Block 4 - Viral hepatitis Flashcards by Markus M

Hepatitis A-E

Feces is a source for which one?

A + E

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Hepatitis A-E

Blood, bodily fluids are a source for which one?

B, C, and D

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Hepatitis A-E

Which one presents with a chronic infection?

B, C, and D

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Hepatitis A-E

Which one is preventable via immunization?

A, B and D

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Hepatitis A-E

Which one is prevented by safe drinking water?

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Hepatitis A-E

Which one is prevented by behavior modification or through blood donor screening?

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What kind of virus is Hep. A?

RNA virus of Picornaviridae family

Self-limiting, usually acute

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How do you treat Hep A?

You dont

Provide supportive care, most fully recover within 6 months

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IM injection + Hep A

HAVRIX and VAQTA are almost the same

Age 1-18 dose = 0.5ml
Age ≥19 dose = 1ml

Schedule month 0 and 6-12 (18 for VAQTA)

TWINRIX, which covers Hep A and B, it has 3 doses at month 0,1,6

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What kind of virus is Hep B?

DNA virus, partially double stranded

Highly virulent, 50-100x more infectious than HIV

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What are the Hep B vaccines?

Engerix, Recombivax, and Heplisav-B

TWINRIX for Hep A + B

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Engerix
Recombivax
Heplisav-B

Which one is for all ages?

Engerix

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Engerix
Recombivax
Heplisav-B

Which one has 3 doses?

Engerix + Recombivax (months 0, 1, 6)

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Engerix
Recombivax
Heplisav-B

Which one is approved for ages ≥1 yo?

Recombivax

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Engerix
Recombivax
Heplisav-B

Which one is approved for ages ≥18yo?

Heplisav-B

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Engerix
Recombivax
Heplisav-B

Which one has 2 doses?

Heplisav-B (months 0, 1)

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Anyone which active HBV is defined as…

HBV DNA >2000

ALT≥2x ULN or evidence of advanced fibrosis

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What is the first line Tx for chronic HBV?

Pegylated IFN
Entecavir
Tenofovir DF
Tenofovir Ala..

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Pegylated IFN
Entecavir
Tenofovir DF
Tenofovir Ala..

Which one is contraindicated if CrCl <15?

Tenofovir Ala.

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Pegylated IFN
Entecavir
Tenofovir DF
Tenofovir Ala..

Which one inhibits HBV replication using 3 steps?

Entecavir

Primes polymerase, reverse transcriptase, and then DNA synthesis

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Pegylated IFN
Entecavir
Tenofovir DF
Tenofovir Ala..

Which one has AE of nephropathy?

Tenofovir DF

Pegylated IFN
Entecavir
Tenofovir DF
Tenofovir Ala..

Which one has AE of lactic acidosis?

Entecavir

Pegylated IFN
Entecavir
Tenofovir DF
Tenofovir Ala..

Which one is given SQ?

Pegylated IFN

Pegylated IFN
Entecavir
Tenofovir DF
Tenofovir Ala..

Which one must monitor CBC, TSH, and any psychiatric disorders?

Pegylated IFN

Pegylated IFN Entecavir Tenofovir DF Tenofovir Ala.. Which one has a dose increase if lamivudine experienced or has decompensated cirrhosis?

Entecavir (from 0.5 to 1 tablet)

Pegylated IFN Entecavir Tenofovir DF Tenofovir Ala.. Which one has to be taken with food?

Tenofovir Ala.

Pegylated IFN Entecavir Tenofovir DF Tenofovir Ala.. Which one is treated in a finite amount of time?

Pegylated IFN (48 wks)

HBV with HCV co-infection, what should you know?

Screen for HCV Reactivation of HBV can occur while on HCV tx

HBV with HDV co-infection, what should you know?

Must have HBV infection Pegylated interferon is DOC

HBV with HIV co-infection, what should you know?

Tx should include one of the tenofovirs + another drug

Pegylated IFN Entecavir Tenofovir DF Tenofovir Ala.. Which one is approved for children ≥1yo?

Pegylated IFN

Pegylated IFN Entecavir Tenofovir DF Tenofovir Ala.. Which one is approved for children ≥2 yo?

Entecavir

Pegylated IFN Entecavir Tenofovir DF Tenofovir Ala.. Which one is approved for children ≥12 yo

Tenofovir DF

If HBV DNA in mother is >_______then ____ is recommended to be used in the ____ trimester

If HBV DNA is > 200,000 IU/mL, then TDF is recommended in the 3rd trimester

When should infants receive hep B immunoglobulin when they are born?

Within 12 hrs

Pegylated IFN Entecavir Tenofovir DF Tenofovir Ala.. Which one is safe to use while pregnant?

Tenofovir DF Pegylated IFN is used BEFORE pregnancy

What type of virus is Hep C?

Single stranded RNA virus

What are the Tx options for Hep. C?

NS3/4A "previrs" NS5B "buvirs" NS5A "asvir" Always choose ≥2 agents from different classes

Which Rx cover all genotypes of Hep. C?

S/V G/P S/V/V

Which Hep C regimen should avoid w/ rosuvastatin?

S/L Amiodarone too

All Hep C regimens should avoid with what?

anticonvulsants, rifamycins, St. Johns Wort

Which Hep C regimen should avoid w/ cyclosporine?

G/E

Which Hep. C regimen requests RAS testing?

G/E Also elevates AST/ALT

Which Hep C regimen should avoid PPIs, amiodarone?

S/V

Which Hep C regimen requires 3 tablets every day with food?

G/P S/V/V requires just food tho

Which Hep C regimen should be avoided with >100mg cyclosporine, ethinyl estradiol, atorvastatin, lovastatin, and simvastatin

G/P

HCV 1a, Tx regimen and duration?

S/V 12wks G/P 8wks G/E 12wks S/L 8 or 12wks (8 if no HIV and <6mil units)

HCV 1b, Tx regimen and duration?

Same as 1a

HCV 2 or 3, Tx regimen and duration?

S/V 12 wks G/P 8 wks

HCV 4, Tx regimen and duration?

Same as 1a

Post treatment of HCV, when should you check the viral load?

In 12 weeks