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ID > HEPATITIS > Flashcards

HEPATITIS Flashcards

1
Q

Type A

A

ssRNA
fecal-oral transmission
acute
NOT oncogenic

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2
Q

Type B

A

dsDNA
blood borne and/or sexual
acute &/or chronic
YES oncogenic

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3
Q

Type C

A

ssRNA
blood borne and/or sexual
chronic
YES oncogenic

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4
Q

Type D

A

ssRNA
blood borne and/or sexual
Chronic
UKNOWN oncogenic

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5
Q

Type E

A

ssRNA
Fecal-oral transmission
chronic
NOT oncogenic

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6
Q

Score 1 =

A

mild fibrosis
fibrous portal expansion
periportal fibrotic expansion

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7
Q

Score 2 =

A

moderate fibrosis
rare bridges or septa
periportal septa (>1 septum)

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8
Q

Score 3 =

A

severe fibrosis
numerous bridges or septae
portal-central septae

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9
Q

Score 4 =

A

cirrhosis
numbered bridges or septa
cirrhosis

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10
Q

Class A =

A

5-6 points
least severe liver disease

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11
Q

Class B =

A

7-9 points
moderately severe liver disease

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12
Q

Class C =

A

10-15 points
most severe liver disease

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13
Q

HBsAg

A

Hep B SURFACE
- Detectable at sx onset (acute and chronic)

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14
Q

HBeAg

A

Hep Be
- marker of replication and infectivity

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15
Q

Anti-HBeAg

A

-replaces HBeAG once infection or NO HBV replication
-reversion to HBeAg+ may occur

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15
Q

Anti-HBsAg

A

develops from HBV infection OR vaccination

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15
Q

HBcAg

A

Hep B core
- protein promoting immune-mediated cell death
- ONLY present infection

16
Q

IgM Anti-HBcAg

A

-detectable in acute (< 6mo)

17
Q

IgG Anti-HBcAg

A

-replaces IgM Ab and PERSISTS LIFELONG (chronic >6mo)

18
Q

Pegylated Interferon a-2a, a-2b (Pegasus, Pegintron) MOA and dose

A
  • inhibit viral replication, immunomodulatory; seroconversion advantage over PO anti-HBV agents
  • Peg-IFN a-2a( 18+mo) = 180 mcg SQ weekly
  • IFN a-2b (1+ y) = 3M IU/m2 SQ 3x/wk then 6M IU/m2 SQ 3x/wk
19
Q

Pegylated Interferon a-2a, a-2b (Pegasus, Pegintron)
CONTRAINDICATIONS

A
  • uncontrolled major depression
  • suicidal ideation
  • autoimmune hepatitis or disease
  • solid organ transplant
  • decompensated cirrhosis or HCC
  • uncontrolled thyroid disorder
20
Q

Entecavir (Baraclude)
MOA, dose

A
  • guanosine nucleoside analog inhibits HBV DNA replication
  • 0.5mg PO daily (naive)
  • 1mg PO daily (lamivudine resistance/refractory)
  • wt-based (peds; 2+yo)
  • dose reduction in renal dx
21
Q

Entecavir (Baraclude)
administration

A

EMPTY STOMACH; > 2H before or after meal
–well-tolerated. stopping abruptly = HBV exacerbated

22
Q

Tenofovir disoproxil fumarate (TDF, Viread)
MOA & dose

A
  • adenosine nucleotide analog inhibits HBV DNA replication
  • 35+ kg: 300mg PO daily
  • 2 oz and 10 + kg: wt-based
  • dose reduction in renal dysfunction
23
Q

Tenofovir disoproxil fumarate (TDF, Viread)
ADE

A

-nausea, nephrotoxicity, osteomalacia, Falconi syndrome
- stopping abruptly=HBV exacerbation

24
Q

Tenofovir alafenamide (TAF, Vemlidy)
MOA & dose

A
  • Phosphonamidate prodrug of tenor; adenosine nucleotide analog inhibits HBV DNA replication
  • adults (18+): 25mg PO daily w/ food
  • **AVOID ECrCl , 15mL/min
25
Q

Tenofovir alafenamide (TAF, Vemlidy)
ADE

A
  • stopping abruptly=HBV exacerbation
  • HA, ab pain, cough, backache, fatigue
  • Less BMD decreases and nephrotoxicity vs TDF
26
Q

Non-preferred HBV Therapy

A
  • lamivudine (Epivir-HBV)
  • Emtricitabin (Emtriva)
  • Adefovir (Hepsera)
  • Telbivudine (Tyzeka)
26
Q

HBV/HIV Co-infection

A

-Emtricitabine, lamivudine, TDF & TAF
-TDF/em;la TAF/em

27
Q

HBV/HIV Co-infection alternative

A

entecavir w/ suppressive HIV regimen
continue HBV active agents if HIV virologic failure

28
Q

Adults DOT

A

Nucleos(t)ide analogs:
- 12+ for HBeAg w/ or w/o cirrhosis….NOT FINISHED
- Peg-IFN-a: 48 wks

29
Q

Children DOT

A

IFN-2b: 24 weeks
antivirals: > 1yr until > 1 yr after HBeAg seroconversion

30
Q

HCV Testing Recommendations

A
  • 1-time, routine, opt out for 18 & 18+
  • 1-time 18-<18 y if risky activities, exposures, or conditions or circumstances
  • routine prenatal care w/ each pregnancy
  • periodically if risky activities, exposures, or conditions/ circumstances
  • annually: IVDU, HIV (+) MSM unprotected sex, and MSM taking PrEP
31
Q

DAAs MOA

A

Direct acting antivirals (DAAs): target specific nonstructural (NS) proteins for HCV leading to disruption in viral replication and infection

31
Q

HCV Life Cycle

A
  1. receptor binding & endocytosis
  2. Fusion & uncoating
  3. Translation & polyprotein processing
  4. RNA replication
  5. Virion assembly
  6. transport & release
31
Q

Velpatasvir/sofosbuvir (Epclusa) -PANGENOTYPIC
DDIs

A
  • H2RAs: simultaneously w/ or 12hrs apart; avoid comparable doses > famotidine 40mg BID
  • PPIs: not recommended; if needed, take Epclusa W/ FOOD & 4hrs before Omeprazole 20mg daily
  • indicated for GT 1-6
  • 3+
32
Q

Ledipasvir/sofosbuvir (Harvoni)
DDIs

A
  • H2RAs: simultaneously w/ or 12hrs apart; avoid comparable doses > famotidine 40mg BID
  • PPIs: simultaneously w/ fasting conditions; avoid comparable doses > omeprazole 20mg daily
  • indicated for GT 1,4,5,6; GT1 decomposition cirrhosis + RBV; GT1 or 4 liver transplant pt w/o cirrhosis or compensated cirrhosis + RBV
  • 3+
32
Q

Glecaprevir/pribrentasavir (Mavyret)

A

-take with food
- CI: mod-sev. hepatic impairment (CTP class B or C); h/o prior hepatic decompression; coadministration w/ atazanavir and rifampin
- indicated for GT 1-3, GT1 prev. treated w/ NS5A or NS3/4A
- 3+

33
Q

Elbasvir/grazoprevir (Zepatier)

A
  • CI: mod-sev hepatic impairment
  • indicated for GT 1 or 4
    –12+ and 30+ kg
33
Q

Sofosbuvir/velpatasvir/voxilaprevir (Vosevi)

A
  • take w/ food
  • DDI: many! see Epclusa
  • CI: coadministration with rifampin
  • indicated for GT 1-6, GT 1a or 3
  • ADULTS

ID (8 decks)

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