Hepatitis & Liver Disease Flashcards
transmission of hep A
fecal-oral
transmission of hep B
blood-blood
transmission of hep C
blood-blood
first line treatment for Hep B
PEG-NRTI
NRTI(tenofovir or entecavir)
first line treatment for Hep C
Treatment naive: DAA combo
DAA combo + RBV
DAA combo + RBV + PEG-INF
Ritonavir MOA
not active for HCV but is used to boost levels of HCV protesase inhibitors used with it
NS3/4A protease inhbitors name clue
-previr
P for PI
NS5A replication complex inhibitor name clue
-asvir
A for NS5A
NS5B polymerase inhibitor name clue
-buvir
B for NS5B
DAAs + statins
increase concentration of statin and risk of myopathy
Interferon Alpha is used to treat what (3)
HBV
HCV
some cancers
Interferon Beta is used to treat?
Multiple sclerosis
MOA of NRTIs in HBV
inhibit HBV replication by inhibiting HBV polymerase resulting in DNA chain termination
NRTI stands for?
nucleoside/tide reverse transcriptase inhibitors
Prior to starting HBV therapy what should be checked
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
List NRTIs for HBV (4)
tenofovir -disoproxil fumarate -alafenamide Entecavir Adefovir Lamivudine
CrCL dose adjustment for all HBV NRTIs
CrCl <50 mL/min
Boxed warning for all HBV NRTIs (3)
Lactic acidosis
severe hepatomegaly with steatosis
exacerbations of HBV on discontinuation
First line HBV agents (2)
tenofovir
entacavir
DDI: Ribavirin + NRTI
lactic acidosis
DDI: lamivudine +SMX/TMP
inc. lamivudine levels
Define cirrhosis
advanced fibrosis (scarring) of the liver that usually irreversible
normal range for AST and ALT
10-40 units/L
specific lab abnormality for acute liver toxicity, including from drugs
inc. AST/ALT
specific lab abnormality for chronic liver disease
inc. AST/aLT, alk phos, Tbili, LDH, PT/INR
dec. albumin
specific lab abnormality for alcoholic liver disease
inc. AST > inc. ALT (AST double ALT)
gamma-glutamul transpeptidase (GGT) inc
specific lab abnormality for hepatic encephalopathy
inc. ammonia
Child Pugh Scores and classes A,B,C
Class A (mild disease) Score <7 Class B (mod disease) Score 7-9 Class C (severe disease) Score 10-15
Meld (model for end-stage liver disease) what do higher numbers indicate
0-40
higher numbers indicate greater risk of death within three months
Key Drugs with boxed warning for liver damage
APAP Ketoconazole MTX NRTIs VPA
What 3 drugs are used for ETOH relapse
naltreoxne
acamprosate
disulfiram
purpose of thiamine for alcoholics
treat wenicke-korsakoff syndrome
condition that cause brain damage due to lack of vitamin B1
Define esophageal varices and 1 cause
enlarged veins in the lower part of the esophagus
cause: portal HTN
treatment for bleeding varices (2)
band ligation (band around the vessel) sclerotherapy (injecting a solution into the vessel to make it collapse and close)
Drugs that can help vasoconstrict the splanchnic (GI) circulation
octreotide: selective for splanchnic vessels
vasopressin: non-selective
Which two ABX are options for prophylaxis in patients with a variceal bleed for up to 7 days
cetriaxone
quinolone
Secondary prevention of variceal bleeding
Non-selective beta-blocker
nadolol
propranolol
MOA of BB in variceal bleeding prevention
- dec. cardiac output via beta 1
2. dec. splanchnic blood flow by vasocontriction via beta 2
Major caution with using non-selective BB
asthma
severe COPD
PAD and Raynaud’s
S&S of hepatic encephalopathy
musty order of breath and/or urine
changes in thinking/confusion/forgetfulness
asterexis (hand tremor)
cause of hepatic encephalopathy
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.
What lifestyle modification needs addressed in HE
restrict daily protein intake to 1-1.5 g/kg
First line and second line tx for acute and chronic HE
Lactulose
Rifaximin
lactulose MOA
convert ammonia produced by bacteria to ammonium, which is polar and therefore cannot readily diffuse into the blood
What two ABX are used to inhibit the activity of urease-producing bacteria which decreases the ammonia
neomycin
metornidazole
define ascites
fluid accumulation within the peritoneal space
ascites can lead to what 2 conditions
SBP: spontaneous bacterial peritonitis
HRS: hepatorenal syndrome
treatment for ascites due to portal HTN (3)
diet restriction of Na to <2g/day
avoid Na-retaining medications (NSAIDS)
use diuretics to inc. fluid loss
Which diuretic therapy is preferred for ascites
spironolactone monotherapy
spironolactone + furosemide
-ratio of 100mg S: 40 mg F
-to maintain potassium balance
Define SBP
acute infection of the ascitic fluid
What two organisms are a concern in SBP
streptococci
enteric gram- pathogens
What ABX to treat SBP
ceftriaxone
secondary ppx of SBP
PO cipro or SMX/TMP
define HRS
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
treatment of HRS (3)
albumin
octreotide
midodrine
