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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
What's Octreotide (Sandostatin) an analogue of?
Somatostatin T4 has greater potency and longer duration of action
26
What's the brand name of Vasopressin (used in acute variceal bleeding)?
Pitressin
27
Howz Vasopressin (Putressin) use in practice?
Not 1st line Used with NTG IV to prevent MI
28
What's unique about Octreotide (Sandostatin) SE?
Monitor BG too (In addition to HR, ECG)
29
Whats hepatic encephalopathy (HE)?
Syndrome of neuropsychiatric abnormalities caused by acute or chronic hepatic insufficiency
30
What causes the sx of Hepatic Encephalopathy (HE)?
Accumulation of gut-derived nitrogenous substances in the blood e.g. Ammonia, glutamate
31
Tx of hepatic encephalopathy (HE)?
Identifying and treating precipitating factors And Reducing ammonia levels through diet (limiting amt of diet) and drug therapy
32
How much protein should a pt with HE get daily?
1-1.5 g/kg
33
What does the acute and chronic therapy of HE consist of?
Nonabsorbable disaccharides (such as lactose) + antibiotics (Rifaximin, neomycin etc)
34
What's the first line tx for HE? Followed by?
Lactulose - 1st line (for both acute and chronic prevention therapy) Followed by Rifaximin
35
List agents used in HE?
Lactulose (Constulose, Enulose, Generlac) Neomycin (Neo-Fradin) Rifaximin (Xifaxan) Metronidazole (Flagyl ER, Metro)
36
Which of these HE agents is used off-label?
Metronidazole (Flagyl ER, Metro)
37
SEs of Lactulose (Constulose, Enulose, Generlac)?
Flatulence Diarrhea Dyspepsia Abdominal discomfort
38
SE of Neomycin (Neo-Fradin)?
GI upset
39
What's ascites?
Fluid accumulation within the peritoneal space that can lead to dev of spontaneous bacterial peritonitis (SBP) and hepatotrenal syndrome (HRS)
40
What should be initiated for acute and chronic ascites?
Combo of Furosemide + Spironolactone Max : 40mg to 100mg (for max wt loss of 0.5kg/day)
41
When should liver transplantation be considered?
In pts with cirrhosis + ascites
42
What's spontaneous bacterial peritonitis (SBP)?
An acute infection of the ascetic fluid
43
What's used for SBP?
Ceftriaxone (or equivalent) for 5-7 days Targeting strep and enteric gm-negative
44
What's used for primary prophylaxis (& prevent recurrence) of SBP?
Norfloxacin or Trimethoprim-Sulfamethoxazole
45
What's hepatorenal syndrome (HRS)?
Dev of renal failure in pts with advanced cirrhosis
46
What's viral hepatitis?
Viruses that damage the liver Hepatitis A through E, along with herpes, CMV, Epstein-Barr virus and adenovirus eps
47
Which viruses cause the most hepatitis cases?
A, B, C
48
What's hepatitis A Virus (HAV)?
A vaccine preventable dx that causes an acute self-limiting illness
49
Hows hepatitis A Virus (HAV) infection treated?
Supportive No antiviral agents are needed
50
What's hepatitis B Virus (HBV)?
A vaccine preventable that causes acute illness and may lead to chronic infection, cirrhosis, liver cancer, liver failure and death
51
What's used for chronic tx of HBV? Duration?
Many antivirals (NRTIs) and Interferons For about 1 yr if tx
52
What's hepatitis C Virus (HCV)?
A non-vaccine preventable dx that can cause acute dx, but more commonly is silent until chronic dx emerges
53
How many diff genotypes of HCV are there?
3 different genotypes Genotype 1- req 48 wks of tx (most difficult to treat) Genotypes 2 & 3- 24 wks of tx
54
What's interferon alfa indicated for?
Tx of HBV and HCV
55
What are interferons?
Naturally-produced cytokines that have antiviral, antiproliferative, and immonomodulatory effects
56
Which interferon is for HBV, HCV and many cancers?
Interferon-alpha-2b (Intron A) Pegylated interferon-alpha-2a (Pegasys)
57
Which interferon is for HCV only?
Pegylated interferon-alpha-2b (PegIntron) Interferon Alfacon-1 (Infergen)
58
Which is the combo product of interferon alfa?
Interferon-alpha-2b + Ribavirin (Rebetron)
59
What's the dosing of Intron A (Interferon-alpha-2b) in HCV?
3 million units SC 3 times weekly
60
What's the dosing of Pegintron (Pegylated Interferon-alpha-2b) in HCV?
1.5 mcg/kg SC weekly
61
What's the dosing of Pegasys (Pegylated Interferon-alpha-2a) in HCV?
180 mcg SC weekly
62
Black box warning associated with all interferon alfa pdts?
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
SEs of Interefron alfa pdts?
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
What can be used to pre-treat pt to avoid flu-like SE of interferon pdts
Pre-treat with acetaminophen, antihistamine
65
What's the usual injection site of interferons? Exceptions?
Abdomen If pt is too thin; use top of thigh or outer surface of upper arm
66
What sx should pt on interferons report to Dr?
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
MOA of Nucleoside Reverse Transcriptase Inhibitors?
Inhibit HIV replication by inhibiting HBV polymerase resulting in DNA chain termination
68
Which hepatitis is Nucleoside Reverse Transcriptase Inhibitors used for?
HBV only
69
List agents in Nucleoside Reverse Transcriptase Inhibitors?
Lamivudine (Epivir HBV) Adefovir (Hepsera) Tenofovir (Viread) Entecavir (Baraclude) Telbivudine (Tyzeka)
70
Which of the MOA of Nucleoside Reverse Transcriptase Inhibitors is first line?
Tenofovir (Viread) Entecavir (Baraclude)
71
Whats the brand name of Entecavir (1st line Nucleoside Reverse Transcriptase Inhibitors)?
Baraclude
72
Whats the brand name of Tenofovir (1st line Nucleoside Reverse Transcriptase Inhibitors)?
Viread
73
For ALL Nucleoside Reverse Transcriptase Inhibitors agents, when should dosing be reduced?
CrCl < 50mL/min
74
For ALL Nucleoside Reverse Transcriptase Inhibitors agents, what the black box warning for them?
Lactic acidosis and severe hepatomegaly with steatosis, which may be fatal Exacerbation of HBV may occur upon d/c, monitor closely
75
Black box warning for Lamivudine (Epivir HBV)?
Don't use Epivir HBV for HIV tx
76
Black box warning for Adefovir (Hepsera)?
Use caution in pts with renal impairment or those at risk of renal toxicity (including concurrent nephrotoxicity agents or NSAIDs)
77
SEs of Tenofovir (Viread)?
Fanconi syndrome, renal insufficiency, osteomalacia and reduced bone density
78
How do u use Entecavir (Baraclude)?
Take on empty stomach
79
SEs of Telbivudine (Tyzeka)?
Increased CPK
80
What Ribavirin indicated for?
HCV in combo with interferon alfa
81
CI to Ribavirin use?
CrCl < 50mL/min
82
Black box warning for Ribavirin?
Significant teratogenic effects (preg cat X)
83
SEs of Ribavirin?
Hemolytic anemia - primary toxicity T4 check baseline RBC and often during first 4 wks of therapy
84
How long after tx should pregnancy be avoided? Both in women using Ribavirin and female partners of men that use it?
At least 6 months after stopping Ribavirin Use 2 reliable forms of contraception
85
What's protease inhibitors indicated for in hepatitis?
Tx of chronic hepatitis C genotype 1 infection when used in combo with Peginterferon alfa and Ribavirin in adult pts
86
List protease inhibitors used in hepatitis?
Boceprevir (Victrelis) Telaprevir (Incivek) Simeprevir (Olysio)
87
CI to Boceprevir (Victrelis); Telaprevir (Incivek); Simeprevir (Olysio) use?
Pregnancy! Use 2 reliable forms of contraception, both in women using Ribavirin and female partners of men that use it?
88
SE of Boceprevir (Victrelis)?
Fatigue Anemia (requiring ESA use) Neutropenia Taste distortion (dysgeusia)
89
What must NEVER be done while on Boceprevir (Victrelis)?
Never reduce dose/ interrupt therapy as tx failure may result Never use as monotherapy; must always combine with Peginterferon and Ribavirin
90
SEs of Telaprevir (Incivek); Telaprevir (Incivek); Simeprevir (Olysio) use?
Serious skin rash (d/c all tx if progressive or severe) Fatigue Itching Taste distortion (dysgeusia) Anemia Anorectal disorders
91
What's Sofosbuvir indicated for?
HCV only
92
What SEs may pt receiving interferon therapy experience?
Depression Flu-like syndrome Anorexia Hypothyroidism
93
Which med used in hepatitis can lead to renal Insufficiency and osteomalacia?
Tenofovir (Viread)
94
How should the syringes used for Interferon be used?
Safety tips are required to prevent accidental needle-stock injuries
95
When is fluid restriction recommended in ascites, portal HTN?
Only in pts with symptomatic severe hyponatremia (serum Na < 120mEq/L)
96
What's hepatitis?
Inflammation of the liver

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