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957 Block 2 > 8. Viral Hepatitis > Flashcards

8. Viral Hepatitis Flashcards

1
Q

What is the route of transmission of Hepatitis A?

A

fecal-oral

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2
Q

What is the route of transmission of Hepatitis B?

A

percutaneous/permucosal

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3
Q

What is the route of transmission of Hepatitis C?

A

percutaneous/permucosal

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4
Q

Which hepatitis causes chronic infections?

A

B and C

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5
Q

Which hepatitis is there vaccinations for?

A

A and B

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6
Q

What are HAV risk factors?

A
  • personal contact
  • contaminated food or water
  • blood exposure (rare)
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7
Q

What are the clinical presentations of preicteric HAV?

A

flu-like symptoms, anorexia, NV, RU quadrant pain

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8
Q

What are the clinical presentations of icteric HAV?

A
  • increased LFTs, T. bilirubin
  • dark urine
  • light grey stools
  • worsening systemic symptoms
  • pruritus
  • jaundice
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9
Q

Fulminant liver failure is very common in HAV. (T/F)

A

False, fulminant failure is rare in HAV

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10
Q

HAV is almost always a self-limiting disease. (T/F)

A

True

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11
Q

Nearly all cases of HAV resolve in __ months.

A

6

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12
Q

HAV Ig_ is positive at onset.

A

M

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13
Q

HAV Ig_ is positive after 3-12 months.

A

G

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14
Q

What is the mainstay of treatment for HAV?

A

symptomatic relief and supportive care

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15
Q

How is HAV transmission prevented?

A
  • hand washing
  • improve water source handling
  • no raw foods in endemic areas
  • vaccines and immunoglobulins
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16
Q

Havrix and Vaqta are live vaccines. (T/F)

A

False, inactivated

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17
Q

How many doses are HAV vaccines divided into and how are they administered?

A

2

IM

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18
Q

The CDC recommends HAV vaccine for whom?

A
  • Children at age 1 (since 2006)
  • travelers to endemic areas
  • MSM
  • drug users
  • occupational risk
  • persons with clotting factor disorders
  • chronic liver disease
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19
Q

HAV immunoglobulin is __-__% effective if administered within __ days of exposure.

A

80-90%

14 days

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20
Q

CDC recommends HAV immunoglobulin for whom?

A
  • household contacts of infected persons
  • child care center staff and attendees in outbreak
  • institutional outbreaks
  • common source exposure (food prepped by infected handler)
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21
Q

What are HBV risk factors?

A
  • sexual activity
  • IV drug abuse
  • perinatal transfer from mother to child
  • healthcare workers
  • household contacts
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22
Q

What body fluids have high HBV concentrations?

A

blood
serum
wound exudates

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23
Q

What body fluids have moderate HBV concentrations?

A

semen
vaginal fluid
saliva

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24
Q

What body fluids have low/undetectable HBV concentrations?

A

urine
feces
sweat/tears
breast milk

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25
Q

HIV is 100x more infectious than HBV. (T/F)

A

False. HBV is 100x more infectious than HIV

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26
Q

What triggers the body’s immune response against HBV?

A

damage to hepatocytes

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27
Q

What immune cells kill infected hepatocytes?

A

cytolytic T-cells

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28
Q

What causes fulminant liver failure in HBV?

A

T-cell response (killing infected hepatocytes)

29
Q

HAV is the most common cause of fulminant liver failure. (T/F)

A

False. HBV is the most common cause of fulminant liver failure.

30
Q

> 95% of adults with acute HBV recover completely without sequelae. (T/F)

A

True

31
Q

At what age of infection is the risk of chronic HBV development greatest?

A

young age

32
Q

What are the physical findings in HBV?

A
  • fatigue/malaise
  • jaundice/scleral icterus
  • ascites
  • spider angioma
  • asterixis (liver flaps)
  • severe liver failure
33
Q

What are some symptoms of fulminant hepatitis (severe liver failure)?

A

encephalophathy

coagulopathy

34
Q

HBV immunoglobulin (HBIG) can be administered within __ hours to prevent infection.

A

48

35
Q

Who should receive the HBV vaccine?

A
  • all infants born in US after 1991
  • healthcare workers
  • End-stage kidney disease
  • immunocompromised
  • high risk behaviors (MSM, multiple sex partners, IV drug use)
36
Q

What patients should be considered for HBV treatment?

A
  • HBsAg + for > 6 months
  • persistant elevation in LFTs
  • evidence of viral replication (HBV DNA > 20k)
  • signs of chronic hepatitis from liver biopsy
37
Q

What is seroconversion?

A

The point at which HBV antibodies (HBeAg) become detectable.

38
Q

In a patient who is HBeAg+ what are the treatment options and durations?

A
  • PEG IFN-alpha: 48 weeks

- Nucleoside(tide) analogs: 12 months + at least 6 months after seroconversion

39
Q

In a patient who is HBeAg- what are the treatment options and durations?

A
  • PEG IFN-alpha: 12 months

- Nucleoside(tide) analogs: > 12 months (often indefinite)

40
Q

What is PEG IFN-alpha?

A

Pegylated INF-alpha (Pegasys)

41
Q

What are the generic names of nucleoside(tide) analogs (antivirals) for HBV?

A
  • Adefovir
  • Entecavir
  • Lamivudine
  • Telbivudine
  • Tenofovir
42
Q

What agent(s) are first line in HBV treatment?

A

entecavir and tenofovir

43
Q

Which agents have (somewhat) linked resistance?

A

entecavir and lamivudine

44
Q

What are ADRs of tenofovir?

A

renal insufficiency (Fanconi syndrome)

45
Q

Tenofovir is cross resistant with entecavir. (T/F)

A

False. tenofovir is cross resistant with adefovir

46
Q

What are ADRs with Lamivudine?

A

headache, NV, pancreatitis, peripheral neuropathy

47
Q

What antivirals are good to use in combination in cases of resistance?

A

adefovir and lamivudine

48
Q

How does interferon treat HBV?

A

induce host antiviral gene expression to
inhibit virus replication, protein synthesis, and
assembly along with enhancing immune
response

49
Q

IFNs are ideal in patients with decompensated cirrhosis. (T/F)

A

False, not indicated for patients with decompensated cirrhosis

50
Q

What are HCV risk factors?

A
  • IV drug use
  • hemodialysis
  • accidental injuries (needles)
  • sexual or household exposure
  • multiple sex partners
  • perinatal from mother to child
  • tattoos (especially nonprofessional)
51
Q

What is the most common HCV genotype in the US?

A

1

52
Q

What are 3 treatment options for G1 HCV (cirrhotic and non-cirrhotic)?

A
  • Sofosbuvir/ ledipasvir (Harvoni)
  • Sofosbuvir/ velpatasvir (Epclusa)
  • Elbasvir/ grasoprevir (Zepatier)
53
Q

Which agent should be used with caution when used with gastric acid-reducing agents?

A

sofosbuvir containing agents

54
Q

What are 3 treatment options for G1 HCV (cirrhotic ONLY)?

A
  • Ombitasvir + paritarevir + ritonavir + dasabuvir
    (Viekira Pak)
  • Daclatasvir (Daklinza) + Sofosbuvir (Sovaldi)
  • Simeprevir (Olysio) + Sofosbuvir (Sovaldi)
55
Q

What are the treatment options for G2 HCV?

A

Sofosbuvir/ Velpatasvir

Declatasvir + Sofosbuvir

56
Q

What are the treatment options for G3 HCV?

A

Sofosbuvir/ Velpatasvir

Declatasvir + Sofosbuvir (12 weeks non-cirrhotic, 24 weeks +/- ribavirin if cirrhotic)

57
Q

What is the dosing recommendation for severe renal dysfunction or ESRD for Sofosbuvir?

A

None, should not be used in ESRD or severe renal dysfunction ( CrCl < 30 mL/min)

58
Q

Which HCV agents are negatively affected by acid-reducing agents?

A

Ledipasvir

Velpatasvir

59
Q

What is the “recipe” of Zepatier?

A

Elbasvir + grazoprevir

NS5A inhibitor + NS3/4A protease inhibitor

60
Q

RAV testing for GT_ is required for ______ (drug).

A

GT1a

Zepatier

61
Q

What is the MOA of Simeprevir?

A

NS3/4A protease inhibitor

62
Q

What is decompensated cirrhosis?

A

When the body is no longer compensating for significant liver damage and decreased liver function.

63
Q

You may use monotherapy in HBV treatment. (T/F)

A

True

64
Q

You may use monotherapy in HCV treatment. (T/F)

A

False - never use monotherapy

65
Q

Hepatitis A is transmitted by

a. blood transmission
b. sexual transmission
c. fecal-oral transmission
d. airbourne transmission

A

c. fecal-oral transmission

66
Q

True or false: Hepatitis B is 100x more infectious than HIV.

A

True

67
Q

Which of the following typically puts a patient at greater risk of chronic HBV infection and HCC?

a. being a current smoker
b. being infected in another country outside the US
c. being overweight
d. younger age at the time of infection

A

d. younger age at the time of infection

68
Q

Which of the following patient populations is considered the highest priority for HCV treatment?

a. persons on long-term hemodialysis
b. pregnant women
c. people with advanced fibrosis or cirrhosis
d. debilitating fatigue

A

c. people with advanced fibrosis or cirrhosis

69
Q

Which of the following is a medication used to treat HCV based on current guidelines?

a. Entecavir
b. Ledipasvir/sofosbuvir
c. Interferon
d. Lamivudine

A

b. Ledipasvir/sofosbuvir

957 Block 2 (14 decks)

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