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NAPLEx > Hepatitis and liver disease > Flashcards

Hepatitis and liver disease Flashcards

1
Q

Hep A

A

Acute
fecal-oral
vaccine yes
1st tx is supportive

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2
Q

Hep B

A

acute and chronic
blood, body fluid
vaccine yes
1st tx- PEG-INF or NRT (tenofovir or entacavir)

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3
Q

Hep C

A

acute and chronic
blood, body fluid
vaccine no
1st tx- treatment-naive: DAA combo

other: DAA combo + RBV or/w PEG-INF

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4
Q

Interferon

A

not recommended but could play a role DAA to expensive

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5
Q

ritonavir

A

not active for HCV, generally used as a boost to PI

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6
Q

NS3/4A
Protease Inhibitors

A

-previr
P for PI

ex: glecaprevir, grazoprevir, paritaprevir, voxilaprevir

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7
Q

NS5A
Replication Complex Inhibitors

A

-asvir
A for NS5A

ex: elbasvir, ledipasvir, ombitasvir, pibrentasvir, velpatasvir

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8
Q

NS5B
Polymerase inhibitors

A

-buvir
B for NS5B

ex: dasabuvir, sofosbuvir

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9
Q

PIG

A

protease inhibitor & Grub
Take With Food
except Zepatier- w/o regard to food, fosamprenavir oral suspension w/o food

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10
Q

All DAAs

A
  • risk of reactivation HBV, test all pt for HBV before starting
  • sofsobuvir- regimens do not use amiodarone! serious bradycardia
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11
Q

Glecaprevir/pibrentasvir

A

Mavyret
w/food
- contra in child-pugh B or C
- do not use with efavirenz or HIV protease inhibitors (atazanavir, darunavir, lopinavir, ritonavir), or Ethinyl estradiol contain products

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12
Q

Sofosbuvir/velpatasvir

A

epclusa

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13
Q

protect from moister

A

savaldi, epclusa, harvoni, vosevi
because it contains sofosbuvir that needs to be protected from most. these are combo drugs with sofosbuvir

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14
Q

pan-genotypic

A

approved for all 6 HCV geno types for patient- naive pts.
Epclusa and Mavyret

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15
Q

8 week course for select pts

A

Mavyret

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16
Q

salvage therapy (in failed previous therapy)

A

Vosevi and Mayvret (select pts)

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17
Q

sofosbuvir/velpatasvir/voxilaprevir

A

Vosevi

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18
Q

sofosbuvir

A

sovaldi
monotherapy not effective

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19
Q

DAA Drug interaction

A

-contra for strong cyp inducers… carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, rifabutin, st. johns worst.

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20
Q

Sofosburvir/ledipasvir

A

Harvoni

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21
Q

Harvoni, Epclusa and Vosevi
DI

A

antacids, H2RAs, and PPI, can decrease concentration
- antacids separate by 4 hrs
- PPI not recommended with Epclusa

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22
Q

Paritaprevir/ritonavir/ombitasvir +dasaburvir

A

Viekira Pak
contra with- strong cyp3A4 inducers, ethylin estradiol-containing products,

23
Q

Elbasvir/grazoprevir

A

Zepatier
Do not use with efavirenz or HIV PIs

24
Q

Ribavirin

A

can be used for HCV in combo
- teratogenic
- not effective monotherapy
- hemolytic anemia
- avoid male and female prego, till past 6 months after therapy

25
interferon alfa
HBV, HCV and some cancer
26
interferon beta
Multiple sclerosis
27
interferon alfa-2b pegylated 2a pegylated 2b
Intron A 3 times weekly Pegasys and pegintron weekly boxed warning, neuropsych, autoimmune, infection SE: flu like symptom, myelosuppression, CNS (fatigue, depression)
28
All HBV NRTS
CrCl<50 decrease dose or fequency lactic acidosis, hepatomeglay with steatosis exacerbation of HBV
29
interferon alfa
approved as monotherapy for HBV
30
Viread
Tenofovir Disoproxil fumarate TDF 300mg daily preferred therapy renal tox, Fanconi syndrome, osteomalacia and decrease bone mineral density keep in original container - HBV NRTS
31
Vemlidy
Tenofovir alafenamide TAF 25mg w/food CrCL< 15 is not recommended preferred therapy renal tox, Fanconi syndrome, osteomalacia and decrease bone mineral density keep in original container - HBV NRTS
32
Baraclude
Entecavir preferred therapy take on empty stomach - HBV NRTS
33
Epivir HBV
Lamivudine done not use in HIV pts, lower dose of lamivudine - HBV NRTS
34
Adefovir
Hepsera renal tox, avoid use with nephrotoxic drugs like NSAIDS - HBV NRTS
35
- HBV NRTS DI
tenofovir formulations avoid use with adefovir bactrim can increase lamivudine levels
36
ALT and AST range
10-40 units/L
37
acute liver tox from drugs
increased ALT/AST
38
chronic liver disease (cirrhosis)
Increased ALT/AST, ALK Phos, LDH, PT/INR Decreased albumin
39
alcoholic liver disease
increased AST>ALT (double), increased gamma-glutamyl transpeptidase (CGT
40
hepatic encephalopathy
increased ammonia
41
jaundice
increased Tbili
42
Child-pugh classification system
scores from 0-15, class a mild <7 class b moderate - 7-9 class c severe - 10-15
43
food hepatotoxic
kava, comfrey, and flavocoxid people use milk thistle extract to help tx Hep C... not real data, could contra with meds
44
stop hepatotoxic drugs when
>3 times upper limit of normal so >150 (AST or ALT)
45
key drugs that damage liver
Acetaminophen amiodarone isoniazide ketaconazole (oral) methotrexate Nafazodone Nevirapine NRTIs propylthiouracil valporic acid
46
wernicke-korsakoff syndrome
thiamine is used to prevent, brain damage due to lack of vitamin B1
47
Octreotide ... use
selective for splanchnic vessels where other vasopressins are non-selective for bleeding varices
48
Octreotide
Sandostatin IV SE: bradycardia, cholelithiasis, biliary sludge
49
non-selective BB for portal hypertension
Nadolol (corgard) propranolol (inderal)
50
Hepatic encephalopathy
accumulation of gut-derived nitrogenous substances in the blood lactulose first line rifaximin second line zinc may be helpful
51
Lactulose
enulose, constulose SE: flatulence, diarrhea, dyspepsia, abdominal pain monitor bowel moment and ammonia - Hepatic encephalopathy
52
rifaximin
xifaxan
53
ascities
fluid accumulation within the peritoneal space, diuretic therapy, spironolactone monotherapy or with combo of furosemide and spironolactone (ratio 40 to 100) furosemide itself is not enough
54
spontaneous bacterial peritonitis infection
ceftriaxone

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