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Gastro Review > Hep viruses > Flashcards

Hep viruses Flashcards

1
Q

Relapse after sofosbuvir/ledipasvir - what next?

A

Sofosbuvir/Velpatasvir/Voxilaprevir

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2
Q

Which genotypes to use sofosbuvir/ledipasvir?

A

1 and 4

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3
Q

How to tx genotype 3?

A

sofosbuvir/velpatasvir or glecaprevir/pibrentasvir

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4
Q

How to tx pt on dialysis with HCV GT1a?

A

Elbasvir/Grazoprevir

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5
Q

Sofosbuvir/Velpatasvir treatment duration for HCV GT 1a in pts with cirrhosis?

A

12 weeks

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6
Q

How long after exposure and infection with HCV does it take AB to develop?

A

6 weeks - so if suspect infxn prior just check HCV RNA

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7
Q

What is immune tolerant phase of HBV?

A

1st 20-30 yrs in vertical transmission - norml LFTs but high HBV DNA, HBeAg+ but AB -

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8
Q

What is immune clearance phase of HBV?

A

Start to fight virus, LFTs go up and HBeAB turns positive, HBV DNA may decline - after immune tolerant

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9
Q

What is HBV inactive carrier phase?

A

After immune clearance - will have low HBV DNA and +HBeAB, normal LFTs

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10
Q

If HBV DNA ~20,000 and normal LFTs, what is best tx?

A

Monitor LFTs every 6 months

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11
Q

What is best med for HBV seroconversion from HBeAg to HBeAB+ and HBsAg to HBsAB+?

A

peginterferon alfa 2a

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12
Q

Which pts at risk for fulminant liver fx with HAV if infected?

A

HCV pts

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13
Q

Pt with acute HAV - what to offer to household contacts at risk of dz?

A

HAV Immune globulin

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14
Q

Do pts with previous HBV exposure and clearance need monitoring of labs or tx when starting infliximab for IBD?

A

No, no action needed

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15
Q

If chronic hep B and starting infliximab, wat should be done?

A

Start entecavir

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16
Q

If previous HBV clearance and starting chemotx for CA, what should be done?

A

HBV ppx during tx and for 12-18 months following tx.

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17
Q

HCV GT1B and reflux on PPI, which drug regimen to use?

A

grazoprevir/elbasvir

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18
Q

Which drugs interact with PPI?

A

Sofosbuvir/ledipasvir, sofosbuvir/velpatasvir

19
Q

T/F: If starting grazoprevir/elbasvir, pts with HCV GT1B should have NS5A RAV testing.

A

False, 1A pts should have resistance testing, 1B do not need it.

20
Q

If fail primary HCV tx (ie sofosbuvir/ledipasvir), what should be used next for tx?

A

sofosbuvir/velpatasvir/voxilaprevir - approved in GT 1-6

21
Q

T/F: PPX should be used in pts with HBsAg-negative/anti-HBc+ serologic profile who are being treated with prednisone >20 mg daily (or equivalent) for ≥ 4 weeks or are on chronic moderate dose prednisone therapy (10-20 mg daily) during treatment and for at least 6 months after stopping immunosuppression.

A

True - 1-10% risk of reactivation

22
Q

T/F: Sofosbuvir/ledipasvir can be used for GT2 HCV.

A

False, use Glecaprevir/pibrentasvir

23
Q

T/F: Sofosbuvir should not be used in GFR <30

A

True

24
Q

What should tx GT2 or 3 pt with GFR < 30?

A

Glecaprevir/pibrentasvir

25
Q

T/F: Glecaprevir/pibrentasvir is OK to use in decompensated cirrhosis.

A

False, it is poorly tolerated in advanced cirrhotics

26
Q

T/F: Tx with IVIG can lead to transient HBcAB+?

A

True

27
Q

Which women should get HBV tx in 3rd TM of pregnancy?

A

if VL > 200,000

28
Q

Which HBV tx approved in pregnancy?

A

Tenofovir, telbivudine

29
Q

What are 1st line drugs in HBV when needed?

A

Tenofovir or entecavir

30
Q

Decomp cirrhosis with CTP-B - what should be used for tx?

A

Ledipasvir + sofosbuvir + ribavirin

31
Q

If pt with HBV and seroconverts from eAB-/eAg+ to eAB+/eAg- while on tx with entecavir what should be done going forward?

A

Continue tx for 1 year after seroconversion prior to discussing d/c meds

32
Q

When should start HCC surveillance in black man without cirrhosis with HBV?

A

Age 40, like Asian

33
Q

Who to tx for HBV?

A

if eAg- : ALT > 2x ULN and DNA > 2K

If eAg+ : ALT > 2x ULN and DNA > 20K

34
Q

What are CI to PEG-IFN?

A

Psych dz, decomp cirrhosis, AI dz, cytopenias, cardiac dz

35
Q

Who is at risk of HSV hepatitis?

A

ICed and post partum pts

36
Q

Who is at higher risk of HEV infxn?

A

Men over 40 esp after exposure to farm animals

37
Q

T/F: Hepatitis A can have a relapsing course that can go on for up to a year.

A

True

38
Q

post exposure ppx for HAV?

A

Vaccine in 1-40 yo, IG in > 40 yo

39
Q

Post TP pt with CMV - what to tx with?

A

IV ganciclovir or PO valganciclovir

40
Q

T/F: HBV with cirrhosis should be tx for HBV regardless of LFTs.

A

True - may help induce some regression of histology

41
Q

Which HCV med cannot be combined with amiodarone?

A

Sofosbuvir - can lead to life threatening arrhythmias

42
Q

Which HCV med cannot be combined with statins?

A

glecaprevir/pibrentasvir - risk of rhabdo with statins

43
Q

WHat can be used to tx HCV in renal dz pts with severe dz or on HD?

A

GT1 - elbasvir/grazoprevir

GT1-6 - glecaprevir/pibrentasvir

Gastro Review (15 decks)

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