Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SG - Pharm 4 > Hep A & B > Flashcards

Hep A & B Flashcards

1
Q
  • RNA virus Picornavirdae Family
  • Acute, self limiting, low fatality rate
  • Confers lifelong immunity
A

Hep A

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

Hep A

  • Transmission? (2)
  • Treatment?
A
  • Fecal-oral route
  • Ingestion - contaminated water/foods prepared using water
  • Tx: supportive care
    • Immune globulin
    • Handwashing hygiene
  • Prevention w/ vaccination is preferred!
  • NO ROLE FOR ANTIVIRAL agents!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hep A Vaccine

  • Start schedule at what age?
    The ____ of vaccines changes at age ___, but the ____ is the same
  • What vaccine is only for adults?
A
  • 1 year old
  • dose / 19 y/o / schedule of administration (0, 6-18 months)
    • TWINRIX*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

4 ADEs of the Hep A vaccine

A
  • Soreness / warmth at injection site
  • HA
  • Malaise
  • Pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Efficacy of Hep A vaccine is decreased in which 2 scenarios?

A
  • HIV pts w/ CD4 counts <200
  • Co-infected HIV/HCV pts
    • HCV = hep C virus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When does the Hep A pre-exposure prophylaxis vaccine need to be given prior to departure to endemic areas?

A
  • Vaccine can be given regardless of schedule dates of departure
  • If pt is older, immunocompromised, or has hx of chronic liver disease, or other chronic medical condition: If the patient is traveling within 2 weeks then give BOTH Ig and Vaccine
    • IG=passive coverage
    • Vaccine= active coverage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the Post-exposure prophylaxis for Hep A?

A
  • Administer either Vaccine or IG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the concern for the vaccine as post-exposure prophylaxis?

A

Uncertain efficacy in adults older than 40 years or with underlying conditions

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

Hep A - Post-Exposure Prophylaxis

  • Vaccine brands are interchangeable for _____.
A

booster shots

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

Hep A

  • ___ for pre and post exposure when vaccine is not an option
A

IG

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

Hep A Pre/Post exposure

  • Recall that with recent ___ exposure, post-exposure prophylaxis with _____ is preferred.
A

HAV / vaccine

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

Hep A Pre/Post exposure

  • Pts who receive at least 1 dose of the HAV vaccine at least ___ prior to exposure do NOT need pre-exposure or post-exposure prophylaxis w/ IG
A

1 month

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

Hep A Pre/Post exposure

  • IG is indicated when vaccination is NOT an option
  • IG prophylaxis is preferred in 5 cases?
A
  • <12 months or >40 years
  • Immunocompromised
  • Chronic liver disease
  • Underlying medical conditions
  • When vaccine contraindicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hep A

  • Vaccine confers ____ immunity
  • Immunoglobulin confers ____ immunity.
A
  • Vaccine: active
  • IG: passive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Preparation of concentrated antibodies against HAV

  • 85% reduction in infectivity & moderation of infection if given within the first ___ weeks of infection
  • Anaphylaxis has been reported in pts w/ ___ deficiency
A
  • 2 weeks
  • IgA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Dosing of Hep A pre/post exposure

  • Post-exposure prophylaxis and for short term pre-exposure coverage is for <__ months. Dose =0.02
  • Long term pre-exposure prophylaxis of < or = ___ months. Dose =0.06 (dose is tripled for longer exposure)
A
  • 3 months
  • 5 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Administration sites for Hep A pre/post exposure

  • Older than 24 months use which 2 muscles?
  • Younger than 24 months use which muscle?
A
  • >24 months: deltoid or gluteal
  • <24 months: anterolateral thigh muscle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hep B

  • How many genotypes? US?
    Transmission?
  • Highly infectios (50-100x more infectious than HIV)
  • Stable in environment for at least __ days
  • Incubation for both acute & chronic infections?
    *
A
  • 10, US-G
  • sexually, parenterally, perinatally (present in saliva, semen, vaginal excretions)
  • 7
  • 6 weeks to 6 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the most predictive factor for developing a chronic infection of Hep B?

A

Age

  • Perinatal (100% immune tolerance to virus)
  • Infants & children (30%) are at high risk for chronic infection
  • Adults <5%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
  • Hep B leads to an increased risk for what 2 conditions?
  • Which sex is more at risk?
A
  • Cirrhosis
  • Hepatocellular carcinoma
  • Men
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

T/F

  • Hep B virus itself does not seem to be pathogenic to cells
    • Immune response to the virus is cytotoxic to _____
A

True

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

______ is critical to viral clearance of Hep B

  • Suppress HBV replication, prevents disease progression to cirrhosis and HCC
  • Loss of HBsAg
    • Confers _____
  • Loss of HBeAg
    • Confers _____
A

The immune response

  • HBsAg: immunity & clearance
  • HBeAg: infection resolved
23
Q

Patients who continue to have detectable HBsAg for more than __ months have chronic HBV.

  • Infections can be controlled, cure is NOT possible bc/ HBV template is integrated into the ______.
A
  • 6
  • host genome
24
Q

What is the “acute supportive” tx of Hep B?

A

Immune Globulin (IVIG) for acute exposure

25
Q

What is the prevention for Hep B?

A
  • Vaccine at 0, 1, and 6 months
  • Serology marker anti-HBsAg only (Anti HBs)
26
Q

2 things for Chronic Management of Hep B

A
  • Interferons
  • Antivirals
27
Q
  • What is the vaccine schedule of Hep B for adults?
  • What are the 2 names of the vaccines?
A
  • 1 mL IM at 0, 1, & 6 months (3 doses)
  • Engerix-B
  • Recombivax HB
28
Q

Hep B Vaccine for infants

  • Amount?
  • Doses / Schedule?
  • 2 vaccines names?
A
  • 0.5 mL/dose
  • 3 doses at 0, 1, & 6 months
  • Engerix-B
  • Recombivax HB
29
Q

What do the combination vaccines for infants for Hep B contain?

A
  • Hep B
  • DTaP
  • HIB

(**Should not be used for the “birth” dose of Hep B, but may be used to complete the course beginning after the infant is 6 weeks old or greater**)

–> DTaP and HIB are given at 2 months old

30
Q

Newborn first dose depends on the ____ status of the mother

A

HBsAG

31
Q

Infants w/ HBsAg ____ mothers

  • first dose: 0.5 mL at birth or before discharge (may be delayed in certain cases)
A

negative

32
Q

Infants w/ HBsAg ____ mothers:

  • 1st dose: 0.5 mL *within first 12 hours of life*, even if premature and regardless of birth weight
  • Hepatitis immune globulin should be administered at the same time at a different site
A

Positive

33
Q

Infants with mother’s HBsAg status ____

  • 1st dose: 0.5 mL *within 12 hours of birth* even if premature and regardless of birth weight
A

Unknown

34
Q

Serologic testing and revaccination may be necessary in patients w/ ______.

  • Serologic testing is recommended __ - __ months after the final dose of the primary vaccine series & ____ to determine the need for booster doses
A

renal impairment

  • 1 -2
  • annually
35
Q

Serologic Testing & Revaccination for Hep B

  • Persons w/ anti-HBs concentrations of <___ should be revaccinated with __ doses of the vaccine
A
  • 10 mIU/mL
  • 3 doses
36
Q

What adjustment is needed for hepatic impairment for serologic testing w/ Hep B?

A

No adjustment needed

37
Q

Hypersensitivity to which 3 things w/ Hep B?

A
  • Yeast
  • Hep B vaccine
  • any component of the formulation
38
Q

Syncope associated w Hep B vaccine

  • reported w/ injectable vaccines
  • May be accompanied by which 3 sxs?
A
  • transient visual disturbances
  • weakness
  • tonic-clonic movements
39
Q

What are the 5 dermatologic ADEs from Hep B vaccine?

A
  • Angioedema
  • Petechiae
  • Pruritis
  • Rash
  • Urticaria
40
Q

What may diminish the therapeutic effect of Hep B vaccines (inactivated)?

A

Immunosuppressants

41
Q

Hep B Vaccines should be given __ inches apart or in separate arms.

A

2

42
Q

Treatment of Hep B may require ___ therapy w/ resistance as a concern.

  • Post - exposure within __ days
    • Hep B Immunoglobulin
    • Adult: .06ml/kg IM
    • Follow with HBV
A
  • Long Term Therapy
  • 7
43
Q

What is the treatment for Chronic Hep B?

A
  • Immunomodulating agent: PEG-INF alpha (PegaSys) (interferon)
  • Antivirals:
    • Lamivudine
    • Adefovir
    • Entecovir***
    • Telbivudine
    • Tenofovir***
  • Vaccinate against HAV
44
Q
  • Long term Hep B therapy may require long term therapy which has the potential for developing ____.
A

Resistance

45
Q

Long Term Hep B Therapy

  • Resistance to ____ and _____ is most common!
  • Resistance to ___ and ____ can occur…
  • Less resistance to ______ (=
  • Optimal tx of resistant strains is _____
A
  • MC: lamivudine & Telbivudine
  • Can occur: Adefovir & Entecavir
  • Least: Tenofovir
  • Unknown
46
Q

Recommendations for pts w/ Hep B

  • Vaccinate ____ and ____ contacts
  • Avoid _____
  • what other atypical tx option?
A
  • sexual & household
  • alcohol
  • milk thistle
    • (protective & restores liver hepatocytes, not replicated in western medicine. GOOD evidence of being hepatoprotective)
    • Also not replicated & has good evidence: horse chestnut given for HF
47
Q

What 2 circumstances of Chronic Hep B require immediate treatment?

A
  • Jaundice
  • Decompensation
48
Q

Suggested management algorithm based on AASLD for chronic Hep B pts w/ CIRRHOSIS?

A
  • If ALT <2 or less than ULN
    • –> observe
  • If ALT >2
    • Initial tx: IFN, PEG - IFN, Entecavir, or Tenofovir
  • Immediate tx if jaundice or decompensation
49
Q

Goal of Hep B Tx

  • Hepatic damage is sustained by _____
  • Drug therapy suppresses viral replication by either ____ or ____ (the nucleoside agents - NAs)
A
  • ongoing viral replication
  • immunomodulating agents / antivirals
50
Q

Tx of Chronic Hep B**

ADE:

  • HA, fatigue, upper abd pain
  • lactic acidosis
A

Entecavir

51
Q

Tx of Chronic Hep B**

ADE:

  • Nausea, abd pain, diarrhea
  • dizziness, nephropathy
  • lactic acidosis
A

Tenofovir disoproxil

52
Q

Tx of Chronic Hep B**

ADE:

  • Flu-like sxs
  • fatigue
  • mood disturbances** (depression)
  • Cytopenias
  • Autoimmune disorders
A

Pegylated interferon alfa-2a

53
Q

What is almost a guaranteed ADE of Pegylated interferon alfa-2a?

A

Depression, so start antidepressants before giving interferon.

SG - Pharm 4 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions