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Hepatitis and Liver Disease > Hepatitis & Liver Disease > Flashcards

Hepatitis & Liver Disease Flashcards

1
Q

Transmission of Hep A

A

Fecal - Oral

Self-limiting

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2
Q

Transmission of Hep B

A

Blood - Blood

Not curable

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3
Q

Transmission of Hep C

A

Blood - Blood

Curable

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4
Q

First line treatment for Hep B

A

PEG-INF (pegylated interferon)

or

NRTI (tenofovir or entecavir)

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5
Q

First line treatment for Hep C

A

Treatment naive: DAA (Direct acting antivirals) combo

DAA combo + RBV (Ribavirin)

or

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 Inhibitors name clue

A

-previr

P for Protease Inhibitor

Grazoprevir
Paritaprevir
Simeprevir
Voxilaprevir

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8
Q

NS5A replication complex inhibitor name clue

A

-asvir

A for NS5A

Daclatasvir
Ledipasvir
Ombitasvir
Pibrentasvir
Velpatasvir
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9
Q

NS5B Polymerase Inhibitor name clue

A

-buvir

B for NS5B

Dasabuvir
Sofosbuvir

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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

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

decrease dose or frequency

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18
Q

BBW for all HBV NRTIs (3)

A

Lactic acidosis

Severe hepatomegaly with steatosis

Exacerbations of HBV on discontinuation

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19
Q

DDI: Ribavirin + NRTI

A

Lactic acidosis

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20
Q

DDI: Lamivudine + SMX/TMP

A

SMX/TMP increases Lamivudine levels

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21
Q

Define Cirrhosis

A

Advanced fibrosis (scarring) of the liver that usually irreversible

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22
Q

Normal range for AST and ALT

A

10 - 40 units/L

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23
Q

Specific lab abnormality for acute liver toxicity, including from drugs

A

Elevated AST and/or ALT

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24
Q

Specific lab abnormality for chronic liver disease

A

Elevated:

AST/ALT
Alk phos
Tbili
LDH
PT/INR

Decreased:
Albumin

25
Q

Specific lab abnormality for alcoholic liver disease

A

Elevated AST > Elevated ALT
***AST double ALT

Elevated Gamma-glutamul transpeptidase (GGT)

26
Q

Specific lab abnormality for Hepatic Encephalopathy

A

Elevated Ammonia

27
Q

Child Pugh Scores class interpretation (A,B,C)

A

Class A (mild disease) Score < 7

Class B (mod disease) Score 7 - 9

Class C (severe disease) Score 10 - 15

28
Q

Meld (model for end-stage liver disease);

What do higher numbers indicate

A

0-40

higher numbers indicate greater risk of death within 3 months

29
Q

Key Drugs with boxed warning for liver damage

A 
APAP
Ketoconazole
MTX
NRTIs
VPA
30
Q

What 3 drugs are used for ETOH relapse

A

Naltreoxne

Acamprosate

Disulfiram

31
Q

Purpose of Thiamine for alcoholics

A

To treat Wenicke-Korsakoff syndrome,

a condition that cause brain damage due to lack of vitamin B1

32
Q

Define Esophageal Varices and 1 cause

A

Enlarged veins in the lower part of the esophagus

cause: portal HTN

33
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)

34
Q

Drugs that can help vasoconstrictor the splanchnic (GI) circulation

A

Octreotide: selective for splanchnic vessels

Vasopressin: non-selective

35
Q

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

A

Ceftriaxone

Quinolone

36
Q

Secondary prevention of Variceal bleeding

A

Non-selective beta-blocker:

  • Nadolol
  • Propranolol
37
Q

MOA of BB in variceal bleeding prevention

A
  • Decreases cardiac output via beta 1

- Decreased splanchnic blood flow by vasoconstriction via beta 2

38
Q

Major caution with using non-selective BB

A
  • Asthma
  • Severe COPD
  • PAD
  • Raynaud’s
39
Q

S&S of Hepatic Encephalopathy

A
  • Musty order of breath and/or urine
  • Changes in thinking/confusion/forgetfulness
  • Asterexis (hand tremor)
40
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.

41
Q

What lifestyle modification needs addressed in Hepatic Encephalopathy?

A

Restrict daily Protein intake to 1 - 1.5 g/kg

42
Q

First line and second line tx for acute and chronic Hepatic Encephalopathy

A

Lactulose

Rifaximin

43
Q

Lactulose MOA

A

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

44
Q

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

A

Neomycin

Metornidazole

45
Q

Define Ascites

A

Fluid accumulation within the peritoneal space

46
Q

Ascites can lead to what 2 conditions

A

SBP: spontaneous bacterial peritonitis

HRS: hepatorenal syndrome

47
Q

Treatment for Ascites due to Portal HTN

A
  • Diet restriction of Na to <2 g/day
  • Avoid Na-retaining medications (NSAIDS)
  • Diuretics to increase fluid loss
48
Q

Which diuretic therapy is preferred for ascites

A

Spironolactone monotherapy

Spironolactone + Furosemide

  • ratio of S:F 100 mg: 40 mg
  • to maintain potassium balance
49
Q

Define SBP

A

Acute infection of the ascitic fluid

50
Q

What two organisms are a concern in SBP

A

Streptococci

Enteric gram ( - ) pathogens

51
Q

What ABX to treat SBP

A

Ceftriaxone

52
Q

Second line treatment of SBP

A

Cipro or SMX/TMP

53
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

54
Q

Treatment of HRS (3)

A
  • Albumin
  • Octreotide (Sandrostatin)
  • Midodrine
55
Q

Harvoni generic

A

Sofosbuvir/Ledipasvir

56
Q

Epclusa generic

A

Sofosbuvir/Velpatasvir

57
Q

Mavyret generic

A

Glecaprevir/Pibretasvir

58
Q

Viekira Pak, Viekira XR generic

A

Paritaprevir/Ritonavir/Ombitasvir + dasabuvir

59
Q

DAA (Direct acting antivirals) combo recommendation

A

2 to 3 agents for different MOA

Hepatitis and Liver Disease (1 decks)

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