Hepatitis/Liver Disease Flashcards
How is Hep A contracted?
poor hand washing – food/water (fecal -oral)
how is Hep B and C contracted?
transmission of infectious blood or other bodily fluids
Hep A or B or C?
can cause acute illness AND lead to chronic infection as well (cirrhosis, liver cancer, failure)
B and C
Hep A or B or C?
acute infection only
A
Hep A or B or C?
has a vaccine available for it
A and B
Hep A or B or C?
treatment consists of just supportive care
A
Hep A or B or C?
treatment consists of PEG-INF or NRTI
Hep B
Hep A or B or C?
treatment consists of DAA (direct acting antivirals)
C
Preferred Hep C treatment:
(if tx naive and no cirrhosis)
consists of ___#___ of direct acticg antivirals with DIFFERENT mechanisms for usually ______ weeks
2 - 3; 12 weeks (8 weeks in some regimens)
______ is used in some Hep C regimens but it is only used for a boost of HCV protease inhibitors
ritonavir
T or F:
DAAs can actually lead to a cure of Hep C
true
DAA (direct acting antiviral) drugs and MOA:
NS3/A4 Protease inhibitor: what is their name clue?
-Previr
P for protease
DAA (direct acting antiviral) drugs and MOA:
NS5A replication complex inhibitor: what is their name clue?
-Asvir
A for NS5A
DAA (direct acting antiviral) drugs and MOA:
NS5B replication complex inhibitor: what is their name clue?
-Buvir
B vor NS5B
T or F: the following are an appropriate combination
dasabuvir and sofosbuvir
FALSE — they are from the same drug class and should not be used together
T or F: the following are an appropriate combination
daclatasvir + sofosbuvir
TRUE — they are from different drug classes
the HIV and Hep C protease inhibitors have what following counseling point in common?
take with food
boxed warning for ALL DAA’s?
risk of reactivating HBV
test all patients for HBV prior to starting DAA
warning for sofosbuvir containing regimens?
contaminant amiodarone has led to serious symptomatic bradycardia!!
Generics for Harvoni?
sofosbuvir and ledipasvir
Generics for Epclusa
sofosbuvir and velpatasivr
for the combination paritaprevir/ritonavir/ombitasvir (+/- dasabuvir) product:
what are the two biggest warnings?
- hepatic decompensation/hepatic failure with cirrhosis / increased LFTs (esp with ethinyl estradiol)
- significant drug interactions (ritonavir portion!)
All DAAs are contraindicated with _________
CYP 3A4 INDUCERS
Harvoni, Epclusa, and Vosevi:
all must avoid _______ therapy and can decrease concentrations of ledipasvir and velpatasvir
Acid supression
- separate from antacids for 4 hours,
- for H2RAs: take at same time or separate by 12 hours
- PPI use not recommended (may differ per various products)
Dasabuvir is a substrate of _____
CYP2C8
Technivie and Viekira are substrates/inhibitors of ______
CYP3A4/PGP
With Technivie and Viekira products: ______ containing medications must be stopped
ethinyl estradiol
Ribavarin (RBV) is an antiviral used in HCV: as monotherapy or in combo
combo only!
What dosage form of ribavarin may e used for RSV
aerosolized ribavarin
Ribavarin:
avoid in _______ patients due to _____ effects and even at least _______ after end of therapy
pregnant; teratogenic effects
(even avoid pregnancy in female partners to male patients under treatment)
even for at least 6 months of stopping
what other drug (that is not a direct antiviral) can be used for treatment of HCV but is not used a lot because of hella toxicities and lab abnormalities
interferon alpha
Interferon Alpha:
boxed warnings: can cause or exacerbate what things?
neuropsychiatric, autoimmune, ischemic, or infectious disorders
Ribavarin and Interferon alpha can cause ______ anemia
hemolytic
Side effects of interferon alpha: \_\_\_\_ effects \_\_\_\_ upset increased \_\_\_\_\_\_\_ \_\_\_\_\_\_ syndrome
CNS effects (fatigue/depression)
GI upset
increased LFTs
Flu like syndrome (pre treat with APAP and antihistamine)
T or F:
interferon alpha can be used as monotherapy for HBV
true
what antiviral drug class is used for HBV?
NRTIs
(tenofovir disoproxil fumurate and alafenamide!!)
(also lamivudine, entacavir are used)
Generic for Viread and vimlidy
Viread: tenofovir DF
Vimlidy: tenofovir ala
Epivir HBV comes in tablet and oral solution — are they interchangeable?
NO
Cirrhosis = advanced fibrosis/scarring – most common 2 causes in US are ?
alcohol
Hep C
Common objective criteria/lab values to look at for evaluating the cirrhosis?
- AST/ALT (liver enzymes)
- Albumin
- total bilirubin
- prothrombin
If cirrhosis is present, the lab will be elevated or decreased?
ALT and AST
elevated
higher = more acute/active
If cirrhosis is present, the lab will be elevated or decreased?
albumin
decreased
If cirrhosis is present, the lab will be elevated or decreased?
bilirubin
increased
If cirrhosis is present, the lab will be elevated or decreased?
PT/prothrombin
increased
to rank the severity of liver disease _____ classification is used
child pugh
what natural product is thought to be good for liver detox (alcohol, Hep B or C)
milk thistle
Drug induced liver injury:
step 1) STOP THE DRUG – done normally when LFTs are > _____ times the upper limit of normal
3 (aka 150)
what are the key drugs that can liver damage
APAP isoniazid ketoconazole methotrexate nevirapine NRTIs Propylthiouracil Tipranavir Valproic acid Nefazodone
what does steatosis mean
fatty liver
alcohol liver disease can include what 3 diff types of liver issues?
fatty liver
alcoholic hepatitis
chronic hepatitis
Treatment of alcoholic liver disease:
1st part of treatment is obvs alcohol cessation
2nd: treatment programs may use _____ for acute withdrawl (inpatient) or ______ is used for outpatient
benzodiazepines;
anticonvulsants
Treatment of alcoholic liver disease:
what drugs are used to prevent relapses
naltrexone
acamprosate
disulfiram
Treatment of alcoholic liver disease:
_______ is used to prevent and treat ________ syndrome
thiamine (vit B1);
wernicke-korsakoff
what are the main complications with liver disease/ cirrhosis?
-portal HTN/variceal bleeding
-hepatic encphalopathy
-ascites
-spontaneous bacterial peritonitis
(and hepatorenal syndrome)
the variceal bleeding typically occurs where?
esophagus
Variceal bleeding can be fatal:
1st line therapy includes: _______ or _______
band ligation (put a band around the vessel)
or
sclerotherapy (inject something to make the vessel close)
what medications can be injected to vasoconstrict the GI circulation (to fix variceal bleed)
- ocreotide (selective option)
- vasopressin (non-selective option)
__________ should be added after resolution of variceal bleeding for SECONDARY prevention
non selective beta blockers
ex: nadolol or propranolol
vasopression is a _______ _____ analog
antidiuretic hormone analog
Hepatic Encephalopathy (HE): sxs include what?
- changes in thinking/confusion/forgetfulness
- musty odor of breath
- asterixis (hand tremor)
Hepatic Encephalopathy (HE): Symptoms of this occur by accumulation of \_\_\_\_\_\_\_\_\_\_\_ in the blood (like \_\_\_\_\_\_)
gut derived nitrogenous substances (ammonia)
what drugs are used to decrease ammonia levels for Hepatic Encephalopathy (HE)?
lactulose and antibiotics (rifaximin or neomycin)
Hepatic Encephalopathy (HE):
1st line tx is _______; works by converting ammonia to ______
2nd line is _______
1st: lactulose
2nd: Rifaximin
Ascites is fluid accumulation in the ________
peritoneal space
For patients with ascites:
dietary ________ intake should be restricted
sodium
Treating Ascites:
_______ monotherapy is ok
________ + _______ is ok
_________ monotherapy is ineffective
spironolactone alone is ok
spironolactone + furosemide is ok
furosemide alone is NOT ok
Treating Ascites:
Need a ratio of ____ mg furosemide to ____ mg spironolactone to maintain potassium balance
40 mg furos
100 mg spiro
A patient with ______ and ______ should be considered for liver transplantation
cirrhosis; ascites
Spontaneous bacterial peritonitis (SBP):
acute infection of ascitic fluid —- treat with _____
ceftriaxone
may add on albumin and patient will get a prophylactic abx after
