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Pharmacotherapy II > Hepatitis B > Flashcards

Hepatitis B Flashcards

1
Q

The highest concentration of the HBV is found in

A

Blood and serous fluid

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2
Q

Primary Modes of Transmission?

A

blood or body fluids through

perinatal, sexual, or percutaneous exposure

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3
Q

Infants born to mothers who are
infected with actively replicating HBV have a____ risk of becoming chronic
HBV carriers

A

90%

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4
Q

Risk Factors for Acquiring HBV:

A
  • Individuals with multiple heterosexual partners
  • IV drug users using unsterilized needles
  • Recipients of blood products
  • Household contacts with acute hepatitis B with open cuts
  • Healthcare providers in contact with contaminated needles
  • Patients undergoing dialysis
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5
Q

Hepatitis B structure?

A

double-stranded DNA virus with a phospholipid layer
containing hepatitis B surface antigen (HBsAg) that surrounds the
nucleocapsid.

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6
Q

The ______ is detectable at the onset of clinical symptoms.

A

HBsAg

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7
Q

Its persistence
past______ after initial detection corresponds to chronic infection and
indicates an increased risk for _______

A

6 months; cirrhosis, hepatic decompensation and HCC

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8
Q

antibodies against hepatitis B core antigen (antiHBc) are measurable/non-measurable in blood?

A

measurable

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9
Q

Viral replication occurs when the

A
  • hepatitis B envelope antigen (HBeAg) is

present and circulating in the blood

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10
Q

Measures the viral infectivity and quantifies viral replication

A

Serum HBV DNA concentration

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11
Q

Once Hepatitis B infection resolves, antibodies against Hepatitis

A

-antibodies against the hepatitis B
envelope (antiHBe)

-antibodies against hepatitis B surface antigen
(antiHBs) develop, and HBV DNA levels become undetectable.

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12
Q

Approximately 90% of adults infected with the HBV develop_____, which
results in lifelong immunity

A

antiHBs

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13
Q

In _____individuals, the disease resolves

spontaneously and does not lead to further complications.

A

immunocompetent

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14
Q

In
____persons, the HBV is less likely to be eradicated, thus
causing persistent infection. This often leads to hepatic cell damage and
inflammation that may lead to cirrhosis and hepatocellular carcinoma

A

immunocompromised

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15
Q

Symptoms of Disease?

A
  • Most patients have no symptoms
  • Symptomatic persons experience a flu-like syndrome, anorexia, nausea, vomiting, diarrhea, dark urine, pale-appearing stools, pruritus, and abdominal pain
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16
Q

Signs of Disease

A

Jaundice- Scleral Icterus in eye
HepatoMegaly and Hepatic Encephalopathy ( Coma and Asterixis)
- Extrahepatic Symptoms: arthritis, postcervical
lymphadenopathy, palmar erythema, cryoglobulinemia, and vasculitis.

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17
Q

Diagnosis of viral Hepatitis

A

Laboratory Serologies

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18
Q

Liver function are used in ?

A
  • Extent of cholestatic and hepatocellular injury
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19
Q

Why are lab serologies?

A
  • Individuals are asymptomatic & symptomatic patients cant identify a specific type of hepatitis
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20
Q

The definitive test to determine the amount of damage and inflammation of hepatic cells is _____

A

liver biopsy

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21
Q

Look at the figure .5

A

Look at the figure .5

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22
Q

Detectable in serum

A

HBsAg

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23
Q

Undetectable in serum

24
Q

The presence of antibodies against HBcAg to IgM indicates

A

active Infection

25
Q

Check out figure 5 & 6

A

Check out figure 5 & 6

26
Q

Hepatitis B Prevention?

A
  • minimize their risk of acquiring the hepatitis B infection by
    avoiding contaminated blood products or participating in high-risk behavior
    such as IV drug use
  • Screening pregnant women for hepatitis B and providing universal Hepatitis B to all newborn is effective in preventing hepatitis B infections
27
Q

_____ with Hepatitis B immune globulin ( HBIG) is recommended to prevent acute infection and complications associated with HBV

A

Post-exposure prophylaxis

28
Q

HBIG- Hepatitis B Immune globulin

A

_____ is a sterile solution containing
antibodies prepared from pooled human plasma that has a high concentration
of anti-HBs

29
Q

_____ provides passive immunization for post-exposure prophylaxis against
HBV

30
Q

HBIG Doses?

A
  • 0.06 ml/kg 1M= chronic

-

31
Q

Side effects of HBIG?

A
  • Erythema at injection site

- Headache, myalgia, fatigue, nausea, vomiting

32
Q

Rare side effects of HBIG?

A
  • Liver function test abnormalities, arthralgias, and anaphylactic reactions
33
Q

Hepatitis B vaccine in United States?

A

Recombivax Hb and Engerix-B

34
Q

Pre-exposure prophylaxis?

A
  • Hepatitis B

virus should be vaccinated with the hepatitis B vaccine at months 0, 1, and 6.

35
Q

The hepatitis B vaccine dose depends on the ____

A

person’s age

36
Q

Post-exposure Prophylaxis?

A

the hepatitis B vaccine is indicated after
exposure to prevent CHB
(Chronic necroinflammatory disease).

37
Q

Adults acutely exposed to blood containing HBsAg from an accidental needlestick,
sexual contacts, or IV drug use should receive the hepatitis B vaccine with or without
HBIG, preferably within

38
Q

What to give to a patient who has previously been vaccinated and got tested positive for HBsAg-positive

A

Administer HB vaccine booster dose

39
Q

What to give to a patient who has not been vaccinated and got tested positive for HBsAg-positive

A

HBIG and initiate HB vaccine series

40
Q

What to give to a patient who has not been vaccinated and got tested unknown for HBsAg-positive

A

No treatment

41
Q

What to give to a patient who have not been vaccinated and got tested unknown for HBsAg-positive

A

Initiate HB vaccine series

42
Q

Post-exposure prophylaxis for perinatal exposure depends on

A
  • maternal HBsAg status and newborn Weight
43
Q

Mothers with HBsAg-positive should be immunized within?

A

12-24 hours after birth with Hepatitis B vaccine and HBIG 0.5ml

44
Q

If the mother is

HBsAg-negative, the newborn should only receive?

A

Hepatitis B vaccine

45
Q

CHECK OUT TABLE PG9

A

CHECK OUT TABLE PG9

46
Q

adverse effects experienced by infants include:

A

local reactions at the injection site, fever, headache, dizziness and irritability

47
Q

Recommendation for HBV vaccination

A
  • Infants
  • Adolescents including unvaccinated children
  • All unvaccinated adults at risk for infection
     Persons with a history of multiple sex partners
     Current or recent injection-drug users
     Household contacts and sex partners of persons with chronic hepatitis B
    infection
     Healthcare workers with exposure to blood in the workplace
     International travelers to regions with high or intermediate levels of endemic
    HBV infection
     Recipients of clotting factor concentrates
     Chronic dialysis
48
Q

Hepatitis A and B Combination Vaccine?

49
Q

Conditions for using Twinrix

A

older than 18 years old

50
Q

Dosage Twinrix ?

A

0, 7, 21 to 31 day and the fourth dose at month

12.

51
Q

Goals of therapy?

A
  • Suppress HBV replication
  • Loss of HbsAg
  • Prevents disease progression to cirrhosis and HCC
52
Q

How is the response to therapy monitored?

A
  • Biochemically
  • Histologic
  • Virologic response
53
Q

Therapy….

  • Biochemically
  • Histologic
  • Virologic response
A
  • Normalize ALT
  • Decrease in Histology activity by atleast 2 points as compared with baseline biopsy
  • Virologic: Undetectable HBV DNA
54
Q

Recommendations for treatment consider?

A
  • Patients Age, serum HBV DNA and ALT level as well as Histologic Evidence and clinical progression of disease
55
Q

How are patients monitored during drug therapy?

A
  • ALT at 3-6 months intervals

- HBeAg should be checked every 12-6 months

56
Q

Patients

A

HBeAg positive with HBV DNA levels >20,000 IU/mL after a
3-6 month period of elevated ALT levels between 1-2 ULN, or who remain HBeAg
positive with HBV DNA levels >20,000 IU/mL and are >40 years old, should be
considered for liver biopsy and treatment should be considered if biopsy shows
moderate/severe inflammation or significant fibrosis.

57
Q

When is liver biopsy not recommended?

A
  • Liver biopsy is usually not
    necessary in young patients (below 30) who are HBeAg positive and have
    persistently normal ALT.

Pharmacotherapy II (3 decks)

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