Chronic Liver Disease Flashcards
What lab tests are characteristic to jaundice?
high ALP and high conjugated bilirubin levels
Alcoholic liver disease AST to ALT ratio?
2:1
ALT is greater than AST by 1000x in what condition?
acute viral hepatitis
alpha-1 antitrypsin deposition of excessive abnormal A1AT occurs in what condition?
Cirrhosis
List the names of drugs that require LFT Monitoring.
Amiodarone
Statins
Acetaminophen toxicity
Methotrexate
Ketoconazole
Itraconazole
Terbinafine
What should be monitored after 2-4 weeks of starting MTX?
ALT
What are baseline tests of methotrexate?
CBC
platelet count
hepatic enzymes
renal function
chest x-ray
For patients on MTX, how often should monitoring occur for hematology and hepatic enzymes?
hematology = atleast monthly
hepatic enzyme and renal function = every 1-2 months
For a patient that is prescribed Terbinafine, what is the baseline tests monitored?
ALT (baseline + periodically)
What are ascites ?
fluid retention in the peritoneal cavity of liver
Drug of choice to treat Ascites
Spironolactone 100-200 mg/day, then add Furosemide 40 mg-160 mg/day
If refractory –> add Metolazone
Symptoms of hepatic encephalopathy
agitation, excitement, disorientation, confusion, slurred speech, loss of consciousness
Treatment for hepatic encephalopathy?
lactulose (to induce 2-3 bowel movements per day).
if no improvement, add rifaximin and reassess in 1-2 days
Treatment for spontaneous bacterial peritonitis
Prophylaxis: cotrimoxazole (cost effective) or norfloxacin
Treatment: 3rd gen ceph - cefotaxime or ceftriaxone x 5 days - add albumin on day 3 of treatment.
Patient has renal impairment. When treating for spontaneous bacterial peritonitis, ceftriaxone is prescribed for 5 days. what is the dose adjustment?
not required in renal impairment.
symptoms of chronic cholestasis (jaundice)?
yellow skin and eyes, itchy skin, abdominal pain, dark urin.
Lab results: high ALP, GGT, bilirubin
Treatment for jaundic
ursodiol or ursodeoxycholic acid - improves serum liver biochemical tests in pts with primary biliary cholangitis and primary sclerosing cholangitis
If a patient has ascites and cannot tolerate spironolactone, what should be an alternative drug used?
amiloride
A patient has spontaneous bacterial peritonitis + ascites. They recovered from SBP, removed the ileum**. What vitamin is required?
Vit b12 injection
*recall: b12 is absorbed in ileum
What is viral hepatitis?
presence of virus in the blood 6 months after the infection
What lab results confirms chronic hepatitis B infection?
Hep B surface antigen (HBsAg) + Hep B antigen test
What lab results confirms the diagnosis of chronic hepatitis C infection?
Hep C antibody and HCV RNA
how do hep B and hep C get transmitted?
parenteral, blood, sexual, needle (hep B)
what is the severity for each type of hepatitis?
Hep A - acute (mild)
Hep B & C - chronic
Hep D & E - mild
Incubation period of hepatitis B?
90 days
How many vaccines for hepatitis A ?
1 dose for travellers; indicated in > 1 yo
What is the incubation period for Hep C?
40 days
What is the incubation period for Hep A?
30 days
A person is traveling - what is the risk of infection from food?
Hep A
A person who is travelling to the Carribean for the holidays wants recommendations for vaccines. What should they be?
VACCINES WHEN TRAVELING TO CARIBBEAN AND SOUTH AMERICA:
- hep A and hep B (can use Twinrix)
- typhoid (aka Vivotif)
- Cholera (aka Dukoral)
- yellow fever
- rabies
**would not need a Gonococcal vaccine
A person is traveling to an area with high risk for Hep B. What should be a counseling point to avoid?
Avoid unprotected intercourse.
What is the treatment for acute Hepatitis A?
No treatment needed; spread by food, water, oral-fecal
when to initiate therapy for hep B ?
if hep B surface antigen is positive, ALT and BV-DNA is > 20,000
how is hepatitis B contracted?
sexual contacts, needle sharing, blood transfusion.
AEs of peginterferon shots?
CNS toxicity, neutropenia.
Contraindications of peginterferon shots
Avoid in decompensated cirrhosis, HIV, immunocompromised (low response), severe cardiac disease, solid organ transplant (Except liver)
Examples of nucleoside analogues?
- tenofovir disoproxil fumarate
- tenofovir alafenamide fumarate
both active against HIV and Hep B virus, and lamivudine-resistant HBV; not used as monotherapy in HIV+HB
contraindications of TDF (tenofovir diso. fumarate)
CrCl < 30
fanconi syndrome
lactic acidosis
osteomalacia
contraindications of TAF (tenofovir alaf. fumarate)
CrCl < 15
lactic acidosis
hepatomegaly with statosis
in all patients with HIV, they must also be screened for ___ virus?
hepatitis B
based on HIV Guidelines, which HIV infected patient is eligible to be screened for hepatitis C ?
HIV + drug addiction history
Examples of protease inhibitors
ends with “-Previr”
asuna-previr
gleca-previr
grazo-previr
parita-previr
voxila-previr
cyp enzyme involvement of protease inhibitors?
substrate of cyp3a4, so avoid moderate inducers and inhibitors
examples of NS5A inhibitors
ends with “asvir”.
daclatasvir
elbasvir
ledipasvir
ombitasvir
pibrentasvir
velpatasvir
DDIs with NS4A inhibitors?
all are subsrates of 3a4, pgp.
DDI with: anti-HIV, rifampin, statins, antacids and PPIs reduce absorption.
*note: ledipasvir is not a substract of cyp
Examples of NS5B polymerasee inhibitors
ends with ‘buvir’
ex: sofosbuvir, dasabuvir
which NS5B polymerase inhibitor is a potent Pgp inducer?
sofosbuvir
True/False - contraception is advised during antiviral therapy.
true
Side effect of PEG interferons
depression, possible abortifacient
When a patient takes lactulose for hepatic encephalopathy, when is it determined to be effective?
when consciousness is improved
