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GI Exam 2 > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

What types of hepatitis are most likely to be asymptomatic?

A
  1. HBV
  2. HBC
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2
Q

What types of hepatitis is symptomatic?

A

HAV

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3
Q

What viral specific test is used for HAV?

A

IgM anti-HAV

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4
Q

What viral specific test is used for HBV?

A
  1. IgM anti-HBC (+)
  2. HBsAG (+)
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5
Q

True or False: HAV is preventable

A

True

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6
Q

True or False: HAV is treatable

A

False

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7
Q

True or False: HAV is not curable

A

False

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8
Q

How is HAV transmitted?

A
  1. Person to person
  2. Ingestion of contaminated food/water
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9
Q

What patient population can be asymptomatic carriers to HAV?

A

Children

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10
Q

How long does HAV last?

A

2 months

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11
Q

What type of hepatitis is considered acute?

A

HAV

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12
Q

True or False: HAV has a high mortality rate

A

False

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13
Q

What patients are more susceptible to mortality with HAV?

A
  1. Older patients
  2. Ones with a waning immune system
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14
Q

What 6 clinical presentations are shown with HAV?

A
  1. Flu-like symptoms
  2. GI upset
  3. Dark urine
  4. Alcoholic stools
  5. Pruritis
  6. Jaundice and sclera icterus
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15
Q

True or False: There is no role for antiviral agents in HAV

A

True

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16
Q

What are the 2 key things for prevention in HAV?

A
  1. Vaccine
  2. Immunoglobulin
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17
Q

HAV vaccines are recommended for what age?

A

All children at 1 year of age

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18
Q

If previously unvaccinated for HAV, when should patients get the vaccine?

A

Prior to travel

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19
Q

What patients can utilize HAV immunoglobulin?

A
  1. Not previously vaccinated
  2. Immunocompromised patients
  3. Patients with chronic liver disease
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20
Q

When can short term pre-exposure prophylaxis with HAV immunoglobulin be used?

A

If traveling soon < 2 weeks

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21
Q

How long does pre and post exposure prophylaxis last with the 0.02 dose of immunoglobulin?

A

3 months

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22
Q

How long does pre and post exposure prophylaxis last with the 0.06 dose of immunoglobulin?

A

5 months

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23
Q

True or False: the immunoglobulin should only be used by itself and cannot be combined with the HAV vaccine

A

False

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24
Q

True or False: HBV is preventable

A

True

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25
Q

True or False: HBV is not curable

A

True

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26
Q

True or False: HBV is not treatable

A

False

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27
Q

How is HBV transmitted?

A
  1. Sexually
  2. Parenterally
  3. Perinatally
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28
Q

What can HBV cause?

A

Chronic hepatitis

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29
Q

What does HBV have a risk for? 2

A
  1. Cirrhosis
  2. Hepatocellular carcinoma
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30
Q

What are 7 risk factors for HBV?

A
  1. Multiple high risk sexual partners
  2. Men who have sex with men
  3. Injection-drug use
  4. Household contact
  5. Healthcare workers at risk for blood exposure
  6. Hemodialysis patients
  7. Travel to HBV endemic countries
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31
Q

What is the incubation period for HBV?

A

4-10 weeks

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32
Q

True or False: HBV can be self limiting or a seroconverting disease

A

True

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33
Q

-HBsAG: negative
- anti-HBc: negative
-anti-HBs: negative

A

Susceptible

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34
Q

-HBsAG: negative
- anti-HBc: positive
-anti-HBs: positive

A

Immune due to natural infection

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35
Q

-HBsAG: negative
- anti-HBc: negative
-anti-HBs: positive

A

Immune due to HBV vaccination

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36
Q

-HBsAG: negative
- anti-HBc: negative
-anti-HBs: negative
-IgM anti-HBC: positive

A

Acutely infected

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37
Q

-HBsAG: positive
- anti-HBc: positive
-anti-HBs: negative
-IgM anti-HBC: negative

A

Chronically infected

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38
Q

What is a marker for treatment success in HBV but is not present in all patients?

A

HBeAg

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39
Q

What are the 2 main drugs used to treat HBV?

A
  1. Tenofovir
  2. Entecavir
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40
Q

When should entecavir be taken?

A

On an empty stomach

41
Q

What does tenofovir have lower rates of?

A
  1. Renal
    AND
  2. Bone adverse effects
42
Q

Lamivudine has a _____ dose in HBV than in HIV

A

Lower

43
Q

What drug used in HBV can increase the immune response and inflammation?

A

Interferon-alpha

44
Q

What is the main ADE seen with interferon-alpha?

A

Neuropsychiatric disorders (depression)

45
Q

What HBV viral load is needed for treatment?

A

> 20,000

46
Q

What does the ALT threshold need to be for treatment in HBV?

A

> 2x upper normal limit

47
Q

How would you treat patients who are HBeAg positive?

A
  1. Treatment until HBeAg seroconversion to anti-HBeAg
  2. Undetectable HBV viral load
  3. Additional 6 months of treatment
48
Q

How would you treat HBeAg negative patients?

A

Until HBsAg clearance

49
Q

What does HBsAg show?

A

Surface antigens

50
Q

What does positive anti-HBc show?

A

No active immunity

51
Q

What does negative anti-HBc show?

A

Active immunity

52
Q

What does anti-HBs show?

A

Surface antibodies

53
Q

How many doses of HBV are needed at child birth?

A

3-dose series

54
Q

When should you administer HBV immunoglobulin for needle stick exposure?

A

< or = to 7 days

55
Q

When should you administer HBV immunoglobulin for sexual exposures?

A

< or = 14 days

56
Q

How long does HBV immunoglobulin provide passive antibody protection?

A

3-6 months

57
Q

True or False: HCV is not preventable

A

True

58
Q

True or False: HCV is treatable

A

True

59
Q

True or False: HCV is not curable

A

False

60
Q

What is the most common blood borne pathogen?

A

HCV

61
Q

What can chronic HCV result in?

A

End stage liver disease

62
Q

How is HCV transmitted?

A
  1. Parenterally
  2. Sexually
  3. Perinatally
63
Q

Blood transfusions or transplants before _________ is a risk factor for HCV

A

July 1992

64
Q

Clotting factors given before _____ is a risk factor for HCV

A

1987

65
Q

True or False: IVDU is a risk factor for HCV

A

True

66
Q

True or False: professionally done tattoos are a risk factor for HCV

A

False

67
Q

True or False: most patients are symptomatic in acute and chronic HCV

A

False (asymptomatic)

68
Q

What are the 2 laboratory criteria for diagnosing HCV?

A
  1. HCV RNA
  2. Anti-HCV antibodies
69
Q

What process in the HCV lifecycle do the drugs target?

A

Poly protein processing

70
Q

What is a black box warning for DAAs?

A

HBV reactivation

71
Q

What are two drug interactions for the DAAs?

A
  1. All contraindicated with strong CYP3A4 inhibitors
  2. Can increase the risk of myopathy with statin use
72
Q

What should you monitor for with simeprevir?

A

LFTs

73
Q

Simeprevir

A

OLYSIO

74
Q

What should you avoid using Sofosbuvir with? Why?

A

Amiodarone —> serious bradycardia

75
Q

What test should be used prior to using Olysio?

A

Resistance test

76
Q

Sofosbuvir/Ledipasvir

A

Harvoni

77
Q

What Sofosbuvir combination is approved in children?

A

Sofosbuvir/Ledipasvir (harvoni)

78
Q

Sofosbuvir/ Velpatasvir

A

Epclusa

79
Q

What Sofosbuvir combination has pan-genotyping therapy?

A

Sofosbuvir/ Veloatasvir (Epclusa)

80
Q

Sofosbuvir/ Velpatasvir/Voxilaprevir

A

Vosevi

81
Q

What Sofosbuvir combination is used for salvage therapy?

A

Sofosbuvir/ Velpatasvir/Voxilaprevir (Volsevi)

82
Q

For all Sofosbuvir combinations, what should they be separated from?

A
  1. Antacids
  2. H2RAs
  3. PPIs
83
Q

What DAA combination has higher rates of hepatic failure?

A

Viekira

84
Q

Ombitasvir/Paritaprevir/Ritonavir/Dasabuvir

A

Viekira

85
Q

What should you test for with Daclatasvir?

A

NS5A resistance

86
Q

What should you test for with Zepatier?

A

NS5A resistance

87
Q

What does Zepatier have a higher risk of?

A

LFT elevation

88
Q

How long is the Mavyret regimen?

A

8 weeks

89
Q

Elbasvir/Grazoprevir

A

Zepatier

90
Q

Glecaprevir/Pibrentasvir

A

Mavyret

91
Q

What are 2 things Mavyret are used for?

A
  1. Pan-genotypic
  2. Salvage therapy
92
Q

Mavyret has a lower drug interaction potential because it inhibits what?

A

P-glycoprotein

93
Q

How long is the duration for Harvoni?

A

12 weeks

94
Q

For Harvoni, what is needed for use?

A
  1. HIV uninfected
  2. HCV RNA < 6 million
95
Q

How long is the duration of Harvoni for HIV infected patients or with a viral load of >6 million?

A

12 weeks

96
Q

How long is the duration for Epclusa?

A

12 weeks

97
Q

What is used as an alternative for genotype 1a with cirrhosis?

A

Zepatier

98
Q

How long is Epclusa used for genotype 2 patients without cirrhosis?

A

12 weeks

99
Q

What should patients avoid after receiving DAA?

A

Excessive alcohol use

GI Exam 2 (11 decks)

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