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NAPLEX > hepatitis and liver disease > Flashcards

hepatitis and liver disease Flashcards

1
Q

hepatitis a virus causes an ___, self limiting illness

A

acute

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2
Q

hep a transmission through

A

fecal oral
improper handwashing after exposure to a contaminated person
or
via contaminated food/water

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3
Q

hep b and c are more ___

A

serious

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4
Q

hep b an c can cause

A 
acute illness leading to chronic infection
cirrhosis of the liver
liver cancer
liver failure
and death
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5
Q

how are hep b and c transmitted

A

through blood and body fluids

having sex with an infected person, sharing contaminated needles, infected mother to newborn

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6
Q

which hep virus is only acute and doesnt lead to chronic infection

A

hep a

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7
Q

which hep virus is fecal oral

A

hep a

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8
Q

which two hep virus has vaccine

A

hep a and b

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9
Q

first line tx for hep a

A

supportive care

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10
Q

first line tx for hep b

A

PEG-INF or NRTI (tenofovir or entecavir)

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11
Q

first line tx for hep c

A

Direct acting antiviral combination

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12
Q

preferred tx regimen for hep c infection

A

2-3 direct acting anti virals with different mechanisms for 8-12 weeks

some combos include ritonavir which is used to boost the protease inhibitor levels

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13
Q

mavyret combo and epclusa combo are preferred for tx naive patients what are in these

A

glecaprevir/pibrentasvir (PI (NS3/4A)/ replication complex inhbitor (ns5a))

sofosbuvir/ velpatasvir (polymerase inhbitor (NS5B)/ replication complex inhibitor (NS5A))

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14
Q

Previrs mechanism

A

protease inhibitors with food
work at the NS3/4A

P for PI

glecaprevir
grazoprevir
paritaprevir
voxilaprevir

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15
Q

Asvirs mechanism

A

replication complex inhibitors
works at Ns5A

A for NS5A

ledipasvir
ombitasvir
pibrentasvir
velpatasvir

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16
Q

Buvir mechanism

A

polymerase inhibitors
works at NS5B

B for NS5B

Dasabuvir
Sofosbuvir

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17
Q

what do protease inhibitors for HCV and HIV have in common

A

must take with food

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18
Q

all direct acting antiviral boxed warning

A

risk of reactivating HBV

test all patients for HBV before starting DAA

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19
Q

warning for sofosbuvir containing regimens

A

serious symptomatic bradycardia when taking amiodarone

DO NOT USE THESE TWO TOGETHER

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20
Q

do not use sofosbuvir containing regimens with what other med

A

amiodarone

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21
Q

generally DAA are ___ ___

A

well tolerated

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22
Q

sofosbuvir/velpatasvir is what

A

epclusa

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23
Q

sofosbuvir monotherapy

A

not recommended obviously lol

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24
Q

solvaldi, epclusa, harvoni, vosevi

A

protect from moisture and dispense in original container

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25
eplcusa, harvoni, vosevi avoid/ minimize
acid suppressive therapy
26
two best combos for tx naive hcv patients
mavyret and epclusa
27
sofosbuvir/ledispasvir
harvoni
28
take mavyret with
food
29
glecaprevir/pibrentasvir
mavyret
30
approved for salvage therapy (failed previous therapy)
vosevi, mavyret
31
approved for 8 week course of therapy
mavyret
32
approved for hcv,hiv co infection
epclusa, harvoni, mavyret
33
approved for children 12 or greater with certain genotyes
sovaldi and harvoni
34
all direct acting antivirals are CI with strong cyp 3a4 ____
inducers | PSPORCS
35
most DAA increase the concentration of ____ which increases myopathy risk
statins
36
DAA and insulin, might need to decrease the dose of ___ to avoid ___
insulin, hypoglycemia
37
do not use mavyret with
efavirenz HIV protease inhibitors (atazanavir, darunavir, lopinavir, ritonavir) ethinyl estradiol containing products cyclosporine
38
antacids h2ras and ppis can decrease the concentrations of ___ and ___ seperate by 4 hours
ledispasvir and velpatasvir | harvoni,epclusa,vosevi
39
using ppis with __ is not recommended
epclusa
40
technivie and viekira pack are CI with
strong inducers of cyp 3a4, ethinyl estradiol products, lovastatin and simvastatin
41
ribavirin is oral it is used
not alone but in combo for hCV
42
boxed warnings for ribavirin
teratogenic effects | hemolytic anemia
43
ribavirin is CI in
pregnancy!!
44
SE of ribavirin
hemolytic anemia
45
ribavirin notes
avoid preg. in females during therapy and 6 months after completion 2 reliable forms of contraception during tx and 6 months following
46
interferons are approved dfor tx of
hbv and hcv
47
pegylated forms prolong the
half life and reduce the dosing to once weekly
48
interferons are injected _
sc
49
interferons do not provide a cure and have lots of __
toxicities
50
what does interferon alfa treat
HBV, HCV, some cancers
51
what does interferon beta treat
multiple sclerosis
52
interferon alfa boxed warnings
``` can cause or exacerbate neuropsychiatric autoimmune ischemic infectious disorders ```
53
SE for interferons
CNS effects (fatigue, depression) GI upset increase LFTS (5-10x ULN) myleosupression FLU like syndrome (fever, chills malaise, pre treat with tylenol and an antihistamine)
54
do you pretreat with interferons
yes tylenol and antihistaine
55
hep b treatment
interferon monotherapy and is preferred treatment | nrtis can also be used to treat HBV
56
if starting an NRTI for HBV patient needs to be tested for HIV because
you can use and anti viral that treats both at the same time
57
all HBV NRTIS have boxed warning for
lactic acidosis and severe hepatomegaly with steatosis | can be fatal
58
NRTIS renal dosing
crcl less than 50 decrease dose or frequency
59
3 preferred NRTI therapy for HBV
viread (TDF) vemlidy (TAF) entecavir (baraclude)
60
lamivudine brand for HBV
epivir HBV
61
do not use epivir hbv (lamivudine) in patients with
HIV
62
warnings with TAF (vemlidy) and TDF (viread)
renal toxicity fanconi syndrome osteomalacia decrease bone mineral density
63
SEs TDF (viread)
renal impairment | decrease BMD
64
SEs TAF (vemlidy)
nausea
65
vemlidy (taf) only approved for
HBV
66
cirrhosis is advanced __ of the liver
scarring
67
causes of cirrhosis
hep c and alcohol
68
pain in the liver is presented as
upper right quad
69
liver enyzmes
ast (aspartate aminotransferase) alt (alanine aminotransferase) normal range 10-40 units
70
other signs of liver disease labs
``` decreases albumin increase alk phos or ALP increase total bilirubin increase lactate dehydrogenase increase prothrombin time ```
71
hepatic panel
ast, alt, Tbili, alk phos | all increased in chronic liver disease
72
scoring systems for liver disease
child pugh and meld
73
child pugh 0-15
``` class a mild disease less than 7 class b moderate disease 7-9 class c severe disease 10-15 ```
74
meld 0-40
higher number is greater risk of death in 3 months
75
kava is a natural ___
hepatotoxin
76
milk thistle is used in people with
liver disease
77
hepatotoxic drugs are usually stopped when what
when the LFTS are GREATER than 3x the upper limit of normal | >150u/L of ast/alt
78
nsaids should be avoided in patients with cirrhosis!! why
it can lead to decompensation including bleeding
79
drugs with boxed warning for liver damage
``` acetaminophen (high doses) amiodarone isoniazid ketoconazole methotrexate nefazodone nevirapine nrtis ptu tipranavir valproic acid ```
80
benzos are used for | anticonvulsants are used for
alcochol withdrawl in inpatients | outpatients
81
what medications are used to prevent relapses in patients with alcohol associated liver disease
naltrexone (vivitrol) acamprosate disulfiram ( antabuse)
82
what vitamin is used to prevent and treat wernike-korsakoff syndrome
thiamine
83
wernickes is due to __ damage cause by lack of vitamin B ___
brain, B1
84
one complication of liver disease is ___ hypertension which can lead to bleeding of the veins in the ____
portal | esophagus
85
acute variceal bleeding can be ___
fatal
86
tx of a variceal bleed
band ligation and sclerotherapy are first line medication after: octreotide (sandostatin) or vasopressin short term abx for up to 7 days (ceftriaxone or quinilone) after resolution of variceal bleed add non selective beta blocker for prevention of a secondary bleed
87
vasoconstricting medications for variceal bleed
sandostatin (ocreotide) IV | vasopressin IV
88
sandostatin is selective for the splanic vessels where as __ is not
vasopressin is not
89
vasopressin is a
antidiuretic hormone analog (not first line)
90
ocreotide (sandostatin) SE
bradycardia, cholelithiasis, biliary sludge
91
beta blockers reduce __ pressure
portal
92
non selective BBs for use after variceal bleed
nadolol (corgard) | propanolol (inderal)
93
do not withdraw ___ abrubtly
BBs | taper over 1-2 weeks to avoid tachycardia, HTN
94
avoid non selective BBs in patients with __ and___
asthma/ copd
95
hepatic encephalopathy think __
ammonia
96
hepatic encephalopathy symptoms
musty odor of breath | changes in thinking, confusion, forgetfulness
97
symptoms of HE result from an accumulation of gut derived nitrogenous substances in the blood (such as ___)
ammonia, glutamate)
98
tx for HE includes reducing
blood ammonia levels through diet (limiting the amount of animal protein) and drug therapy
99
HE happens because ___ isnt working properly to remove ammonia
liver
100
drug therapy for HE include
lactulose | rifaximin
101
what is first line therapy for HE (acute and chronic (prevention))
lactulose
102
how does lactulose work
by converting ammonia produced by intestinal bacteria to ammonium which is polar therefore cannot readily diffuse into the blood
103
lactulose is also used for
constipation
104
SE of lactulose
flatulence diarrhea dyspepsia abdominal discomfort
105
what is ascites
fluid accumulation within the peritoneal space can lead to peritonitis
106
ascites tx
restrict dietary sodium intake ``` spironolactone monotherapy or spironolactione+lasix 40 mg Furosemide: 100 mg spironolactone important to maintain potassium levels in these patients never use lasix alone ``` all patients with cirrhosis and ascites should be considered for liver transplant
107
tx of spontaneous bacterial peritonitis
acute infection of the ascitic fluid tx with ceftriaxone 5-7 days (target strep and enteric gram neg. pathogens)
108
nrtis can cause BBW
lactic acidosis
109
take entecavir on an ___ stomach
empty
110
ribavirin is teratogenic and can cause what else
hemolytic anemia

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