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NAPLEX Prep > Hepatitis/Liver Disease > Flashcards

Hepatitis/Liver Disease Flashcards

1
Q

How is Hep A contracted?

A

poor hand washing – food/water (fecal -oral)

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2
Q

how is Hep B and C contracted?

A

transmission of infectious blood or other bodily fluids

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3
Q

Hep A or B or C?

can cause acute illness AND lead to chronic infection as well (cirrhosis, liver cancer, failure)

A

B and C

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4
Q

Hep A or B or C?

acute infection only

A

A

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5
Q

Hep A or B or C?

has a vaccine available for it

A

A and B

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6
Q

Hep A or B or C?

treatment consists of just supportive care

A

A

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7
Q

Hep A or B or C?

treatment consists of PEG-INF or NRTI

A

Hep B

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8
Q

Hep A or B or C?

treatment consists of DAA (direct acting antivirals)

A

C

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9
Q

Preferred Hep C treatment:
(if tx naive and no cirrhosis)
consists of ___#___ of direct acticg antivirals with DIFFERENT mechanisms for usually ______ weeks

A 
2 - 3;
12 weeks (8 weeks in some regimens)
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10
Q

______ is used in some Hep C regimens but it is only used for a boost of HCV protease inhibitors

A

ritonavir

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11
Q

T or F:

DAAs can actually lead to a cure of Hep C

A

true

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12
Q

DAA (direct acting antiviral) drugs and MOA:

NS3/A4 Protease inhibitor: what is their name clue?

A

-Previr

P for protease

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13
Q

DAA (direct acting antiviral) drugs and MOA:

NS5A replication complex inhibitor: what is their name clue?

A

-Asvir

A for NS5A

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14
Q

DAA (direct acting antiviral) drugs and MOA:

NS5B replication complex inhibitor: what is their name clue?

A

-Buvir

B vor NS5B

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15
Q

T or F: the following are an appropriate combination

dasabuvir and sofosbuvir

A

FALSE — they are from the same drug class and should not be used together

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16
Q

T or F: the following are an appropriate combination

daclatasvir + sofosbuvir

A

TRUE — they are from different drug classes

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17
Q

the HIV and Hep C protease inhibitors have what following counseling point in common?

A

take with food

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18
Q

boxed warning for ALL DAA’s?

A

risk of reactivating HBV

test all patients for HBV prior to starting DAA

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19
Q

warning for sofosbuvir containing regimens?

A

contaminant amiodarone has led to serious symptomatic bradycardia!!

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20
Q

Generics for Harvoni?

A

sofosbuvir and ledipasvir

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21
Q

Generics for Epclusa

A

sofosbuvir and velpatasivr

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22
Q

for the combination paritaprevir/ritonavir/ombitasvir (+/- dasabuvir) product:
what are the two biggest warnings?

A
  • hepatic decompensation/hepatic failure with cirrhosis / increased LFTs (esp with ethinyl estradiol)
  • significant drug interactions (ritonavir portion!)
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23
Q

All DAAs are contraindicated with _________

A

CYP 3A4 INDUCERS

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24
Q

Harvoni, Epclusa, and Vosevi:

all must avoid _______ therapy and can decrease concentrations of ledipasvir and velpatasvir

A

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)
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25
Q

Dasabuvir is a substrate of _____

A

CYP2C8

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26
Q

Technivie and Viekira are substrates/inhibitors of ______

A

CYP3A4/PGP

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27
Q

With Technivie and Viekira products: ______ containing medications must be stopped

A

ethinyl estradiol

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28
Q

Ribavarin (RBV) is an antiviral used in HCV: as monotherapy or in combo

A

combo only!

29
Q

What dosage form of ribavarin may e used for RSV

A

aerosolized ribavarin

30
Q

Ribavarin:

avoid in _______ patients due to _____ effects and even at least _______ after end of therapy

A

pregnant; teratogenic effects
(even avoid pregnancy in female partners to male patients under treatment)

even for at least 6 months of stopping

31
Q

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

A

interferon alpha

32
Q

Interferon Alpha:

boxed warnings: can cause or exacerbate what things?

A

neuropsychiatric, autoimmune, ischemic, or infectious disorders

33
Q

Ribavarin and Interferon alpha can cause ______ anemia

A

hemolytic

34
Q 
Side effects of interferon alpha:
\_\_\_\_ effects
\_\_\_\_ upset 
increased \_\_\_\_\_\_\_
\_\_\_\_\_\_ syndrome
A

CNS effects (fatigue/depression)
GI upset
increased LFTs
Flu like syndrome (pre treat with APAP and antihistamine)

35
Q

T or F:

interferon alpha can be used as monotherapy for HBV

A

true

36
Q

what antiviral drug class is used for HBV?

A

NRTIs
(tenofovir disoproxil fumurate and alafenamide!!)

(also lamivudine, entacavir are used)

37
Q

Generic for Viread and vimlidy

A

Viread: tenofovir DF
Vimlidy: tenofovir ala

38
Q

Epivir HBV comes in tablet and oral solution — are they interchangeable?

A

NO

39
Q

Cirrhosis = advanced fibrosis/scarring – most common 2 causes in US are ?

A

alcohol

Hep C

40
Q

Common objective criteria/lab values to look at for evaluating the cirrhosis?

A
  • AST/ALT (liver enzymes)
  • Albumin
  • total bilirubin
  • prothrombin
41
Q

If cirrhosis is present, the lab will be elevated or decreased?
ALT and AST

A

elevated

higher = more acute/active

42
Q

If cirrhosis is present, the lab will be elevated or decreased?
albumin

A

decreased

43
Q

If cirrhosis is present, the lab will be elevated or decreased?
bilirubin

A

increased

44
Q

If cirrhosis is present, the lab will be elevated or decreased?
PT/prothrombin

A

increased

45
Q

to rank the severity of liver disease _____ classification is used

A

child pugh

46
Q

what natural product is thought to be good for liver detox (alcohol, Hep B or C)

A

milk thistle

47
Q

Drug induced liver injury:

step 1) STOP THE DRUG – done normally when LFTs are > _____ times the upper limit of normal

A

3 (aka 150)

48
Q

what are the key drugs that can liver damage

A 
APAP
isoniazid
ketoconazole
methotrexate
nevirapine
NRTIs
Propylthiouracil
Tipranavir
Valproic acid
Nefazodone
49
Q

what does steatosis mean

A

fatty liver

50
Q

alcohol liver disease can include what 3 diff types of liver issues?

A

fatty liver
alcoholic hepatitis
chronic hepatitis

51
Q

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

A

benzodiazepines;

anticonvulsants

52
Q

Treatment of alcoholic liver disease:

what drugs are used to prevent relapses

A

naltrexone
acamprosate
disulfiram

53
Q

Treatment of alcoholic liver disease:

_______ is used to prevent and treat ________ syndrome

A

thiamine (vit B1);

wernicke-korsakoff

54
Q

what are the main complications with liver disease/ cirrhosis?

A

-portal HTN/variceal bleeding
-hepatic encphalopathy
-ascites
-spontaneous bacterial peritonitis
(and hepatorenal syndrome)

55
Q

the variceal bleeding typically occurs where?

A

esophagus

56
Q

Variceal bleeding can be fatal:

1st line therapy includes: _______ or _______

A

band ligation (put a band around the vessel)
or
sclerotherapy (inject something to make the vessel close)

57
Q

what medications can be injected to vasoconstrict the GI circulation (to fix variceal bleed)

A
  • ocreotide (selective option)

- vasopressin (non-selective option)

58
Q

__________ should be added after resolution of variceal bleeding for SECONDARY prevention

A

non selective beta blockers

ex: nadolol or propranolol

59
Q

vasopression is a _______ _____ analog

A

antidiuretic hormone analog

60
Q 
Hepatic Encephalopathy (HE):
sxs include what?
A
  • changes in thinking/confusion/forgetfulness
  • musty odor of breath
  • asterixis (hand tremor)
61
Q 
Hepatic Encephalopathy (HE):
Symptoms of this occur by accumulation of \_\_\_\_\_\_\_\_\_\_\_ in the blood (like \_\_\_\_\_\_)
A

gut derived nitrogenous substances (ammonia)

62
Q

what drugs are used to decrease ammonia levels for Hepatic Encephalopathy (HE)?

A

lactulose and antibiotics (rifaximin or neomycin)

63
Q

Hepatic Encephalopathy (HE):
1st line tx is _______; works by converting ammonia to ______
2nd line is _______

A

1st: lactulose
2nd: Rifaximin

64
Q

Ascites is fluid accumulation in the ________

A

peritoneal space

65
Q

For patients with ascites:

dietary ________ intake should be restricted

A

sodium

66
Q

Treating Ascites:
_______ monotherapy is ok
________ + _______ is ok
_________ monotherapy is ineffective

A

spironolactone alone is ok
spironolactone + furosemide is ok
furosemide alone is NOT ok

67
Q

Treating Ascites:

Need a ratio of ____ mg furosemide to ____ mg spironolactone to maintain potassium balance

A

40 mg furos

100 mg spiro

68
Q

A patient with ______ and ______ should be considered for liver transplantation

A

cirrhosis; ascites

69
Q

Spontaneous bacterial peritonitis (SBP):

acute infection of ascitic fluid —- treat with _____

A

ceftriaxone

may add on albumin and patient will get a prophylactic abx after

NAPLEX Prep (19 decks)

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