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Therapeutics IV > Hepatitis - Block 3 > Flashcards

Hepatitis - Block 3 Flashcards

1
Q

What strains of Hep have vaccine coverage?

A

A and B

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2
Q

What are the acute strains

A

A and E

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3
Q

What are the acute and chronic strains?

A

B, C, D, E

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4
Q

Major method of transmission for Hep A-C?

A

A: fecal oral
B: blood
C: blood

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5
Q

Diagnostic for Hep A-C?

A

A: IgM anti-HAV
B: HBsAg, IgM anti-HBc
C: Anti-HCV, HCV-RNA PCR

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6
Q

Who are more at risk for contracting HAV?

A
  1. International travelers
  2. MSM
  3. IVDU
  4. Occupational risk
  5. International adoptee
  6. Homeless
  7. Chronic liver dx
  8. HIV
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7
Q

Sx of HAV?

A
  1. Fever
  2. Jaundise
  3. Scleral icterus
  4. Hepatomegaly
  5. N/V
  6. GI sx
  7. Dark urine/pale poop
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8
Q

Lab presentations of HAV?

A
  1. Elevated ALT and AST
  2. ALT>AST
  3. Elevated bilirubin
  4. IgM anti-HAV for acute HAV
  5. IgM anti-HAV for prior infction or vac
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9
Q

How long does the acute phase of HAV last?

A

2 months

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10
Q

Non pharm for HAV?

A

General supportive care: no specific tx
Prevention of transmission: hand hygiene, vaccination, immune globulin

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11
Q

Who should get vaccinated?

A
  1. Increased risk
  2. Preganant and at risk
  3. Those who request vaccin
  4. Children:
    * All who are 12-23 months
    * All 2-18 YO who are doing catch up
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12
Q

HAV vaccinations?

A

Havrix
Vaqta
Combo A/B: Twinrix

Selection is based on agent, number of doses, and age-based dosing

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13
Q

What is the prophylaxixs hagent for HAV?

A

IVIG IM

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14
Q

How should get HAV prophylaxis?

A
  1. Recommended with vaccination if travel to an HAV high or intermediate risk country will begin in < 2 weeks
  2. Older
  3. Immunocompromised
  4. Chronic liver disease or med condition
  5. If vaccine is not an option
  6. Used for post-ex as well
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15
Q

Etiology of HBV?

A

DNA virus that infect hepatocytes

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16
Q

RF for HBV?

A
  1. IVDU
  2. Unprotected sex
  3. MSM
  4. Household with HBV
  5. Blood contamination
  6. HD
  7. Child born of an infected mother
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17
Q

Recommended serological testing for hep B screening?

A
  1. Hep B surface antigen (HBsAg) - used for acute and chronic (>6months) and whether they are infectious
  2. Hep B surface antibody (anti-HBs)
  3. Total antibody to hep B core antigen (anti-HBc)

Others include: IgM anti-HBc and HBe-Ag

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18
Q

When should IgM ant-HBc be tested?

A

When acute infection is a concern (<6months)

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19
Q

What components do HBe-Ag look at?

A

Viral replication
High viral loads
Infectivity

…..

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20
Q

S/s of HBV?

A
  1. Younger patients are asymptomativ
  2. Jaudice
  3. Dark urine
  4. White stool
  5. Ab pain
  6. Fever, chils, fatigue
  7. Loss appetite
  8. Pruritus
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21
Q

Lab findings of HBV?

A
  1. Elevated AST/ALT (ALT/AST)
  2. Elevated bilirubin
  3. IgM antiHBc +
  4. HBsA g +
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22
Q

What are presentation of progressive HBV?

A
  1. Cirrhosis
  2. Hepatocellular carcinoma (HCC)
  3. Ascites
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23
Q

Is HBV curable

A

No

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24
Q

Goals of HBV tx?

A
  1. Suppress HBV replication
  2. Prevent progression to cirrhosis/HCC
  3. Prevent transmission
  4. Prvent reactivation
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25
Q

Criteria for HBV tx?

A

Positive or negative HBeAg, active infection with:
1. HBV DNA >2000 and
2. ALT>2xULN

Presence of cirrhosis ith detectble HBV DNA and any ALT level

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26
Q

Tx for HBV?

A

Pegylated IFN: Peginterferon Alfa-2a (Pegasys)

Nucleos(tide) transcriptase inhibitors:
* Entecavir (Baraclude)
* TDF (Viread)
* TAF (Vemlidy)

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27
Q

Caution when using IFN tx?

A

High risk of infectin in decompensated cirrhotic patients

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28
Q

How long should +HBeAg patient be treated for?

A

Until HBeAg seroconversion and undetectable viral load

FOr 6 months of additional tx

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29
Q

How long should -HBeAg patient be treated for?

A

Indefinitely

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30
Q

BBW of Pegasys?

A

Cause or aggrevate fatal/life-threatening neuropsychiatric, autoimmune, ischemia, and infectious dx

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31
Q

When HBV combos used?

A

HIV co-infection

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32
Q

What is preferred HBV tx?

A

Pegylated-interferon-alpha 2a, entecavir, TAF or TDF
* Do not use entecavir if lamivudine resistance present
* Entecavir and tenofovir -> renal dosing

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33
Q

Alt for HBV?

A
  1. Lamivudine
  2. Telbivudine
  3. Adefovir
  • High rates of resistance
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34
Q

What HBV medication provides activity against HIV?

A
  1. Tenofovir
  2. Lamivudine
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35
Q

HBX meds taken QD?

A
  1. TDF
  2. TAF
  3. Entecavir
36
Q

ADR of TDF?

A
  1. Bone dx
  2. Renal impairment
37
Q

Indcation of TAF use?

A

Consider use in patients previous nucleoside exposure
* age greater than 60
* bone disease
* renal impairment

38
Q

Indication of lamivudine? Cons

A

Indication: preganacy HBV
Cons: high risk for resistance

39
Q

ADR and CI of adefovir

A
  1. Reversible increase sCr
  2. Avoid in pregnancy (embryotoxic)
40
Q

Indication for pegylated IFN? DOsing? ADR?

A

Indication: Patients w/o cirrhosis who may want a finite duration of tx
Dosing: Inj QW
ADR: not well tolerated

41
Q

Indications for HBV IG?

A
  1. Post-exposure px following acute exposure to blood, plasma, serum
  2. Perinatal exposure of infants born to HBsAg-positive mothers or in mothers whose test results are not available/evidence of possible HBV infection
  3. Px of HBV recurrence after liver transplantation in a HBsAg-positive recipient
42
Q

What should HBIG not be used for?

A
  1. Active HB infection
  2. Chronic active HB infection
43
Q

Advantages of HBV vaccine?

A
  1. Effective for prevention
  2. Against human cancer
  3. Vaccines use HBsAg to prompt active immunity
44
Q

Who should get HBV vaccine?

A
  1. All infants
  2. All children and adolescent ≤19 YO who have not been vaccinated
  3. 19-59 YO
  4. ≥60 YO with RF for hep B

May get vaccine:
* ≥60 YO w/o RF for hep B

45
Q

Pediatric HBV vaccine?

A
  1. Comvax (Hib and HBV0
  2. Pediarix (HBV, dTap, pertussis, polio)
  3. Vaxelis (HB, Hib, pertussis, tDap)
46
Q

Antigen only HBV vac?

A
  1. Recombivax HB
  2. Energix B
47
Q

Nove adj for HBV?

A

Heplisav B

48
Q

HBV with 3 surface antigens

A

PreHeybrio

49
Q

RF of HCV?

A
  1. IVDU
  2. Unprotected sex
  3. MSM
  4. Household with HCV
  5. Blood contamination
  6. HD
  7. Child from infected mother
  8. Clotting facter prior to 1987
  9. Blood transfussion prior to 1992
50
Q

Screening for HCV?

A

Hepatitis C antibody (anti-HCV)
HCV RNA

51
Q

How do you interpret HCV screening?

A

Chronic is detectable HCV RNA for 6 month or more

52
Q

S/s of HCV?

A
  1. Dark urine
  2. Jaundic
  3. White stool
  4. Ab pain
  5. Fatigue
  6. Fever
  7. Loss app
  8. Pruritus
  9. 2/3 are asymptomativ
53
Q

Lab findings for HCV

A
  1. Elevated ALT/AST (ALT>AST)
  2. Elevated bilirubin
  3. HCV RNA +
54
Q

Clinical presentation of chronic HCV?

A

+ for >6 months:
1. RNA levels and ALT levels can fluctuate or be unetectable
2. Hepatomegaly
3. Hepatic and extrahepatic manifestations (renal dysfunction, cyroglobulinemia)

55
Q

What is the overall goal of HCV tx?

A

Virologic cure or sustained virologic response (SVR):
* nondetectable HCV RNA at least 12 weeks after tx completion

56
Q

HCV pretreatment evaulation components?

A
  1. Quantitative HCV testing and genotyping
  2. Assess underlying liver dx and renal function
  3. Screening for HBV, HIV, pregnancy
  4. Med rec
  5. Alcohol or illicit drug use
57
Q

Who should not get HCV tx?

A
  1. Short life expectancy (<12m)
  2. No benefit
  3. Liver transplantation
  4. Other directed tx
58
Q

Enzymes targeted by HCV tx?

A
  1. MS5A protease
  2. NS5B polymerase
  3. NS3/4A protein
59
Q

Preferred agents for HCV?

A

NS3/4A PI: Glecaprevir, Grazoprevir, Voxilaprevir
NS5A inhibitor: Elbasvir, Ledipasvir, Pibrentasvir, Velpatasvir
NS5B Polymerase inhibitor: Sofosbuvir

60
Q

NS5B Polymerase Inhibitors/NS5A Inhibitors

A

Sofosbuvir/Ledipasvir (Harvoni)

Sofosbuvir/Velpatasvir (Epclusa)

61
Q

NS5B Polymerase Inhibitors/NS5A Inhibitor/NS3/4A Protease Inhibitors

A

Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi)

62
Q

NS3/4A Protease Inhibitor/NS5A Inhibitor

A

Grazoprevir/elbasvir (Zepatier)
Glecaprevir/pibrentasvir (Mavyret)

63
Q

Genotype coverge for Harvoni?

A

1, 4, 5, 6

64
Q

Genotype coverage for Epclusa

A

1-6

65
Q

Genotype coverage for Mavyret

A

1-6

66
Q

Genotype coverage for Zepatier?

A

1, 4

67
Q

Genotype coverage for Vosevi?

A

Genotypes 1-6 with previous failed tx

68
Q

Caution with Sofosbuvir

A

caution/avoid coadmin with amiodarone due to risk of symptomatic bradycardia

69
Q

Caution with Sofosbuvir & simeprevir?

A

Not a monotherapy

70
Q

CP of ribavirin?

A
  1. Used as add on in difficult to treat patients
  2. Teratogenic
  3. Dose is based on weight, renal and hepatic function
71
Q

Counseling with Mavyret?

A

Take with a meal

72
Q

Should pegylated IFN be used for HCV?

A

No

73
Q

HCV tx used for renal impairment including dialysis?

A
  1. Mavyret
  2. Zepatier
74
Q

HCV tx used for patient decompensated cirrhosis?

A
  1. Harvoni
  2. Epclusa
75
Q

HCV that hve a DDI with accid-suppressing agents?

A
  1. Harvoni
  2. Epclusa
  3. Vosevi
76
Q

What is the simplefied HCV tx?

A

Expands the number of HCP who prescribe antiviral tx and increase the NNT

77
Q

Simplified HCV regimen in tx naive w/o cirrhosis?

A

No genotyping required:
* Glecaprevir/pibrentasvir (Mavyret) x 8 weeks
* Sofosbuvir/velpatasvir (Epclusa) x 12 weeks

78
Q

Simplified HCV regimen in tx naive w cirrhosis?

A

Genotype 1-6: glecaprevir/pibrentasvir (Mavyret) x 8 weeks
Genotype 1, 2, or 4-6: sofosbuvir/velpatasvir (Epclusa) x 12 weeks

79
Q

What do you monitor for in HCV tx?

A
  1. Hypoglycemia (anti-diabetic med)
  2. INR (warfarin)
  3. LFTs (cirrhosis)
  4. QuantitativeHCV
  5. RNA and a hepatic function panel at 12 weeks or later following completion of therapy to confirm HCV RNA is undetectable
80
Q

BBW with DDA for HCV?

A

Risk of fulminant hepatitis, hepatic failure, death

81
Q

When is Hep D most likely to occur?

A

With Hep B infection

82
Q

Diagnosis for HDV?

A

Antibodies against HDV or HDV RNA

83
Q

Tx for HDV?

A

No tx

0

84
Q

Transmission of HEV?

A
  1. Stool of infected person
  2. Drinking feces-contaminated water

Overll uncommon and asymptomatic

85
Q

Tx for HEV?

A
  1. Good sanitation and clean drinking water
  2. Boiling and chlorination of water
86
Q

Non pharm for all hep infections?

A
  1. Limit alcohol
  2. HBV and HAV vaccination to prevetn transmission
  3. Prevent transmission of HBV and HCV by risk factor
    4.
87
Q

How often do you followup with hep patients? What do you counsel them on?

A

Annually:
* Counsel on behaviors (adequate fluids, minimal alcohol and fats, optimal BW, avoid hepatotoxic med)
* Educate on s/s of liver dysfunction

Therapeutics IV (39 decks)

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