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NAPLEX Content > Hepatitis And Liver Dx > Flashcards

Hepatitis And Liver Dx Flashcards

1
Q

Sx of liver dx

A

Nausea

Loss of appetite

Vomiting diarrhea

Malaise

Abdominal pain in upper right quadrant of abdomen

Yellowed skin and whites of eyes (jaundice)

Darkened urine and/or lightened color (white or clay-colored)

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2
Q

What are the liver enzymes

A

Alanine aminotransferase (ALT)

And

Aspartate aminotransferase (AST)

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3
Q

What’s tne usual values of ALT & AST?

A

ALT: 7-55 units/L

AST: 8-48 units/L

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4
Q

T/F? The higher the values of AST and ALT, the worse the liver dx?

A

True

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5
Q

Natural pdts that can cause liver damage?

A

Comfrey, Flavocoxid (Limbrel), a medical food

Kava

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6
Q

What’s the classification of liver dx?

A

Hepatocellular: high AST and ALT

Cholestatic: high Alk. Phos and Tbili

Mixed: high AST and ALT, and Alk. Phos and Tbili

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7
Q

What’s used to classify severity of liver dx?

A

Child-Pugh classification system, which has a scoring 0-15

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8
Q

What does class A of Child-Pugh classification imply?

A

Mild dx (score < 7)

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9
Q

What does class B of Child-Pugh classification imply?

A

Moderate dx (score 7-9)

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10
Q

What does class C of Child-Pugh classification imply?

A

Severe dx (score 10-15)

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11
Q

Whats primary tx for drug-induced liver damage?

A

Stop the drug

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12
Q

Whats alcoholic liver dx?

A

A term the encompasses the hepatic manifestations of alcohol over-consumption, including fatty liver, alcoholic hepatitis and chronic hepatitis with hepatic fibrosis or cirrhosis

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13
Q

What’s the main tx for inpatient alcohol withdrawal?

A

BZD

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14
Q

What’s the main tx for outpatient alcohol withdrawal?

A

Anticonvulsants:

Naltrexone (ReVia)

Acamprostate (Campral)

Disulfiram (Antabuse)

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15
Q

What vitamins and trace minerals can help reverse malnutrition?

A

Vit. A, D, Thiamine (Vit. B1), folate, pyridoxine (Vit. B6) & zinc

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16
Q

What’s thiamine (Vit. B1) used for?

A

To prevent and treat Wernicke-Korsakoff syndrome

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17
Q

Whats Wernicke-Korsakoff syndrome?

A

Different conditions that are both due to brain damage caused by lack of Vit. B1 (thiamine)

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18
Q

List main complications of liver dx

A

Portal HTN

Variceal bleeding

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19
Q

What’s used for primary prevention of portal HTN?

A

Non-selective BB e.g. Nadolol & Propranolol

Or

Endoscopic variceal ligation (EVL)

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20
Q

What’s the target HR while on BB?

A

Titrated to max tolerated dose (target HR 55-60 BPM) and continued indefinitely

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21
Q

What’s the brand name of Nadolol (non-selective BB used in primary prevention of portal HTN)?

A

Corgard

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22
Q

What’s the brand name of Propranolol (non-selective BB used in primary prevention of portal HTN)?

A

Inderal LA

InnoPran XL

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23
Q

List drugs used in managing acute variceal bleeding

A

Octreotide (Sandostatin)

Vasopressin (Pitressin)

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24
Q

What’s the brand name of Octreotide (used in acute variceal bleeding)?

A

Sandostatin

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25
Q

What’s Octreotide (Sandostatin) an analogue of?

A

Somatostatin

T4 has greater potency and longer duration of action

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26
Q

What’s the brand name of Vasopressin (used in acute variceal bleeding)?

A

Pitressin

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27
Q

Howz Vasopressin (Putressin) use in practice?

A

Not 1st line

Used with NTG IV to prevent MI

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28
Q

What’s unique about Octreotide (Sandostatin) SE?

A

Monitor BG too (In addition to HR, ECG)

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29
Q

Whats hepatic encephalopathy (HE)?

A

Syndrome of neuropsychiatric abnormalities caused by acute or chronic hepatic insufficiency

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30
Q

What causes the sx of Hepatic Encephalopathy (HE)?

A

Accumulation of gut-derived nitrogenous substances in the blood e.g. Ammonia, glutamate

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31
Q

Tx of hepatic encephalopathy (HE)?

A

Identifying and treating precipitating factors
And
Reducing ammonia levels through diet (limiting amt of diet) and drug therapy

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32
Q

How much protein should a pt with HE get daily?

A

1-1.5 g/kg

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33
Q

What does the acute and chronic therapy of HE consist of?

A

Nonabsorbable disaccharides (such as lactose) + antibiotics (Rifaximin, neomycin etc)

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34
Q

What’s the first line tx for HE? Followed by?

A

Lactulose - 1st line (for both acute and chronic prevention therapy)

Followed by Rifaximin

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35
Q

List agents used in HE?

A

Lactulose (Constulose, Enulose, Generlac)

Neomycin (Neo-Fradin)

Rifaximin (Xifaxan)

Metronidazole (Flagyl ER, Metro)

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36
Q

Which of these HE agents is used off-label?

A

Metronidazole (Flagyl ER, Metro)

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37
Q

SEs of Lactulose (Constulose, Enulose, Generlac)?

A

Flatulence

Diarrhea

Dyspepsia

Abdominal discomfort

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38
Q

SE of Neomycin (Neo-Fradin)?

A

GI upset

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39
Q

What’s ascites?

A

Fluid accumulation within the peritoneal space that can lead to dev of spontaneous bacterial peritonitis (SBP) and hepatotrenal syndrome (HRS)

40
Q

What should be initiated for acute and chronic ascites?

A

Combo of Furosemide + Spironolactone

Max : 40mg to 100mg (for max wt loss of 0.5kg/day)

41
Q

When should liver transplantation be considered?

A

In pts with cirrhosis + ascites

42
Q

What’s spontaneous bacterial peritonitis (SBP)?

A

An acute infection of the ascetic fluid

43
Q

What’s used for SBP?

A

Ceftriaxone (or equivalent) for 5-7 days

Targeting strep and enteric gm-negative

44
Q

What’s used for primary prophylaxis (& prevent recurrence) of SBP?

A

Norfloxacin or Trimethoprim-Sulfamethoxazole

45
Q

What’s hepatorenal syndrome (HRS)?

A

Dev of renal failure in pts with advanced cirrhosis

46
Q

What’s viral hepatitis?

A

Viruses that damage the liver

Hepatitis A through E, along with herpes, CMV, Epstein-Barr virus and adenovirus eps

47
Q

Which viruses cause the most hepatitis cases?

A

A, B, C

48
Q

What’s hepatitis A Virus (HAV)?

A

A vaccine preventable dx that causes an acute self-limiting illness

49
Q

Hows hepatitis A Virus (HAV) infection treated?

A

Supportive

No antiviral agents are needed

50
Q

What’s hepatitis B Virus (HBV)?

A

A vaccine preventable that causes acute illness and may lead to chronic infection, cirrhosis, liver cancer, liver failure and death

51
Q

What’s used for chronic tx of HBV? Duration?

A

Many antivirals (NRTIs) and Interferons

For about 1 yr if tx

52
Q

What’s hepatitis C Virus (HCV)?

A

A non-vaccine preventable dx that can cause acute dx, but more commonly is silent until chronic dx emerges

53
Q

How many diff genotypes of HCV are there?

A

3 different genotypes

Genotype 1- req 48 wks of tx (most difficult to treat)

Genotypes 2 & 3- 24 wks of tx

54
Q

What’s interferon alfa indicated for?

A

Tx of HBV and HCV

55
Q

What are interferons?

A

Naturally-produced cytokines that have antiviral, antiproliferative, and immonomodulatory effects

56
Q

Which interferon is for HBV, HCV and many cancers?

A

Interferon-alpha-2b (Intron A)

Pegylated interferon-alpha-2a (Pegasys)

57
Q

Which interferon is for HCV only?

A

Pegylated interferon-alpha-2b (PegIntron)

Interferon Alfacon-1 (Infergen)

58
Q

Which is the combo product of interferon alfa?

A

Interferon-alpha-2b + Ribavirin (Rebetron)

59
Q

What’s the dosing of Intron A (Interferon-alpha-2b) in HCV?

A

3 million units SC 3 times weekly

60
Q

What’s the dosing of Pegintron (Pegylated Interferon-alpha-2b) in HCV?

A

1.5 mcg/kg SC weekly

61
Q

What’s the dosing of Pegasys (Pegylated Interferon-alpha-2a) in HCV?

A

180 mcg SC weekly

62
Q

Black box warning associated with all interferon alfa pdts?

A

May cause or exacerbate autoimmune disorders; may cause or aggravate infectious disorders; may cause or aggravate ischemic and hemorrhagic cerebrovascular events; combo tx with Ribavirin may cause birth defects and/or fetal mortality and/or hemolytic anemia

63
Q

SEs of Interefron alfa pdts?

A

Flu-like syndrome 1- hrs after admin (fever, chills, headache, malaise, arthralgia, myalgia, diaphoresis - can last 24 hrs)

CNS effects (fatigue, anxiety, depression, weakness)

GI upset (n/v/ anorexia, weight loss)

High LFTs (5-10 x ULN during tx)

Myelosuppression

Mild hair loss

64
Q

What can be used to pre-treat pt to avoid flu-like SE of interferon pdts

A

Pre-treat with acetaminophen, antihistamine

65
Q

What’s the usual injection site of interferons? Exceptions?

A

Abdomen

If pt is too thin; use top of thigh or outer surface of upper arm

66
Q

What sx should pt on interferons report to Dr?

A

Pt becomes pregnant

New/ worsening mental health problems

Decreased vision

Trouble breathing/ chest pain

Severe stomach/ lower back pain

Bloody diarrhea/ bloody bowel movements

High fever

Easy bruising/ bleeding

67
Q

MOA of Nucleoside Reverse Transcriptase Inhibitors?

A

Inhibit HIV replication by inhibiting HBV polymerase resulting in DNA chain termination

68
Q

Which hepatitis is Nucleoside Reverse Transcriptase Inhibitors used for?

A

HBV only

69
Q

List agents in Nucleoside Reverse Transcriptase Inhibitors?

A

Lamivudine (Epivir HBV)

Adefovir (Hepsera)

Tenofovir (Viread)

Entecavir (Baraclude)

Telbivudine (Tyzeka)

70
Q

Which of the MOA of Nucleoside Reverse Transcriptase Inhibitors is first line?

A

Tenofovir (Viread)

Entecavir (Baraclude)

71
Q

Whats the brand name of Entecavir (1st line Nucleoside Reverse Transcriptase Inhibitors)?

A

Baraclude

72
Q

Whats the brand name of Tenofovir (1st line Nucleoside Reverse Transcriptase Inhibitors)?

A

Viread

73
Q

For ALL Nucleoside Reverse Transcriptase Inhibitors agents, when should dosing be reduced?

A

CrCl < 50mL/min

74
Q

For ALL Nucleoside Reverse Transcriptase Inhibitors agents, what the black box warning for them?

A

Lactic acidosis and severe hepatomegaly with steatosis, which may be fatal

Exacerbation of HBV may occur upon d/c, monitor closely

75
Q

Black box warning for Lamivudine (Epivir HBV)?

A

Don’t use Epivir HBV for HIV tx

76
Q

Black box warning for Adefovir (Hepsera)?

A

Use caution in pts with renal impairment or those at risk of renal toxicity (including concurrent nephrotoxicity agents or NSAIDs)

77
Q

SEs of Tenofovir (Viread)?

A

Fanconi syndrome, renal insufficiency, osteomalacia and reduced bone density

78
Q

How do u use Entecavir (Baraclude)?

A

Take on empty stomach

79
Q

SEs of Telbivudine (Tyzeka)?

A

Increased CPK

80
Q

What Ribavirin indicated for?

A

HCV in combo with interferon alfa

81
Q

CI to Ribavirin use?

A

CrCl < 50mL/min

82
Q

Black box warning for Ribavirin?

A

Significant teratogenic effects (preg cat X)

83
Q

SEs of Ribavirin?

A

Hemolytic anemia - primary toxicity

T4 check baseline RBC and often during first 4 wks of therapy

84
Q

How long after tx should pregnancy be avoided? Both in women using Ribavirin and female partners of men that use it?

A

At least 6 months after stopping Ribavirin

Use 2 reliable forms of contraception

85
Q

What’s protease inhibitors indicated for in hepatitis?

A

Tx of chronic hepatitis C genotype 1 infection when used in combo with Peginterferon alfa and Ribavirin in adult pts

86
Q

List protease inhibitors used in hepatitis?

A

Boceprevir (Victrelis)

Telaprevir (Incivek)

Simeprevir (Olysio)

87
Q

CI to Boceprevir (Victrelis); Telaprevir (Incivek); Simeprevir (Olysio) use?

A

Pregnancy!

Use 2 reliable forms of contraception, both in women using Ribavirin and female partners of men that use it?

88
Q

SE of Boceprevir (Victrelis)?

A

Fatigue

Anemia (requiring ESA use)

Neutropenia

Taste distortion (dysgeusia)

89
Q

What must NEVER be done while on Boceprevir (Victrelis)?

A

Never reduce dose/ interrupt therapy as tx failure may result

Never use as monotherapy; must always combine with Peginterferon and Ribavirin

90
Q

SEs of Telaprevir (Incivek); Telaprevir (Incivek); Simeprevir (Olysio) use?

A

Serious skin rash (d/c all tx if progressive or severe)

Fatigue

Itching

Taste distortion (dysgeusia)

Anemia

Anorectal disorders

91
Q

What’s Sofosbuvir indicated for?

A

HCV only

92
Q

What SEs may pt receiving interferon therapy experience?

A

Depression
Flu-like syndrome
Anorexia
Hypothyroidism

93
Q

Which med used in hepatitis can lead to renal Insufficiency and osteomalacia?

A

Tenofovir (Viread)

94
Q

How should the syringes used for Interferon be used?

A

Safety tips are required to prevent accidental needle-stock injuries

95
Q

When is fluid restriction recommended in ascites, portal HTN?

A

Only in pts with symptomatic severe hyponatremia (serum Na < 120mEq/L)

96
Q

What’s hepatitis?

A

Inflammation of the liver

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