-p-benzoquinoneimine and gets conjugated with glutathione which causes depletion of glutathion and leads to hepatic necrosis

What pts populations will a lower dose of APAP cause liver damage?

the young and elderly

What effect does 1g QID for 2wks have on your ALT levels?

39% of pts had ALT >3x ULN

Can APAP for long term use cause liver damage and reduce GSH and compromise antioxidant defense capacity?

Yes!!

Who limit APAP to 325mg/tab

FDA

What is the max APAP /day?

4g/day

What is the manufactures max?

3g/day

Is a BBW required on APAP products?

Yes: acetaminophen may cuase severe hepatotoxicity, potentially requiring liver transplant or resulting in death

What is the clinical presentation of APAP hepatotoxicity?

N/V/lethargy, elecated LFTs after 24hrs, jaundice at 72 hours

If ___________ is administers within __ hours after APAP overdose, hepatotoxicity is uncommon.

acetylcysteine; 8 --> be careful of anaphylaxis from acetylcysteine

Can you give it IV or oral?

Yes and Yes

Viral hepatitis and Drug Induced Liver disease Flashcards

(112 cards)