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NAPLEX > Hepatitis & Liver Disease > Flashcards

Hepatitis & Liver Disease Flashcards

1
Q

transmission of hep A

A

fecal-oral

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2
Q

transmission of hep B

A

blood-blood

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3
Q

transmission of hep C

A

blood-blood

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4
Q

first line treatment for Hep B

A

PEG-NRTI

NRTI(tenofovir or entecavir)

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5
Q

first line treatment for Hep C

A

Treatment naive: DAA combo
DAA combo + RBV
DAA combo + RBV + PEG-INF

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6
Q

Ritonavir MOA

A

not active for HCV but is used to boost levels of HCV protesase inhibitors used with it

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7
Q

NS3/4A protease inhbitors name clue

A

-previr

P for PI

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8
Q

NS5A replication complex inhibitor name clue

A

-asvir

A for NS5A

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9
Q

NS5B polymerase inhibitor name clue

A

-buvir

B for NS5B

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10
Q

DAAs + statins

A

increase concentration of statin and risk of myopathy

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11
Q

Interferon Alpha is used to treat what (3)

A

HBV
HCV
some cancers

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12
Q

Interferon Beta is used to treat?

A

Multiple sclerosis

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13
Q

MOA of NRTIs in HBV

A

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

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14
Q

NRTI stands for?

A

nucleoside/tide reverse transcriptase inhibitors

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15
Q

Prior to starting HBV therapy what should be checked

A

test for HIV b/c antivirals used for HBV can have activity against HIV and if a patient is co-infected with both HIV and HBV it is important that the chosen therapy is appropriate for both viruses to minimize risk of HIV antiviral resistance

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16
Q

List NRTIs for HBV (4)

A 
tenofovir
-disoproxil fumarate
-alafenamide
Entecavir
Adefovir
Lamivudine
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17
Q

CrCL dose adjustment for all HBV NRTIs

A

CrCl <50 mL/min

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18
Q

Boxed warning for all HBV NRTIs (3)

A

Lactic acidosis
severe hepatomegaly with steatosis
exacerbations of HBV on discontinuation

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19
Q

First line HBV agents (2)

A

tenofovir

entacavir

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20
Q

DDI: Ribavirin + NRTI

A

lactic acidosis

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21
Q

DDI: lamivudine +SMX/TMP

A

inc. lamivudine levels

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22
Q

Define cirrhosis

A

advanced fibrosis (scarring) of the liver that usually irreversible

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23
Q

normal range for AST and ALT

A

10-40 units/L

24
Q

specific lab abnormality for acute liver toxicity, including from drugs

A

inc. AST/ALT

25
Q

specific lab abnormality for chronic liver disease

A

inc. AST/aLT, alk phos, Tbili, LDH, PT/INR

dec. albumin

26
Q

specific lab abnormality for alcoholic liver disease

A

inc. AST > inc. ALT (AST double ALT)

gamma-glutamul transpeptidase (GGT) inc

27
Q

specific lab abnormality for hepatic encephalopathy

A

inc. ammonia

28
Q

Child Pugh Scores and classes A,B,C

A 
Class A (mild disease) Score <7
Class B (mod disease) Score 7-9
Class C (severe disease) Score 10-15
29
Q

Meld (model for end-stage liver disease) what do higher numbers indicate

A

0-40

higher numbers indicate greater risk of death within three months

30
Q

Key Drugs with boxed warning for liver damage

A 
APAP
Ketoconazole
MTX
NRTIs
VPA
31
Q

What 3 drugs are used for ETOH relapse

A

naltreoxne
acamprosate
disulfiram

32
Q

purpose of thiamine for alcoholics

A

treat wenicke-korsakoff syndrome

condition that cause brain damage due to lack of vitamin B1

33
Q

Define esophageal varices and 1 cause

A

enlarged veins in the lower part of the esophagus

cause: portal HTN

34
Q

treatment for bleeding varices (2)

A 
band ligation (band around the vessel)
sclerotherapy (injecting a solution into the vessel to make it collapse and close)
35
Q

Drugs that can help vasoconstrict the splanchnic (GI) circulation

A

octreotide: selective for splanchnic vessels
vasopressin: non-selective

36
Q

Which two ABX are options for prophylaxis in patients with a variceal bleed for up to 7 days

A

cetriaxone

quinolone

37
Q

Secondary prevention of variceal bleeding

A

Non-selective beta-blocker
nadolol
propranolol

38
Q

MOA of BB in variceal bleeding prevention

A
  1. dec. cardiac output via beta 1

2. dec. splanchnic blood flow by vasocontriction via beta 2

39
Q

Major caution with using non-selective BB

A

asthma
severe COPD
PAD and Raynaud’s

40
Q

S&S of hepatic encephalopathy

A

musty order of breath and/or urine
changes in thinking/confusion/forgetfulness
asterexis (hand tremor)

41
Q

cause of hepatic encephalopathy

A

accumulation of gut-derived nitrogenous substances in the blood such as ammonia glutamate. these are normally cleared by the liver, but when the liver isn’t working blood is shunted through collateral vessels that empty directly into the circulation instead.

42
Q

What lifestyle modification needs addressed in HE

A

restrict daily protein intake to 1-1.5 g/kg

43
Q

First line and second line tx for acute and chronic HE

A

Lactulose

Rifaximin

44
Q

lactulose MOA

A

convert ammonia produced by bacteria to ammonium, which is polar and therefore cannot readily diffuse into the blood

45
Q

What two ABX are used to inhibit the activity of urease-producing bacteria which decreases the ammonia

A

neomycin

metornidazole

46
Q

define ascites

A

fluid accumulation within the peritoneal space

47
Q

ascites can lead to what 2 conditions

A

SBP: spontaneous bacterial peritonitis
HRS: hepatorenal syndrome

48
Q

treatment for ascites due to portal HTN (3)

A

diet restriction of Na to <2g/day
avoid Na-retaining medications (NSAIDS)
use diuretics to inc. fluid loss

49
Q

Which diuretic therapy is preferred for ascites

A

spironolactone monotherapy
spironolactone + furosemide
-ratio of 100mg S: 40 mg F
-to maintain potassium balance

50
Q

Define SBP

A

acute infection of the ascitic fluid

51
Q

What two organisms are a concern in SBP

A

streptococci

enteric gram- pathogens

52
Q

What ABX to treat SBP

A

ceftriaxone

53
Q

secondary ppx of SBP

A

PO cipro or SMX/TMP

54
Q

define HRS

A

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

55
Q

treatment of HRS (3)

A

albumin
octreotide
midodrine

NAPLEX (65 decks)

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