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NAPLEX > Chapter 19: Hepatitis and Liver Disease > Flashcards

Chapter 19: Hepatitis and Liver Disease Flashcards

1
Q

Hepatitis A

A
  • Acute
  • Fecal-Oral transmission
  • Yes vaccine
  • 1st line tx is supportive care
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2
Q

Hepatitis B

A
  • Acute and Chronic
  • Blood and body fluid transmission
  • Yes vaccine
  • 1st line tx PEG-INF or NRTI (tenofovir or entacavir)
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3
Q

Hepatitis C

A

-Acute and Chronic
-Blood and body fluid transmission
-No vaccine
-1st line tx for tx naïve: DAA combination
Other tx: DAA combo + RBV or
DAA combo + RBV + PEG-INF

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4
Q

DAA mechanisms: NS3/4A Protease Inhibitors

A

-previr
P for PI

Glecaprevir
Grazoprevir
Paritaprevir
Voxilaprevir

*PIG
protease inhibitors and grub (take with food)

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5
Q

DAA Mechanisms: NS5A Replication Complex Inhibitors

A

-asvir
A for NS5A

Elbasvir
Ledipasvir
Ombitasvir
Pibrentasvir
Velpatasvir
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6
Q

DAA Mechanism: NS5B Polymerase Inhibitors

A

-buvir
B for NS5B

Dasabuvir
Sofosbuvir

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7
Q

All DAAs boxed warning, warnings, side-effects

A

Boxed: Risk of reactivation of HBV; test all patients prior to starting DAA
Warning: for sofosbuvir containing regimes do not use amiodarone serious symptomatic bradycardia
SE: well-tolerated

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8
Q

Epclusa

A

sofosbuvir/velpatasvir

sofosbuvir monotherapy not recommended
administer in original container
avoid or minimize acid-suppressive therapy

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9
Q

Mavyret

A

Glecaprevir/pibrentasvir

Take with food

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10
Q

Tx for pan-genotypic (all 6 genotypes) for tx naïve pts

A
  • Epclusa

- Mavyret

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11
Q

Tx for salvage therapy

A
  • Mavyret

- Vosevi (sofosbuvir/velpatasvir/voxilaprevir)

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12
Q

Tx for 8 week therapy (select patients)

A

-Mavyret

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13
Q

Tx for HCV/HIV co-infection

A
  • Epclusa
  • Harvoni (sofosbuvir/ledipasvir)
  • Mavyret
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14
Q

Tx for children with certain genotypes

A
  • Solvadi (sofosbuvir) and Harvoni (age >=3 years)
  • Epclusa (age >=6 years)
  • Mavyret (age >=12 years)
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15
Q

Viekira Pak Dose and CI

A

Paritaprevir/ritonavir/ombitasvir qam
and
Dasabuvir bid with meals

CI: use with cyp3A4 substrates or inducers and use with ethinyl estradiol products

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16
Q

Viekir Pak Warnings

A

Hepatic decompensation/failure in patients with cirrhosis, increased LFTs, significant drug interaction potential

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17
Q

Zepatier CI, Warnings

A

Elbasvir/grazoprevir

CI: Strong inducers of cyp3A4
Warnings: increased LFTs, significant drug interaction potential

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18
Q

All DAA CI

A

Strong inducers of CYP3A4: carbamazepine, oxcarbezapine, phenobarbitol, phenytoin, rifampin, rifabutin, and St. John’s Wort

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19
Q

Harvoni, Epclusa, and Vosevi DI

A

Antacids, H2RAs, and PPIs can decrease concentrations of ledipasvir and velpatasvir

PPIs are not recommended with Epclusa

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20
Q

Viekira Pak DI

A

Strong inducers of CYP3A4 (carbamazepine, oxcarbezapine, phenobarbitol, phenytoin, rifampin, rifabutin, and St. John’s Wort)
ethinyl estradiol containing products, lovastatin, simvastatin

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21
Q

Ribavirin MOA

A

Oral antiviral that inhibits replications of RNA and DNA viruses
Never used as monotherapy

22
Q

Ribavirin CI, Boxed Warnings

A

CI: Pregnancy

Boxed Warning: significant teratogenic effects, not effective as monotherapy for HCV, hemolytic anemia

23
Q

Ribavirin SE, Notes

A

SE: Hemolytic anemia

Notes: avoid pregnancy in female patients (including in female partners of male patients) during therapy, and 6 months after completion; use at least 2 reliable forms of contraception during and for 6 months after

24
Q

Interferon Alfa MOA

A

Interferons are naturally produced cytokines that have antiviral, antiproliferative, and immunodmodulatory effects.
Approved for tx of HBV and HCV
PEG-ING-alfa has polyethylene glycol which prolongs half-life

25
Q

INF-alfa Boxed warnings

A

Can cause or worsen neuropsychiatric, autoimmune, ischemic or infectious disorders
If used with ribavirin, teratogenic/anemia risk

26
Q

INF-alfa Side Effects

A

-CNS effects (fatigue, depression)
-GI upset
-Increased LFTs (5-10x the ULN during tx)
-myelosuppression
Flu like syndrome (fever, chills, headache, malaise) pre-treat with apap and antihistamine

27
Q

Nucleoside/Tide Reverse Transcriptase Inhibitors

A

NRTIs

Inhibit HBV replication by inhibiting HBV polymerase resulting in DNA chain termination

28
Q

All HBV NRTIs Dosing, Boxed Warnings

A

Dosing: CrCl <50 decrease dose or frequency

Boxed Warnings: Lactic acidosis and severe hepatomegaly with steatosis which can be fatal. Exacerbations of HBV

29
Q

Viread

A

Tenofovir disoproxil fumarate (TDF)
Preferred therapy
SE: renal impairment, decrease bone density
Warnings Fanconi syndrome
(NOF; nephrotoxicity, osteoporosis, Fanconi syndrome)

30
Q

Vemlidy

A

Tenofovir alafenamide (TAF)
Preferred therapy
SE: nausea

31
Q

Entecavir

A

Baraclude
Preferred therapy
Take on an empty stomach

32
Q

Epivir HBV

A

Lamivudine
Do not use Epivir HBV for tx of HIV
SE: headache, n/v/d

33
Q

Lab Test for Liver Disease: Acute Liver Toxicity

A

Increased AST/ALT

34
Q

Lab Test for Liver Disease: Chronic Liver Disease

A

Increased AST/ALT, Alk Phos, Tbili, LDH, PT/INR

Decreased Albumin

35
Q

Lab Test for Liver Disease: Alcoholic Liver Disease

A

Increased AST > increased ALT (AST will be about double ALT), increased GGT

36
Q

Lab Test for Liver Disease: encephalopathy

A

Increased ammonia

37
Q

Lab Test for Liver Disease: Jaundice

A

Increased Tbili

38
Q

Child-Pugh Score

A 
Class A (mild disease) >7
Class B (moderate disease) 7-9
Class C (severe disease) 10-15
39
Q

MELD Score

A

The higher the numbers indicate a greater risk of death within 3 months

40
Q

Drugs With a Boxed Warning for Liver Damage

A
  • Apap (high doses, acute or chronic)
  • Amiodarone
  • Isoniazid
  • Ketoconazole (oral)
  • Methotrexate
  • Nefazodone
  • NNRTIs
  • NRTIs
  • Propylthiouracil
  • Tipranavir
  • Valproic Acid
41
Q

Octreotide

A

Sandostatin
Selective for splanich vessels to stop bleeding
SE: bradycardia, cholelithiasis, billiary sludge

42
Q

Vasopressin

A

Vasostrict
Non-selective
Antidiuretic hormone analog

43
Q

Non-selective Beta-Blockers for Portal Hypertension

A

Work by 2 mechanisms

  1. decrease cardiac output via beta-1 blockade
  2. decrease splanich blood flow due to vasoconstriction (via beta-2 blockade and alpha activity)
44
Q

Beta-Blockers for Portal Hypertension

A

Nadolol (corgard)

Propranolol (inderal la, inderal XL

45
Q

Beta-Blocker for Porta Hypertension Boxed warnings, warnings

A

Boxed warnings: do not withdraw beta-blocker abruptly

Warning: non-selective drugs are used to portal hypertension, use extreme caution in asthma, severe cop, PVD

46
Q

Lactulose for Hepatic Encephalopathy MOA

A

Works by converting ammonia produced by intestinal bacteria to ammonium which is polar and therefore cannot readily diffuse into the blood

47
Q

Lactulose SE

A

Flatulence, diarrhea, dyspepsia, abdominal discomfort

48
Q

Rifaximin

A

Xifaxin

49
Q

Neomycin

A

Neurotoxicity

GI upset

50
Q

Ratio of furosemide to spironolactone

A

40mg furosemide to 100mg spironolactone to maintain potassium balance

NAPLEX (45 decks)

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