Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NAPLEX 2023 > Chapter 19: Hepatitis & Liver Disease > Flashcards

Chapter 19: Hepatitis & Liver Disease Flashcards

1
Q

How is Hepatitis A transmitted

A

fecal-oral route through improper hand washing after exposure to an infected person or via contaminated food/water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How are Hep B and C transmitted

A

contact with infectious blood or other body fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which type(s) of hepatitis has a vaccine

A

Hep A and B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

First-line treatment for Hep A

A

Supportive therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

First-line treatment for Hep B

A

PEG-INF or NRTI (tenofovir or entecavir)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

First-line treatment for Hep C

A

Treatment naiive: DAA combination (2-3 with different mechs)
Other: DAA combination + RBV or DAA combination + RBV + PEG-INF

DAA treatment lasts 8-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the purpose of ritonavir for HCV

A

used to boost levels of HCV protease inhibitors used with it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

T/F: DAAs offer a cure for most patients with HCV

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which drug class ends in -previr

A

NS3/4A Protease inhibitor (P for PI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which drug class ends in -asvir

A

NS5A Replication Complex Inhibitor (A for NS5A)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which drug class ends in -buvir

A

NS5B Polymerase Inhibitor (B for NS5B)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What do the protease inhibitors used for HIV and HCV have in common?

A

They are taken with food

Remember: PIG - Protease Inhibitors & Grub

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Boxed warning for all DAAs

A

Risk of reactivating HBV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Warning for sofosbuvir-containing regimens

A

Serious symptomatic bradycardia has been reported when amiodarone is taken with sofosbuvir-containing regimen; do not use together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Sofosbuvir/velpatasvir brand name

A

Epclusa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Glecaprevir/pibrentasvir brand name

A

Mavyret

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How are the tablets in Viekira Pak taken

A

2 tabs of paritaprevir/ritonavir/ombitasvir once daily in the morning and 1 dasabuvir tablet twice daily with meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

T/F: Sofosbuvir monotherapy is NOT effective and NOT recommended

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which HCV drugs must you avoid or minimize acid suppressive therapy with during treatment

A

Epclusa, Harvoni, & Vosevi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which HCV drugs are pan-genotypic (approved for all 6 HCV genotypes) for treatment naive

A

Epclusa & Mavyret

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

CI for paritaprevir/ritonavir/ombitasvir (Technivie)

+ dasabuvir (Viekira Pak)

A

3A4 substrates or inducers & use with ethinyl estradiol, lovastatin & simvastatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Warnings for paritaprevir/ritonavir/ombitasvir (Technivie)

+ dasabuvir (Viekira Pak)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

CI for Elbasvir/grazoprevir (Zepatier)

A

3A4 inducers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

warnings for Elbasvir/grazoprevir (Zepatier)

A

Risk of increased LFTs, significant drug interaction potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
All DAAs are CI with strong ____
inducers of 3A4 (e.g., carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, rifabutin, and St. John's Wort)
26
____, ____ & ____ can decrease concentrations of ledipasvir and velpatasvir
Antacids, H2RAs, PPIs
27
PPIs are not recommended for use with ____
Epclusa
28
Do not use Harvoni with ____
Stribild
29
T/F: Ribavirin CANNOT be used as monotherapy for HCV
True - use in combo with other drugs (DAAs and/or interferon alfa)
30
Aerosolized ribavirin has been used for
Respiratory syncytial virus (RSV)
31
Ribavirin boxed warnings
Significant teratogenic effects; hemolytic anemia
32
Ribavirin CI
pregnancy
33
Ribavirin side effects
Hemolytic anemia
34
When should pregnancy be avoided with Ribavirin
during therapy and 6 months after completion; need 2 reliable forms of contraceptives
35
Which form of INF-alfa prolongs the half-life, reducing the dose to once weekly
Pegylated form
36
Interferon alfas are used for: | Interferon betas are used for:
alfa: HBV, HCV, & some cancers beta: multiple sclerosis
37
INF-alfa boxed warnings
can cause or exacerbate neuropsychiatric, autoimmune, ischemic or infectious disorders; if used with ribavirin, teratogenic/anemia risk
38
INF-alfa side effects
``` CNS effects (fatigue, depression), GI upset, increased LFTs (5-10x ULN during treatment), myelpsuppression Flu-like syndrome (fever, chills, HA, malaise), pre-treat with APAP and an antihistamine ```
39
T/F: Interferon alfa CANNOT be used as monotherapy
FALSE
40
What is the preferred treatment for HBV
INF-alfa
41
MOA of NRTIs
Inhibit HBV replication by inhibiting HBV polymerase resulting in DNA chain termination
42
What should be done before a patient can start on an NRTI for HBV
All pts should be tested for HIV
43
Why must patients be tested for HIV before starting an NRTI
Antivirals used for HBV can have activity against HIV and if a pt is co-infected with both HIV and HBV, it is important that the chosen therapy is appropriate for both viruses to minimize risk of HIB antiviral resistance
44
All HBV NRTIs should have a decreased dose or frequency with CrCl < ____ mL/min
50
45
Boxed warnings for all NRTIs
Lactic acidosis and severe hepatomegaly with steatosis, which can be fatal Exacerbations for HBV upon d/c
46
Tenofovir disoproxil brand name
Viread *remember - read dis*
47
Tenofovir alafenamide brand name
Vemlidy
48
Entecavir brand name
Baraclutide
49
Lamivudine brand name
Epivir HBV
50
Which NRTIs are the preferred therapy in HBV
Tenofovir disoproxil Tenofovir alafenamide Entecavir
51
Which NRTI should be taken on an empty stomach
Entecavir (Baraclutide) *remember - empty and entecavir both start with E*
52
Tenofovir disoproxil & Tenofovir alafenamide warnings
renal toxicity and/or Fanconi syndrome, osteomalacia, and decreased bone mineral density
53
Tenofovir disoproxil side effects
renal impairment, decreased bone mineral density
54
Tenofovir alafenamide side effects
nausea | Less renal and bone toxicity
55
Adefovir (Hepsera) boxed warnings
Caution in pts with renal impairment or those at risk of renal toxicity (including concurrent nephrotoxic drugs or NSAIDs)
56
Lamivudine boxed warning
Do not use Lamivudine HBV for treatment of HIV
57
Lamivudine side effects
HA, N/V/D
58
Tenofovir disoproxil & tenofovir alafenamide should not be used with ____ due to increased risk of virologic failure and potential for increased side effects
Adefovir *remember this b/c they have the same ending of -fovir*
59
Most common causes of cirrhosis
Hepatitis C and alcohol consumption | *remember this b/c Hep C and cirrhosis*
60
Clinical presentation of cirrhosis
yellowed skin and yellowed whites of the eyes (jaundice)
61
Albumin will be (high or low) in liver disease Total bilirubin? PT?
low High High
62
Which type of liver disease is associated with: | ↑ AST/ALT
Acute liver toxicity, including from drugs
63
Which type of liver disease is associated with: ↑ AST/ALT, Alk Phos, Tbili, LDH, PT/INR ↓ Albumin
Chronic liver disease (e.g., cirrhosis)
64
Which type of liver disease is associated with: | ↑ AST > ↑ ALT (AST will be ~2x ALT), ↑ GGT
Alcoholic liver disease
65
Which type of liver disease is associated with: | ↑ ammonia
Hepatic encephalopathy
66
Which type of liver disease is associated with: | ↑ Tbili
Jaundice
67
In general, caution is advised when using hepatically cleared drugs in which Child Pugh class
Class C (severe liver disease)
68
Which natural product is used for liver disease
Milk Thistle
69
Which natural product is a known hepatotoxin
Kava
70
Hepatotoxic drugs are typically d/c when the LFTs are > ___ xULN
3 times ULN
71
Which class of drugs should be avoided in patients with cirrhosis because they can lead to decompensation, including bleeding
NSAIDs
72
Key drugs that have a boxed warning for liver damage
``` APAP Amiodarone Isoniazid Ketoconazole (oral) MTX Nefazodone Nevirapine NRTIs PTU Tipranavir Valproic Acid ```
73
Alcoholic liver disease can include
fatty liver, alcoholic hepatitis, and chronic hepatitis
74
chronic alcohol ingestion over a long period of time causes
"steatosis" or fatty liver
75
Which drugs are used for relapse in alcoholics
Naltrexone, acamprosate and disulfuram
76
Which vitamin is used to prevent and treat Wernicke-Korsakoff syndrome in alcoholics
Thiamine (Vitamin B1)
77
Portal hypertension can cause complications including the development and bleeding of
esophageal varices (enlarged veins in the lower part of the esophagus)
78
What are recommended first line treatments for bleeding varices
Band ligation (putting a band around the vessel) or sclerotherapy (injecting a solution into the vessel to make it collapse and close)
79
Which drug is selective for the splanchnic vessels
Octreotide
80
Which drug is non-selective for the splanchnic vessels
Vasopressin
81
Which drug class should be added after resolution of variceal bleeding for secondary prevention
Non-selective BB
82
Which non-selective BB are used for primary prevention of variceal bleeding
Nadolol and propranolol
83
Nadolol brand name
Corgard
84
The BB used for portal hypertension is titrated to the max tolerated dose with a target HR between ___ = ___ BPM and continued indefinitely
55-60 BPM
85
What are symptoms of hepatic encephalopathy
musty odor of breath and/or urine, changes in thinking, confusion, forgetfulness, hand tremor (asterixis) result from an accumulation of gut-derived nitrogenous substances in the blood such as ammonia
86
Besides drug therapy, how is hepatic encephalopathy treated
Reducing blood ammonia levels through the diet (limiting the amount of animal protein)
87
Which drug is first-line for both acute and chronic (prevention) therapy for hepatic encephalopathy
Lactulose followed by rifaximin
88
Lactulose works by
converting ammonia products by intestinal bacteria to ammonium
89
Lactulose side effects
Flatulence, diarrhea, dyspepsia, abdominal discomfort
90
Rifaximin brand name
Xifaxan
91
Neomycin boxed warning
Neurotoxicity
92
Neomycin SE
GI upset
93
Metronidazole should not be used long term d/t
peripheral neuropathies
94
What is ascites
fluid accumulation within the peritoneal space
95
Patients with ascites d/t portal HTN should restrict ______
dietary sodium intake
96
Diuretic therapy for ascites can be initiated with either ______ monotherapy or with a combination of ____ and ____
Spironolactone monotherapy | Furosemide and spironolactone
97
When Furosemide and spironolactone are used in combination for ascites, they should be titrated to a max weight loss of 0.5 kg/day with a ratio of ____ mg furosemide to ___ mg spironolactone to maintain K balance
40 mg furosemide:100 mg spironolactone
98
Which antibiotic is used for Spontaneous bacterial peritonitis
Ceftriaxone to target Steptococci and enteric Gram negative pathogens

NAPLEX 2023 (88 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions