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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
Q

eplcusa, harvoni, vosevi avoid/ minimize

A

acid suppressive therapy

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26
Q

two best combos for tx naive hcv patients

A

mavyret and epclusa

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27
Q

sofosbuvir/ledispasvir

A

harvoni

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28
Q

take mavyret with

A

food

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29
Q

glecaprevir/pibrentasvir

A

mavyret

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30
Q

approved for salvage therapy (failed previous therapy)

A

vosevi, mavyret

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31
Q

approved for 8 week course of therapy

A

mavyret

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32
Q

approved for hcv,hiv co infection

A

epclusa, harvoni, mavyret

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33
Q

approved for children 12 or greater with certain genotyes

A

sovaldi and harvoni

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34
Q

all direct acting antivirals are CI with strong cyp 3a4 ____

A

inducers

PSPORCS

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35
Q

most DAA increase the concentration of ____ which increases myopathy risk

A

statins

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36
Q

DAA and insulin, might need to decrease the dose of ___ to avoid ___

A

insulin, hypoglycemia

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37
Q

do not use mavyret with

A

efavirenz
HIV protease inhibitors (atazanavir, darunavir, lopinavir, ritonavir)
ethinyl estradiol containing products
cyclosporine

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38
Q

antacids h2ras and ppis can decrease the concentrations of ___ and ___

seperate by 4 hours

A

ledispasvir and velpatasvir

harvoni,epclusa,vosevi

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39
Q

using ppis with __ is not recommended

A

epclusa

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40
Q

technivie and viekira pack are CI with

A

strong inducers of cyp 3a4, ethinyl estradiol products, lovastatin and simvastatin

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41
Q

ribavirin is oral it is used

A

not alone but in combo for hCV

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42
Q

boxed warnings for ribavirin

A

teratogenic effects

hemolytic anemia

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43
Q

ribavirin is CI in

A

pregnancy!!

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44
Q

SE of ribavirin

A

hemolytic anemia

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45
Q

ribavirin notes

A

avoid preg. in females during therapy and 6 months after completion
2 reliable forms of contraception during tx and 6 months following

46
Q

interferons are approved dfor tx of

A

hbv and hcv

47
Q

pegylated forms prolong the

A

half life and reduce the dosing to once weekly

48
Q

interferons are injected _

A

sc

49
Q

interferons do not provide a cure and have lots of __

A

toxicities

50
Q

what does interferon alfa treat

A

HBV, HCV, some cancers

51
Q

what does interferon beta treat

A

multiple sclerosis

52
Q

interferon alfa boxed warnings

A 
can cause or exacerbate 
neuropsychiatric
autoimmune
ischemic
infectious 
disorders
53
Q

SE for interferons

A

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
Q

do you pretreat with interferons

A

yes tylenol and antihistaine

55
Q

hep b treatment

A

interferon monotherapy and is preferred treatment

nrtis can also be used to treat HBV

56
Q

if starting an NRTI for HBV patient needs to be tested for HIV because

A

you can use and anti viral that treats both at the same time

57
Q

all HBV NRTIS have boxed warning for

A

lactic acidosis and severe hepatomegaly with steatosis

can be fatal

58
Q

NRTIS renal dosing

A

crcl less than 50 decrease dose or frequency

59
Q

3 preferred NRTI therapy for HBV

A

viread (TDF)
vemlidy (TAF)
entecavir (baraclude)

60
Q

lamivudine brand for HBV

A

epivir HBV

61
Q

do not use epivir hbv (lamivudine) in patients with

A

HIV

62
Q

warnings with TAF (vemlidy) and TDF (viread)

A

renal toxicity
fanconi syndrome
osteomalacia
decrease bone mineral density

63
Q

SEs TDF (viread)

A

renal impairment

decrease BMD

64
Q

SEs TAF (vemlidy)

A

nausea

65
Q

vemlidy (taf) only approved for

A

HBV

66
Q

cirrhosis is advanced __ of the liver

A

scarring

67
Q

causes of cirrhosis

A

hep c and alcohol

68
Q

pain in the liver is presented as

A

upper right quad

69
Q

liver enyzmes

A

ast (aspartate aminotransferase)
alt (alanine aminotransferase)

normal range 10-40 units

70
Q

other signs of liver disease labs

A 
decreases albumin
increase alk phos or ALP
increase total bilirubin
increase lactate dehydrogenase
increase prothrombin time
71
Q

hepatic panel

A

ast, alt, Tbili, alk phos

all increased in chronic liver disease

72
Q

scoring systems for liver disease

A

child pugh and meld

73
Q

child pugh 0-15

A 
class a mild disease less than 7
class b moderate disease 7-9
class c severe disease 10-15
74
Q

meld 0-40

A

higher number is greater risk of death in 3 months

75
Q

kava is a natural ___

A

hepatotoxin

76
Q

milk thistle is used in people with

A

liver disease

77
Q

hepatotoxic drugs are usually stopped when what

A

when the LFTS are GREATER than 3x the upper limit of normal

>150u/L of ast/alt

78
Q

nsaids should be avoided in patients with cirrhosis!! why

A

it can lead to decompensation including bleeding

79
Q

drugs with boxed warning for liver damage

A 
acetaminophen (high doses)
amiodarone
isoniazid
ketoconazole
methotrexate
nefazodone
nevirapine
nrtis 
ptu
tipranavir
valproic acid
80
Q

benzos are used for

anticonvulsants are used for

A

alcochol withdrawl in inpatients

outpatients

81
Q

what medications are used to prevent relapses in patients with alcohol associated liver disease

A

naltrexone (vivitrol)
acamprosate
disulfiram ( antabuse)

82
Q

what vitamin is used to prevent and treat wernike-korsakoff syndrome

A

thiamine

83
Q

wernickes is due to __ damage cause by lack of vitamin B ___

A

brain, B1

84
Q

one complication of liver disease is ___ hypertension which can lead to bleeding of the veins in the ____

A

portal

esophagus

85
Q

acute variceal bleeding can be ___

A

fatal

86
Q

tx of a variceal bleed

A

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
Q

vasoconstricting medications for variceal bleed

A

sandostatin (ocreotide) IV

vasopressin IV

88
Q

sandostatin is selective for the splanic vessels where as __ is not

A

vasopressin is not

89
Q

vasopressin is a

A

antidiuretic hormone analog (not first line)

90
Q

ocreotide (sandostatin) SE

A

bradycardia, cholelithiasis, biliary sludge

91
Q

beta blockers reduce __ pressure

A

portal

92
Q

non selective BBs for use after variceal bleed

A

nadolol (corgard)

propanolol (inderal)

93
Q

do not withdraw ___ abrubtly

A

BBs

taper over 1-2 weeks to avoid tachycardia, HTN

94
Q

avoid non selective BBs in patients with __ and___

A

asthma/ copd

95
Q

hepatic encephalopathy think __

A

ammonia

96
Q

hepatic encephalopathy symptoms

A

musty odor of breath

changes in thinking, confusion, forgetfulness

97
Q

symptoms of HE result from an accumulation of gut derived nitrogenous substances in the blood (such as ___)

A

ammonia, glutamate)

98
Q

tx for HE includes reducing

A

blood ammonia levels through diet (limiting the amount of animal protein)
and drug therapy

99
Q

HE happens because ___ isnt working properly to remove ammonia

A

liver

100
Q

drug therapy for HE include

A

lactulose

rifaximin

101
Q

what is first line therapy for HE (acute and chronic (prevention))

A

lactulose

102
Q

how does lactulose work

A

by converting ammonia produced by intestinal bacteria to ammonium which is polar therefore cannot readily diffuse into the blood

103
Q

lactulose is also used for

A

constipation

104
Q

SE of lactulose

A

flatulence
diarrhea
dyspepsia
abdominal discomfort

105
Q

what is ascites

A

fluid accumulation within the peritoneal space

can lead to peritonitis

106
Q

ascites tx

A

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
Q

tx of spontaneous bacterial peritonitis

A

acute infection of the ascitic fluid
tx with ceftriaxone 5-7 days

(target strep and enteric gram neg. pathogens)

108
Q

nrtis can cause BBW

A

lactic acidosis

109
Q

take entecavir on an ___ stomach

A

empty

110
Q

ribavirin is teratogenic and can cause what else

A

hemolytic anemia

NAPLEX (24 decks)

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