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therapeutics V > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

Symptoms of hepatitis

A

-nausea
-anorexia
-fever
-malaise
-abdominal pain
-jaundice or elevated transaminases

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2
Q

chronic infection can be produced by

A

HBV and HVC

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3
Q

HAV main transmission

A

fecal-oral

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4
Q

HBV main transmission

A

-blood
-sexual

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5
Q

HCV main transmission

A

blood

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6
Q

hepatitis viruses that can be transmitted perinatally

A

-HBV
-HCV

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7
Q

HCV is/isnt curative

A

is

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8
Q

HBV is/isnt curative

A

isnt

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9
Q

which hepatitis virus does not have protective immunity or a vaccine

A

HCV

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10
Q

you can be reinfected with

A

HCV

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11
Q

Hep A is classification

A

picornavirus

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12
Q

HAV incubation period

A

28 days

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13
Q

HAV risk groups

A

-international travelers
-men who have sex w/ men
-people who use or nject drugs
-people who anticipate close personal contact w/ an international adoptee
-homeless

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14
Q

HAV presntation

A
  • <6yo -> asymptomatic, no jaundice
    -adults -> symptomatic, jaundice
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15
Q

HAV symptoms
abrupt onset

A

-abdominal pain, n/v
- dark urine or clay colored stools
-diarrhea
-fatigue
-fever
-jaundice
-loss of appetite

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16
Q

HAV diagnosis and testing

A

diagnosis of acute HAV requires:
-IgM anti-HAV in serum (detectable w/in 5-10 days)
-HAV RNA in serum or stool
immunity:
-total anti-HAV

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17
Q

HAV prevention

A

vaccines:
-HAVRIX @ 0 and 6-12 mo
-VAQTA @ 0 and 6-18 mo
-Twinrix @ 0, 7, and 6mo

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18
Q

Post exposure HAV

A

-single agent vaccine to persons > 12 mo
-immune globulin given to those <12 mo
-vaccine and immune globulin >40

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19
Q

Hep B is classified as

A

hepadnavirus

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20
Q

HBV incubation

A

90 days to onset of jaundice and 60 days to onset of abnormal ALT levels

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21
Q

HBV cannot be spread through

A

food, water, sharing eating utensils, breastfeeding, kissing, coughing, sneezing

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22
Q

Hep B presentation

A
  • < 5 -> asymptomatic
  • > 30yo -> symptomatic
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23
Q

Hep B symptoms

A

-abdominal pain, n/v
- dark urine or clay colored stools
-fatigue
-fever
-jaundice
-loss of appetite

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24
Q

Chronic HBV is typically

A

asymptomatic until onset of cirrhosis, end stage liver disease or hepatocellular carcinoma

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25
HBV Serologic markers
-Hepatitis B surface antigen -Antibody to hepatitis B surface antigen -antibody to hepatitis B core antigen -immunoglobulin M class of antibody to hep b core antigen
26
Hep B surface antigen (HBsAg)
presence of infection
27
Antibody to hep b surface antigen (anti-HBs)
shows immunity
28
antibody to hep b core antigen (total anti-HBc)
exposure to hep b
29
immunoglobulin M class of antibody to Hep B core antigen (IgM anti-HBc)
recent exposure to virus
30
HBV first line tx
-tenofovir alafenamide -entecavir -first line cytokine -> peginterferon alfa
31
e+ immune tolerant
-normal ALT -elevated HBV DNA
32
e+ immune-active
-elevated ALT -elevated HBV DNA
33
e+ Cirrhosis
-elevated ALT -elevated HBV DNA -low albumin, low platelets
34
e- inactive (carrier)
-normal ALT -low/undetectable HBV DNA
35
e- immune reactivation
-elevated ALT -elevated HBV DNA
36
e- cirrhosis
-elevated ALT -elevated HBV DNA -low albumin, low platelets
37
upper limit of norm for ALT
- 35U/L for men -25 U/L for women
38
Peg-IFN-2a AEs
-flu like symptoms -fatigue -mood disturbances -cytopenia -autoimmune disoreders -anorexia
39
Peg-IFN-2a monitoring
-CBC -TSH -q3mo
40
Entecavir AEs
-lactic acidosis (decompensated cirrhosis)
41
Entecavir monitoring
-lactid acid levels -test for HIV
42
tenofovir disoproxil fumarate AEs
-nephrotoxicity -fanconi syndrome -osteomalacia -lactic acidosis
43
tenofovir disoproxil fumarate monitoring
-crcl -bone density -lactid acid levels
44
tenofovir alafenamide AE
lactid acidosis
45
Tenofovir aafenamide monitoring
-lactic acid levels -crcl -test for HIV
46
HBV reactivation
-flare of disease symptoms -can be severe or fatal -risk factors: --chemo, high dose steroids, hiv infection, organ or bone marrow transplant, HCV
47
HBV prevention
single agent vaccines -engerix-b -recombivax HB -heplisav-b combo vaccine -pediarix -vaxelis -twinrix 3 injections, @ 0, 1, and 6mo
48
HEP C classification
flavivirus
49
HCV genotypes
-7 major genotypes (1-7) -67 subtypes (a,b,c,ect) -1a and 1b are most common
50
HCV transmission
large or repeated percutaneous exposures to infected blood
51
HCV acute infection symptoms
-most asymptomatic
52
HCV chronic infection symptoms
-chronic fatigue and depression -right upper quadrant pain -nausea -poor appetite -hepatomegaly
53
HCV diagnosis and tests
-anti-HCV (8-11weeks) --> not diagnostic - HCV RNA (1-2 weeks) --> diagnostic
54
HCV treatment
-subcutaneous interferon + ribavirin -direct acting antivirals (DAAs) in combo
55
NS3/4A protease inhibitors MOA
CYP3A4 inhibition
56
grazoprevir
-coformulated in zepatier -AEs: fatigue, nausea , insomnia, ALT elevation
57
glecaprevir
-coformulated -> mavyret -AEs: headache, fatigue
58
voxilaprevir
-coformulated -> vosevi -pts previously treated with an ns5a
59
NS5B polymerase inhibitors end in
-buvir
60
NS5B polymerase inhibitors MOA
inhibits RNA NS5B polymerase responsible for HCV replication -nucleotide analog competes for enzyme active site -nonnucleoside agent bind at an allosteric site
61
sofosbuvir AEs
-fatigue, ha
62
sofosbuvir dose
400mg po qd
63
NS5A replication complex inhibitors end in
-asvir
64
NS5A replication complex inhibitors MOA
inhibit NS5A prot needed for RNA replication and assembly
65
NS5A replication complex inhibitors have a ________ resistance barrier and are ______ potent
low; very
66
Elbasvir screening
-NS5A genotype must be preformed - screen for presence of RAS substitutions at baseline -mutations at codons 28, 30, 31, or 93 requires 8 week duration + ribavirin
67
Elbasvir dosing
-zepatier - 100mg po qd
68
Velpatasvir dosing
- 100mg po qd
69
Velpatasvir coformulations
-epclusa -vosevi
70
Velpatasvir genotypes
approved for all genotypes
71
Velpatasvir genotype 3
-Y93H substituition -> add ribavirin or voxilaprevir
72
Zepatier componet class
NS5A inhibitor + NS3/4A protease inhibitor
73
Zepatier componets
-Elbasvir -grasoprevir
74
Zepatier dose
1 tab qd
75
Mavyret componets
-pibrentasvir -caprevir
76
Mavyret componet class
NS5A inhibitor + NS3/4A protease inhibitor
77
Mavyret dosing
3 tabs qd W/ FOOD
78
Vosevi componets
-velpatasvir -sofosbuvir -voxilaprevir
79
Vosevi componets class
NS5A inhibitor + NS5B polymerase inhibitor + NS3/4A protease
80
Vosevi dosing
t1t po qd
81
Harvoni componets
-ledipasvir -sofosbuvir
82
Harvoni componet classes
NS5A inhibitor + NS5B polymerase inhibitor
83
Harvoni dose
t1t po qd
84
Epclusa componets
-velpatasvir -sofosbuvir
85
Epclusa componet classes
NS5A inhibitor + NS5B polymerase inhibitor
86
Ribavirin MOA
unknown guanosine analog
87
Ribavirin dose
-weight based - 1000mg if <75kg -1200mg if > 75kg
88
Ribavirin AEs
-hemolytic anemia, pancreatitis pulmonary dysfunction, insomnia, pruritis
89
Ribavirin counseling points
-teratogenic -contraindicated in pt w/ crcl <50ml/min
90
Ribavirin monitoring
CBC -hgb<10 -> decrease dose -hgb <8.5 -> discontiue
91

therapeutics V (19 decks)

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