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Fall Therapeutics > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

Hepatitis A: patho and cf

A

-Fecal oral transmission
-Usually benign, self limited
-Age < 6: 70% asym
-Age > 6: 70% asym with jaundice
-Fulminant hepA occurs in < 1%, <11 or >40 at more risk
-No chronic hepA
-Sero testing for diagnosis

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2
Q

Hepatitis A: TX

A
  • No specific therapy
  • Abstain from hepatotoxins
  • Alcohol
  • Hepatotoxic drugs
  • Adjust hepatically eliminated drugs
  • Prevention
  • Hand-washing
  • Good hygiene
  • Avoiding risky environments
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3
Q

Hepatitis A: Prevention

A
  • Passive prophylaxis –Immunoglobulin
  • Short duration of protection
  • Mainly used for post-exposure prophylaxis
  • Dose: 0.02 mL/kg IM ASAP (no later than 2 weeks after exposure)
  • Active immunization - vaccine
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4
Q

Hepatitis A Vaccine

A

Recommended for high-risk groups
-Travelers to highly or intermediate endemic areas
-Children living in communities with high HAV
-Men who have sex with men
-IVDA
-Occupational risk
-Clotting factor disorders
-Chronic liver disease

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5
Q

Interpretation of Hepatitis B Serologic Markers

A
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6
Q

Hepatitis B Risk Factors

A
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7
Q

Hepatitis B: cf

A

Similar to other hepatitis viruses

Extrahepatic manifestations:RAG
* Arthralgias, rash
* Glomerulonephritis

Acute Liver Failure or Fulminant Hepatic Failure: HELT
* Onset of hepatic encephalopathy within 8 weeks of sx
* Poor prognosis
* Supportive care and liver transplantation

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8
Q

HBV TX Algorithm
-HBsAg positive and HBeAg positive

A
  1. ALT =< 35 M, 25 F
  2. ALT >25,35 but <50,70
  3. ALT > 50, 70
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9
Q

HBV TX Algorithm
-HBsAg positive and HBeAg negative

A
  1. ALT =< 35 M, 25 F
  2. ALT >25,35 but <50,70
  3. ALT > 50, 70
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10
Q

HBV TX: Peg-IFN-α2a

A

180 mcg SW weekly, 48 weeks

AE: peggy is a CFAM BAT
-Flu-like ss, fatigue, HA
-Mood disturbances
-Cytopenias, autoimmune disorders
-Anorexia, myalgias
-Later: BMS, thyroid, alopecia

CI: decompensated cirrhosis

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11
Q

HBV TX: Entecavir (Baraclude®)

A

-0.5 mg usually
-or 1.0 mg for resistance/refractory pts

AE: enter LAF HAND
-Lactic Acidosis
-dizzy
-HA
-fatigue
-nausea

-In lamivudine resistance, lamivudine should be D/C when switched to entecavir

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12
Q

HBV TX: Tenofovir disoproxil (Viread®) READ the vampire diaries TVD

A

300 mg po daily

AE: NNNOF HALF
-HA, nausea, fatigue
-Nasopharyngitis
-Nephropathy
-Fanconic syndrome
-Osteomalacia, low BD
-Lactic Acidosis

*more potent + less nephrotoxic than TA

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13
Q

HBV TX: Tenofovir alafenamide (Vemlidy®)TA LIDY titty

A

25 mg po daily

Prodrug

AE: LL NN HF
-Lactic Acidosis
-HA, nausea, fatigue
-Nasopharyngitis
-Lower renal/bone effects

Not in Clcr < 15 ml/min or in dialysis

Also a component of Biktarvy for HIV = dual treatment

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14
Q

Peg IFN contraindicated in

A

-autoimmune
-uncontrolled psychiatric disease
-cytopenias
-severe cardiac disease
-uncontrolled seizures
-decompensated cirrhosis

CCCAPS

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15
Q

Previous history of lamivudine resistance

A

avoid entecavir

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16
Q

HBV Reactivation in Patients Receiving Immunosuppression

A

-Consider in cancer, transplant, autoimmune pts

HBsAg (+) or (- ) and antiHBc (+)

Monitor HBV DNA, HBsAg seroconversion, ALT/AST

Prophylactic antiviral therapy with entecavir or tenofovir

6-12 months after discontinuation of immunosuppression

17
Q

Chronic Hepatitis B – Additional Lifestyle Modifications

A
  • Limit or abstain from alcohol
  • Optimize body weight and prevent metabolic complications (i.e. T2D, dyslipidemia)
  • Hepatitis A immunization
18
Q

Recommendation for Infected Persons Regarding Prevention of Transmission to Others

A

-Have household/sexual partners vaccinated
-Use protection during intercourse if partner not vaccinated/immune
-Not share toothbrushes/razors/needles
-Cover open cuts/scratches
-Not donate blood/sperm/organs

19
Q

Hepatitis C – cf

A

-Chronic infection develops in 80%
-Cirrhosis develops in 20%
-Hepatocellular carcinoma (HCC) risk = 1-4% per year

Extrahepatic manifestations
* Glomerulonephritis
* Mixed cryoglobulinemia
* Corneal ulcers
* Rheumatoid arthritis

CCC GRH

20
Q

HCV TXS: DAAs

A
  • High response rates
  • “Interferon-Free”
  • Ribavirin still in guidelines for some difficult-to-treat populations
  • All Oral
  • Shorter durations (8-12 weeks)
  • Well tolerated
  • Use multiple agents in combination to maximize efficacy and minimize resistance
21
Q

Goal of HCV therapy is sustained viral response (SVR)

A

= absence of detectable viral RNA 12 weeks after completion of therapy

22
Q

Drugs for Genotypes

A

Elbasvir/grazoprevir (Zepatier)
= 1, 4

Sofosbuvir/ledipasvir (Harvoni)
= 1, 4, 5, 6

others = all (1-6)

23
Q

Sofosbuvir (Solvaldi®)

A

AE: Fatigue, HA

Avoid strong inducers of intestinal P-gp

-Risk of Hepatitis B reactivation

Amiodarone = serious bradycardia

ss RPH FA

24
Q

Ledipasvir/Sofosbuvir (Harvoni®)

A

AE: Fatigue, HA

Avoid strong P-gp inducers

-Risk of Hepatitis B reactivation

Amiodarone = serious bradycardia

LSH RPH FA

25
Elbasvir/Grazoprevir (Zepatier®)
AE: Fatigue, HA, nausea Avoid strong inducers of CYP3A and OATP1B inhibitors, efavirenz, strong CYP3A inhibitors CI: Childs Class B or C hepatic failure; DDIs **GEEZ hf BECCON**
26
Sofosbuvir/Velpatasvir (Epclusa®)
AE: Fatigue, HA Avoid strong inducers of P- gp; avoid PPIs and other drugs that increase gastric pH -Avoid amiodarone, carbamazepine, rifampin, phenytoin, phenobarbital, SJW -Give H2RAs 12 hrs apart -No PPIs, but 4 hours before omeprazole 20 mg -Rosuvastatin <= 10 mg, monitor for SAMS DDI **CRAPPS** H12 O204 R10
27
Sofosbuvir/Velpatasvir/ Voxilaprevir (Vosevi®)
AE: Fatigue, HA, diarrhea, nausea DDI: -Rifampin -Carbamazepine -St. John’s wort -Amiodarone CI: -Childs Class B or C hepatic failure; DDIs **he DRANCS BC of vose**
28
Glecaprevir/pibrentasvir (Mavyret®)
CAE: Fatigue, HA DDI: -Rifampin -Carbamazepine -St. John’s wort -HMG-CoA reductase inhibitors *decrease pravastatin by 50% *rosuvastatin at <= 10 mg *don't use ator/lova/simva CI: -Child’s Class C -rifampin -atazanavir **mav's did cpr for his CCARSS**
29
Simplified HCV Treatment Algorithm Treatment-Naïve, No Cirrhosis, All Genotypes
Calculate FIB-4 Score (FIB-4 > 3.25 = cirrhosis) = not eligible 1. Glecaprevir (300 mg) / pibrentasvir (120 mg) taken with food for a duration of 8 weeks 2. Sofosbuvir (400 mg) / velpatasvir (100 mg) for a duration of 12 weeks
30
HCV Post Treatment Assessment
HCV RNA and a hepatic function panel are recommended 12 weeks or later Assessment for other causes of liver disease is recommended for patients with elevated transaminase levels after achieving SVR If cure not achieved: -assessment for disease progression every 6 to 12 months with a hepatic function panel, CBC, and INR is recommended
31
Zepatier Name
Elbasvir / Grazoprevir
32
Harvoni Name
Sofosbuvir / Ledipasvir
33
Epclusa Name
Sofosbuvir / Velpatasvir
34
Mavyret Name
Glecaprevir / Pibrentasvir
35
Vosevi Name
Sofosbuvir / Velpatasvir / Voxilaprevir **use when DAA tx failure

Fall Therapeutics (34 decks)

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