Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NAPLEX 21 > Hepatitis & Liver Disease > Flashcards

Hepatitis & Liver Disease Flashcards

1
Q

This type of hepatitis virus usually causes an acute, self-limiting illness.

Transmission is primarily via the fecal-oral route through improper hand washing after exposure to an infected person or via contaminated food/water

A

Hepatitis A virus (HAV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

These hepatitis viruses can cause acute illness and can lead to chronic infection, cirrhosis of the liver, liver cancer, liver failure and death.

Transmission occurs from contact with infectious blood or other bodily fluids, or perinatal transmission (mom to baby)

A

Hepatitis B and Hepatitis C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

This virus is ACUTE, fecal-oral, there is a vaccine for it, first line treatment is supportive care

A

Hep A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Does hep C have a vaccine?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

First-line treatment is PEG-INF or NRTI (tenofovir or entecavir)

A

Hep B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Treatment for naive is direct-acting antivirals

A

Hep C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment in select patients for which liver virus?

Direct-acting antivirals + ribavirin + PEG-INF

A

Hepatitis C treatment in select patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How many HCV genotypes are there?

A

1-6; and various subtypes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Preferred HCV regimens consist of ____ DAAs with different mechanisms usually for how many weeks?

A

2-3 DAAs (often in one tablet), x8-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is ritonavir used for in HCV treatment?

A

It is not active for HCV, but is used to boost/increase levels of HCV protease inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q 
Glecaprevir
Grazoprevir
Paritaprevir
Voxilaprevir
are examples of what type of DAA?
A

NS3/4A Protease Inhibitor

Think –> -previr=P=Protease Inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q 
Ledipasvir
Ombitasvir
Pibrentasvir
Velpatasvir
are examples of what type of DAA?
A

NS5A Replication Complex Inhibitor

Think –> -asvir=A-N5SA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dasabuvir
Sofosbuvir
are examples of what type of DAA?

A

NS5B Polymerase Inhibitor

Think –> -buvir=B=Ns5B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

For treatment-naive patients without cirrhosis but has HCV, recommended regimens are:

A

Glecaprevir/pibrentasvir
NS3/4A Protease Inhibitor/ NS5A Replication Complex Inhibitor

Sofosbuvir/velpatasvir
NS5B Polymerase Inhibitor/NS5A Replication Complex Inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

All DAAs have a risk of reactivating what virus?

A

HBV - must test all patients before starting a DAA – BOXED WARNING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

This DAA has serious symptomatic bradycardia when taken with amiodarone. Do not take these together.

A

Sofosbuvir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Are all DAAs generally well-tolerated?

A

Yes-
HA, fatigue, diarrhea, nausea

Monitoring: LFTs, HCV-RNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Brand: Sovaldi

A

Generic: sofosbuvir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Brand: Epclusa

A

Generic: sofosbuvir/velpatasvir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Brand: Harvoni

A

Generic: sofosbuvir/ledipasvir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Brand: Vosevi

A

Generic: sofosbuvir/velpatasvir/ voxilaprevir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Brand: Mavyret

A

Generic: glecaprevir/pibrentasvir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which DAAs do you take with food?

A

Mavyret

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Mavyret has a contraindication of

A

mod-severe hepatic impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Sofosbuvir monotherapy…

A

NOT recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which DAAs should be dispensed in original container/protect from moisture?

A

Sovaldi, Epclusa, Harvoni, Vosevi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Avoid or minimize acid suppressive therapy with which DAAs?

A

Epclusa, Harvoni, Vosevi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Pan-Genotypic (approved for all 6 HCV genotypes) for treatment naive

A

Epclusa and Mavyret

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Approved for Salvage therapy/failed previous therapy

A

Vosevi and Mavyret in select patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Approved for 8-week course of therapy in select patients

A

Mavyret

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Approved for HCV/HIV co-infection

A

Epclusa, Harvoni, and Mavyret

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Approved for children>12 with certain genotypes

A

Sovaldi and Harvoni

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

All DAAs are contraindicated with strong inducers of

A

CYP3A4: carbamazepine, oxcarbamazepine, phenobarbital, phenytoin, rifampin, rifabutin, and St. John’s Wort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Do NOT use which DAA with efavirenz, HIV protease inhibitors, ethynyl estradiol-containing products, and cyclosporine.

A

Mavyret

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Using PPIs with which DAA is not recommended?

A

Epclusa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Do not use Stribild with which DAA?

A

Harvoni

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

This is an oral antiviral drug that inhibits replication of RNA and DNA viruses. It can be used for HCV in combination with other drugs, but never as monotherapy

A

Ribavirin (RBV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Brand: Rebetol

A

Generic: Ribavirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the boxed warning for Ribavirin?

A

Significant teratogenic effects; not effective for monotherapy of HCV; hemolytic anemia

40
Q

Can Ribavirin be used in pregnancy?

A

NO! avoid in pregnancy, female partners of male patients during therapy and 6 months after completion — 2 reliable forms of effective contraception

41
Q

Do not use Ribavirin with didanosine why?

A

fatal hepatic failure, peripheral neuropathy, and pancreatitis

42
Q

Interferon alfa (INF-alfa) is approved for the treatment of which viruses

A

HBV, HCV

43
Q

Which forms of INF alfa have a prolonged half-life?

A

pegylated forms (PEG-INF).. reduces dosing to once WEEKLY (subQ)

44
Q

This antiviral has a boxed warning that states it can cause or exacerbate neuropsychiatric, autoimmune, ischemic, or infectious disorders; and if used with ribavirin, teratogenic/anemia risk

A

IFN-alfa

45
Q

The side effects of this antiviral is extensive, which is why it has fallen out of favor in HCV. Side effects include:

CNS effects, GI upset, inc LFTs, myelosuppresion, flu-like sx

A

IFN-alfa

46
Q

Interferon-alfa is approved as monotherapy and is a preferred treatment for

A

HBV

47
Q

These drugs inhibit HBV replication by inhibiting HBV polymerase resulting in DNA chain termination

A

Nucleoside/tid reverse transcriptase inhibitors (NRTIs)

48
Q

Prior to starting HBV therapy, all patients should be test for…?

A

HIV.
Antivirals used for HBV can have activity against HIV and if a patient is co-infected with both, it is important to chose therapy appropriate for both to minimize resistance

49
Q

All HBV NRTIs, dec dose or frequency when CrCl < ?

A

<50ml/min

50
Q

ALL NRTIs have a boxed warning for…

A

Lactic acidosis and severe hepatomegaly with steatosis which can be FATAL

51
Q

Brand: Viread

A

Generic: Tenofovir disoproxil fumarate (TDF)

52
Q

Brand: Vemlidy

A

Generic: Tenofovir alafebnamide (TAF)

53
Q

Brand: Baraclude

A

Generic: Entecavir

54
Q

Brand: Epivir HBV

A

Generic: Lamivudine

55
Q

Warnings of these NRTIs include renal toxicity, Falcon syndrome, osteomalacia, and dec bone mineral density

A

TDF> TAF

56
Q

Dispense only in original container in which NRTIs?

A

Viread tablets and Vemlidy

57
Q

Which NRTI do you take on an empty stomach?

A

Entecavir

58
Q

This NRTI has a boxed warning: do not use for treatment of HIV

A

Epivir HBV

59
Q

What are the most common causes of cirrhosis?

A

Hep C and alcohol

60
Q

These labs can indicate cirrhosis

A 
INC ALT AST
DEC albumin
INC alkaline phosphate
INC total bilirubin
INC in PT
61
Q

What are markers of production ability in liver function?

A

Albumin and PT/INR

62
Q

What is milk thistle?

A

an extract derived from a member of the daisy family, sometimes used by those w liver disease

63
Q

When are hepatotoxic drugs typically d/c?

A

LFTs >3x upper limit >150u of ALT or AST

64
Q

inc T bili indicates

A

Jaundice

65
Q

Inc ammonia indicates

A

hepatic encephalopathy

66
Q

Inc AST> Inc ALT (AST is doubled ALT), Inc GGT indicates

A

Alcoholic liver disease

67
Q

Inc AST/ALT, Alk Phos, Tbili, LDH, PT/INR
Dec albumin
indicates

A

chronic liver disease/cirrhosis

68
Q

INC AST/ALT indicates

A

acute liver toxicity including from drugs

69
Q

Can Tylenol be used by patients with cirrhosis?

A

Yes, limited periods of time and lower dosages;

HOWEVER, NSAIDs should be avoided bc it can lead to decompensation

70
Q

What drugs can cause acute liver toxicity?

A 
Tylenol
Amiodarone
Isoniazid
Ketoconazole, PO
Methotrexate
Nefazodone
Nevirapine
NRTIs
Propylthiouracil
Tipranavir
Valproic acid
71
Q

This is the most common type of drug-induced liver disease

A

Alcohol-associated liver disease. Risk increases with the amount of alcohol consumed and duration. Women>men

72
Q

Chronic alcohol ingestion over a long period of time causes…

A

“steatosis” or fatty liver

due to a fat deposition in the hepatocytes

73
Q

Fatty liver, alcoholic hepatitis and chronic hepatitis are all…

A

Alcohol-associated liver disease

74
Q

What do treatment programs mainly use for alcohol withdrawal in inpatient vs outpatient?

A

inpatient - benzos

outpatient- anticonvulsants

75
Q

Naltrexone (Vivitrol), acamprosate, and disulfiram (Antabuse) are used to…

A

prevent relapses

76
Q

What vitamin is used to prevent and treat Wernicke-Korsakoff syndrome?

A

Thiamine (Vitamin B1)

77
Q

Portal hypertension (increased blood pressure in the portal vein) can cause complications including the development and bleeding of:

A

esophageal varices (enlarged veins in the lower part of the esophagus)

Acute variceal bleeding can be FATAL.

78
Q

Tx for acute variceal bleeding

A

Supportive therapy (blood volume, resuscitation/blood products, mechanical ventilation), Band ligation, sclerotherapy

79
Q

Octreotide is selective for the splanchnic vessels whereas vasopressin is non-selective. These drugs are for…

A

vasoconstrictor the splanchnic (GI) circulation

80
Q

Short-term antibiotic prophylaxis should be given to cirrhotic patients with a variceal bleed to reduce bacterial infections & mortality

A

Ceftriaxone or quinolone x 7 days

81
Q

This class of drugs should be added after resolution of a variceal bleed for secondary prevention

A

Non-selective beta- blocker

82
Q

Brand: Sandostatin

A

Generic: Octreotide (IV)

Can cause low HR!!!

83
Q

Brand: Corgard

A

Generic: Nadolol

84
Q

Brand: Inderal LA, Inderal XL

A

Generic: Propranolol

85
Q

This condition is caused by acute or chronic hepatic insufficiency. Sx can include musty odor of the breath, changes in thinking, confusion, hand tremor/asterixis

A

Hepatic encephalopathy

-want to limit the amount of animal protein
BCAAs > AAAs

86
Q

Acute and chronic therapy for HE

A

1st- Lactulose, works by converting ammonia produced by intestinal bacteria to ammonium

2nd- rifaximin, inhibit the activating of urease-producing bacteria, which dec the ammonia production

Others- Neomycin (BW- neurotoxicity) , Flagyl (peripheral neuropathies long term)

?? - Zinc

87
Q

Brand: Enulose, Constulose

A

Generic: lactulose

88
Q

Brand: Xifaxan

A

Generic: Rifaximin

89
Q

Fluid accumulation within the peritoneal space

A

Ascites

Can lead to SBP or hepatorenal syndrome (HRS)

90
Q

Patients with ascites due to portal HTN, tx:

A

restrict dietary sodium <2g/day
avoid sodium retaining meds (NSAIDs)
use diuretics to inc fluid loss

91
Q

Diuretic therapy for ascites

A

Spironolactone monotherapy

furosemide 40mg + spironolactone 100mg (to maintain potassium balance)

92
Q

Who should be considered for liver transplants?

A

All patients with cirrhosis and ascites

93
Q

An acute infection of the ascitic fluid

A

SBP

94
Q

SBP treatment

A

targeting streptococci and enteric gram neg

ceftriaxone x5-7 days
+albumin (1.5g/kg of body weight on day 1 and 1g/kg on day 3)

95
Q

Secondary prophylaxis of SBP

A

Cipro PO or Bactrim

96
Q

the development of renal failure in patients with advanced cirrhosis due to vasoconstriction, mediated by activation of the RAAS system and SNS through a feedback mechanism known as hepatorenal reflex.

A

Hepatorenal syndrome (HRS)

NAPLEX 21 (60 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions