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PHRM 865 > Exam 5: Viral Hepatitis > Flashcards

Exam 5: Viral Hepatitis Flashcards

1
Q

what is hepatitis

A

inflammation of the liver

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2
Q

what is viral hepatitis

A

hepatitis caused by one of at least five distinct viruses

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3
Q

How is hepatitis delta virus developed

A

requires HBV co-infection for replication and expression

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4
Q

How is hepatitis E virus location

A

Primarily occurs in India, Asia, Africa, and Central America

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5
Q

What type of virus is HBV

A

DNA

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6
Q

What is the primary virus of hepatitis

A

RNA

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7
Q

Viral hepatitis acute illness characteristics

A

Nausea, anorexia, fever, malaise, and abdominal pain

Jaundice or elevated liver transaminases

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8
Q

Which hepatitis can produce chronic infection

A

HBV and HCV

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9
Q

Viral hepatitis chronic infection characteristics

A

Subclinical to cirrhosis or hepatocellular carcinoma (HCC)

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10
Q

HAV main transmission

A

fecal-oral

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11
Q

HBV main transmission

A

Blood

sexual

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12
Q

HCV main transmission

A

Blood

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13
Q

HAV perinatal transmission

A

Does not happen

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14
Q

HBV perinatal transmission

A

Yes

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15
Q

HCV perinatal transmission

A

Yes

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16
Q

HAV most common risk factor

A

direct contact with someone with HAV

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17
Q

HBV most common risk factor

A

born to infected mother

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18
Q

HCV most common risk factor

A

Injection drug use

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19
Q

HAV chronic infection

A

Does not happen

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20
Q

HBV chronic infection

A

Yes

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21
Q

HCV chronic infection

A

Yes

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22
Q

HAV course of infection

A

acute, then resolved

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23
Q

HBV course of infection

A

Acute, then sometimes chronic
90% of infants
25-50% of children ages 1-5
5% of adaults

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24
Q

HCV course of infection

A

Acute, then usually chronic

>50% develop chronic infection

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25
HAV treatment of chronic infections
N/A
26
HBV treatment of chronic infections
Yes, not curative
27
HCV treatment of chronic infections?
Yes, curative
28
HAV protective immunity
Yes
29
HBV protective immunity
Yes
30
HCV protective immunity
No
31
HAV vaccine available
Yes
32
HBV vaccine available
Yes
33
HCV vaccine available
No
34
HAV incubation period
28 days (range 15-50 days)
35
HAV virology
picornavirus that replicates in the liver, excreted in the bile, and is shed in the stool
36
HAV symptoms
Abrupt onset, usually lasts less than 2 months: | fever, fatigue, loss of appetite, jaundice, joint pain
37
HAV death rate
Rarely fatal
38
HAV diagnostic testing
IgM anti-HAV in serum (usually detectable in 15-20 days) or HAV RNA in serum or stool
39
What remains detectable providing lifelong immunity in HAV
IgG anti-HAV
40
what is used to assess immunity in HAV
Total anti-HAV (measuring both IgG and IgM)
41
Role of antiviral agents in HAV
No role
42
HAV management
supportive care only
43
How many doses of HAV vaccine
Two: given at 0 and 6-12 months
44
HBV virology classification
hepadnavirus
45
HBV pathogenesis
virus enters the liver through the bloodstream, replicates in the liver
46
What can HBV NOT be spread by
``` FOOD Water Sharing eating utensils breastfeeding kissing ```
47
HAV or HBV: diarrhea
HAV
48
HBV acute symptoms
same as HAV but with no diarrhea
49
HBV chronic infection symptoms
typically asymptomatic until onset of cirrhosis, end-stage liver disease or HCC
50
HBsAg marker
Hep B Surface antigen
51
HBsAg significance
Is the patient infectious? Marker of presence of ongoing infection
52
anti-HBs marker
antibody to hepatitis B surface antigen
53
anti-HBs significance
Is the patient immune? Marker of immunity (indistinguishable whether acquired from disease or vaccination)
54
Total anti-HBc marker
antibody to hepatitis B antigen
55
Total anti-HBc significance
Has the patient been exposed to the virus? Marker of exposure to the infection: persists for life, does not account for time since infection
56
IgM anti-HBc marker
Immunoglobulin M class of antibody to hepatitis B core antigen
57
IgM anti-HBc marker significance
Has the patient been recently exposed to the virus? Marker of acute or recently acquired HBV infection (can give false positives)
58
HBeAg marker
Hepatitis B e antigen
59
HBeAg significance
Is the virus actively replicating? Marker of high infectivity in acute or chronic HBV infection (corresponds to viral replication)
60
anti-HBe marker
antibody to hepatitis B e antigen
61
anti-HBe significance
Has the virus recently stopped replication? Marker of loss of viral replication and lower levels of virus
62
HBV acute infection management
No treatment available | Supportive care
63
HBV chronic infection management
1. achieve sustained suppression of HBV replication 2. remission of liver disease 3. prevent cirrhosis, hepatic failure, and HCC 4. functional cure- HBsAg loss with or without anti-HBe gain- is attainable 5. virological cure- eradication of ccDNA from hepatocyte nuclei- is not yet attainable
64
Lab values to monitor in HBV chronic infection
CBC, liver panel, INR, HBeAg, anti-HBe, HBV DNA PCR
65
What phases of chronic HBV can cause elevated ALT
``` e+ Immune-active e- Immune active (carrier) e-Immune reactivation e+ cirrhosis e- cirrhosis ```
66
what phase of chronic HBV displaces low/undetectable HBV DNA
e- inactive (carrier)
67
e+ immune tolerant chronic HBV characteristics
normal ALT | elevated HBV DNA (++++)
68
e- inactive (carrier) chronic HBV characteristics
normal ALT | low/undetectable HBV DNA
69
e+ immune active chronic HBV characteristics
elevated ALT | elevated HBV DNA (+++)
70
e+ cirrhosis chronic HBV characteristics
elevated ALT elevated HBV DNA (+++) low albumin low platelets
71
e- immune reactivation chronic HBV characteristics
elevated ALT | elevated HBV DNA (+++)
72
e- cirrhosis chronic HBV characteristics
elevated ALT elevated HBV DNA (++_ low albumin low platelets
73
males ALT upper limit of normal
35 U/L
74
females ALT upper limit of normal
25 U/L
75
does HBV treatment eradicate it
No
76
HBV treatment eligibility
2/3 aint bad 1. HBV DNA >2000 IU/mL PLUS 2. ALT >2x ULN or 3. Cirrhosis
77
HBV Treatment eligibility: e+ immune-tolerant
Monitor
78
HBV Treatment eligibility: e- inactive (carrier)
monitor
79
HBV Treatment eligibility: e+ immune active
TREAT if ALT > 2x ULN and HBV DNA >20,000 IU/mL | otherwise monitor
80
HBV Treatment eligibility: e- immune reactivation
TREAT INDEFINITELY if ALT >2ULN, HBV DNA>2,000 IU/mL | otherwise monitor
81
HBV Treatment eligibility: e+ cirrhosis
TREAT INDEFINITELY HBV DNA>2,000 IU/mL | otherwise monitor
82
HBV Treatment eligibility: e- cirrhosis
TREAT INDEFINITELY HBV DNA>2,000 IU/mL | otherwise monitor
83
first line treatment of HBV
nucleoside analogs: TDF TAF entecavir
84
HBV nucleoside MOA
inhibit HBV replication through incorporation into viral DNA by the HBV reverse transcriptase to result in DNA chain termination
85
HBV nucleoside DOC
tenofovir TDF 300mg PO QD | TAF 25 mg PO QD
86
What can happen if you withdrawal of tenofovir
potential ALT flares
87
entecavir dosing in HBV
0.5 mg PO QD in nucleoside naive pts | 1mg PO qd in nucleoside experienced pts
88
entecavir clinical pearls
take on empty stomach
89
first line cytokine for HBV MOA
cytokine with antiviral, antiproliferative, and immunomodulatory effects
90
what cytokine is used to treat HBV
peginterferon alfa 2a
91
peginterferon alfa 2a dosing
180mcg SQ QW for 48 weeks
92
peginterferon alfa 2a contraindications
Pts with current psychosis, severe depression, neutropenia, thrombocytopenia, symptomatic heart disease, decompensated liver disease, and uncontrolled seizures
93
peginterferon alfa 2a potential side effects
flu-like symptoms, fatigue, mood disturbances, cytopenia, autoimmune disorders, anorexia
94
peginterferon alfa 2a monitoring
CBC x 1-3 months TSH x 3 months Monitoring of side effects
95
entecavir potential side effects
lactic acidosis in decompensated cirrhosis only
96
entecavir monitoring
Lactic acid levels | HIV testing before initiation
97
TDF potential side effects
nephropathy fanconi syndrome osteomalacia lactic acidosis
98
TDF monitoring
CrCl | Bone density
99
TAF potential side effects
lactic acidosis
100
TAF monitoring
lactic acid
101
Immune tolerant HBV monitoring
ALT q3-6 months | eAg q6-12 months
102
e- inactive HBV monitoring
ALT q6-12 months
103
NA therapy HBV monitoring
HBV DNA levels q3 months until undetectable (within 96 weeks) then q 3-6 months
104
HIV co-infection with HBV treatment
emtricitabine/tenofovir (truvada, descovy)
105
HCV virology
flavivirus
106
HCV replication site
liver
107
HCV average time from exposure to symptom onset
4-12 weeks (range 2-24 weeks)
108
HCV transmission
spread through large or repeated percutaneous exposures to infected blood
109
HCV acute infection symptoms
most are asymptomatic similar to HBV
110
Can HCV become chronic
Yes: >50% with acute HCV develop chronic infection
111
Classification of chronic HCV
persistently detectable HCV RNA for > 6 months
112
How to detect HCV
anti-HCV after 8-11 weeks of infection | HCV RNA of current infection
113
Goals of HCV therapy
1. obtain virological cure by achieve a sustained virological response- HCV RNA undetectable 12 weeks after cessation of treatment 2. Prevent complications (cirrhosis, HCC) and death
114
HCV therapeutic agents
Direct acting antivirals: NS3/4A protease inhibitors NS5B polymerase inhibitors NS5A replication complex inhibitors ribavirin interferons
115
NS3/4A protease inhibitors
Grazoprevir Glecaprevir Voxilaprevir
116
grazoprevir administration
Only coformulated with Zepatier
117
grazoprevir dosing
100 mg PO QD with food
118
grazoprevir AE
fatigue, headache, nausea, anemia, ALT elevations
119
grazoprevir monitoring
ALT monitoring at 8 weeks; D/C if >5x ULN Contraindicated in Child-Pugh class B or C
120
glecaprevir administration
only in coformulated mavyret: 3 tabs daily
121
glecaprevir dosing
300mg PO QD WITH FOOD
122
glecaprevir AE
headache, fatigue
123
glecaprevir monitoring
Contraindicated in Child-Pugh class B or C
124
voxilaprevir administration
coformulated Vosevi
125
voxilaprevir dosing
100mg PO QD with food
126
voxilaprevir indication
approved for patients who have been previously treated with an NS5A replication complex inhibitors
127
voxilaprevir monitoring
not recommended in Child-Pugh class B or C
128
NS5b polymerase inhibitor
Sofosbuvir
129
sofosbuvir brand name
sovaldi
130
sofosbuvir coformulations
Epclusa, Harvoni, and Vosevi
131
sofosbuvir dosing
400mg PO QD with or without food
132
sofosbuvir AE
fatigue, headache
133
sofosbuvir drug interactions
Avoid amiodarone coadministration due to risk of symptomatic bradycardia
134
NS5A replication complex inhibitors
Ledipasvir Elbasvir Velpatasvir Pibrentasvir
135
ledipasvir administration
coforumulated Harvoni
136
ledipasvir adverse effects
fatigue, headache
137
ledipasvir drug interaction
ledipasvir solubility decreases as pH increases, so spacing apart acid reducing agents in necessary
138
ledipasvir dosing
90 mg PO QD with or without food
139
elbasvir administration
coformulated Zepatier
140
elbasvir dosing
100mg PO QD with or without food
141
velpatasvir administration
coformulated epclusa and vosevi
142
velpatasvir dosing
100mg PO QD with or without food
143
velpatasvir adverse effects
fatigue, headache
144
pibrentasvir administration
coformulated with mavyret
145
pibrentasvir dosing
120mg PO QD with food
146
Zepatier name
elbasvir/grasoprevir
147
Zepatier adult dose
1 tab qd with or without food
148
mavyret name
pibrentasvir/glevaprevir
149
mavyret adult dosing
3 tabs qd with food
150
vosevi name
velpatasvir/sofosbuvir/voxilaprevir
151
vosevi adult dose
1 tab qd with food
152
harvoni name
ledipasvir/sofosbuvir
153
harvoni adult dose
1 tab qd with food
154
epclusa name
velpatasvir/sofosbuvir
155
epclusa adult dose
1 tab qd with or without food

PHRM 865 (59 decks)

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