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Infectious Diseases > Chronic Liver Disease > Flashcards

Chronic Liver Disease Flashcards

1
Q

What lab tests are characteristic to jaundice?

A

high ALP and high conjugated bilirubin levels

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2
Q

Alcoholic liver disease AST to ALT ratio?

A

2:1

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3
Q

ALT is greater than AST by 1000x in what condition?

A

acute viral hepatitis

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4
Q

alpha-1 antitrypsin deposition of excessive abnormal A1AT occurs in what condition?

A

Cirrhosis

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5
Q

List the names of drugs that require LFT Monitoring.

A

Amiodarone
Statins
Acetaminophen toxicity
Methotrexate
Ketoconazole
Itraconazole
Terbinafine

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6
Q

What should be monitored after 2-4 weeks of starting MTX?

A

ALT

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7
Q

What are baseline tests of methotrexate?

A

CBC
platelet count
hepatic enzymes
renal function
chest x-ray

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8
Q

For patients on MTX, how often should monitoring occur for hematology and hepatic enzymes?

A

hematology = atleast monthly

hepatic enzyme and renal function = every 1-2 months

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9
Q

For a patient that is prescribed Terbinafine, what is the baseline tests monitored?

A

ALT (baseline + periodically)

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10
Q

What are ascites ?

A

fluid retention in the peritoneal cavity of liver

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11
Q

Drug of choice to treat Ascites

A

Spironolactone 100-200 mg/day, then add Furosemide 40 mg-160 mg/day

If refractory –> add Metolazone

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12
Q

Symptoms of hepatic encephalopathy

A

agitation, excitement, disorientation, confusion, slurred speech, loss of consciousness

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13
Q

Treatment for hepatic encephalopathy?

A

lactulose (to induce 2-3 bowel movements per day).

if no improvement, add rifaximin and reassess in 1-2 days

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14
Q

Treatment for spontaneous bacterial peritonitis

A

Prophylaxis: cotrimoxazole (cost effective) or norfloxacin

Treatment: 3rd gen ceph - cefotaxime or ceftriaxone x 5 days - add albumin on day 3 of treatment.

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15
Q

Patient has renal impairment. When treating for spontaneous bacterial peritonitis, ceftriaxone is prescribed for 5 days. what is the dose adjustment?

A

not required in renal impairment.

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16
Q

symptoms of chronic cholestasis (jaundice)?

A

yellow skin and eyes, itchy skin, abdominal pain, dark urin.
Lab results: high ALP, GGT, bilirubin

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17
Q

Treatment for jaundic

A

ursodiol or ursodeoxycholic acid - improves serum liver biochemical tests in pts with primary biliary cholangitis and primary sclerosing cholangitis

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18
Q

If a patient has ascites and cannot tolerate spironolactone, what should be an alternative drug used?

A

amiloride

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19
Q

A patient has spontaneous bacterial peritonitis + ascites. They recovered from SBP, removed the ileum**. What vitamin is required?

A

Vit b12 injection
*recall: b12 is absorbed in ileum

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20
Q

What is viral hepatitis?

A

presence of virus in the blood 6 months after the infection

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21
Q

What lab results confirms chronic hepatitis B infection?

A

Hep B surface antigen (HBsAg) + Hep B antigen test

22
Q

What lab results confirms the diagnosis of chronic hepatitis C infection?

A

Hep C antibody and HCV RNA

23
Q

how do hep B and hep C get transmitted?

A

parenteral, blood, sexual, needle (hep B)

24
Q

what is the severity for each type of hepatitis?

A

Hep A - acute (mild)
Hep B & C - chronic
Hep D & E - mild

25
Q

Incubation period of hepatitis B?

A

90 days

26
Q

How many vaccines for hepatitis A ?

A

1 dose for travellers; indicated in > 1 yo

27
Q

What is the incubation period for Hep C?

A

40 days

28
Q

What is the incubation period for Hep A?

A

30 days

29
Q

A person is traveling - what is the risk of infection from food?

A

Hep A

30
Q

A person who is travelling to the Carribean for the holidays wants recommendations for vaccines. What should they be?

A

VACCINES WHEN TRAVELING TO CARIBBEAN AND SOUTH AMERICA:

  1. hep A and hep B (can use Twinrix)
  2. typhoid (aka Vivotif)
  3. Cholera (aka Dukoral)
  4. yellow fever
  5. rabies

**would not need a Gonococcal vaccine

31
Q

A person is traveling to an area with high risk for Hep B. What should be a counseling point to avoid?

A

Avoid unprotected intercourse.

32
Q

What is the treatment for acute Hepatitis A?

A

No treatment needed; spread by food, water, oral-fecal

33
Q

when to initiate therapy for hep B ?

A

if hep B surface antigen is positive, ALT and BV-DNA is > 20,000

34
Q

how is hepatitis B contracted?

A

sexual contacts, needle sharing, blood transfusion.

35
Q

AEs of peginterferon shots?

A

CNS toxicity, neutropenia.

36
Q

Contraindications of peginterferon shots

A

Avoid in decompensated cirrhosis, HIV, immunocompromised (low response), severe cardiac disease, solid organ transplant (Except liver)

37
Q

Examples of nucleoside analogues?

A
  1. tenofovir disoproxil fumarate
  2. tenofovir alafenamide fumarate

both active against HIV and Hep B virus, and lamivudine-resistant HBV; not used as monotherapy in HIV+HB

38
Q

contraindications of TDF (tenofovir diso. fumarate)

A

CrCl < 30
fanconi syndrome
lactic acidosis
osteomalacia

39
Q

contraindications of TAF (tenofovir alaf. fumarate)

A

CrCl < 15
lactic acidosis
hepatomegaly with statosis

40
Q

in all patients with HIV, they must also be screened for ___ virus?

A

hepatitis B

41
Q

based on HIV Guidelines, which HIV infected patient is eligible to be screened for hepatitis C ?

A

HIV + drug addiction history

42
Q

Examples of protease inhibitors

A

ends with “-Previr”

asuna-previr
gleca-previr
grazo-previr
parita-previr
voxila-previr

43
Q

cyp enzyme involvement of protease inhibitors?

A

substrate of cyp3a4, so avoid moderate inducers and inhibitors

44
Q

examples of NS5A inhibitors

A

ends with “asvir”.

daclatasvir
elbasvir
ledipasvir
ombitasvir
pibrentasvir
velpatasvir

45
Q

DDIs with NS4A inhibitors?

A

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

46
Q

Examples of NS5B polymerasee inhibitors

A

ends with ‘buvir’

ex: sofosbuvir, dasabuvir

47
Q

which NS5B polymerase inhibitor is a potent Pgp inducer?

A

sofosbuvir

48
Q

True/False - contraception is advised during antiviral therapy.

A

true

49
Q

Side effect of PEG interferons

A

depression, possible abortifacient

50
Q

When a patient takes lactulose for hepatic encephalopathy, when is it determined to be effective?

A

when consciousness is improved

Infectious Diseases (14 decks)

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