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NAPLEX 2021 > Hepatitis/Liver Disease > Flashcards

Hepatitis/Liver Disease Flashcards

1
Q

Hep A is chronic or acute?

A

acute

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2
Q

Transmission of HAV

A

fecal-oral

  • improper handwashing
  • contaminated food/water
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3
Q

HAV symptoms are usually ____ and ____

A

mild and non-specific

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4
Q

HBV and HCV are usually acute or chronic

A

BOTH!

acute illness that can lead to chronic infection, cirrhosis, cancer, liver failure, and death

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5
Q

HBV/HCV transmission

A

infectious blood or body fluids

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6
Q

Which hepatitis does NOT have a vaccine?

A

HCV

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7
Q

HAV first line tx

A

supportive

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8
Q

HBV first line tx

A

PEG-INF or NRTI (tenofovir or entecavir)

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9
Q

HCV first line treatment naive

A

DAA (direct acting antivirals) combination

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10
Q

How many HCV genotypes are there?

A

6

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11
Q

What three things determine HCV therapy?

A
  1. genotype
  2. presence of cirrhosis
  3. treatment naive?
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12
Q

What is a prefered HCV regimen?

A

2-3 DAAs with different mechanisms

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13
Q

What is the prefered duration of HCV treatment?

A

8-12 weeks

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14
Q

Ritonavir role in HCV treatment

A

dose not have action against HCV itself, but used to boost levels of HV protease inhibitors

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15
Q

Interferon’s role in HCV

A

no recommended in combination therapy can be considered if DAAs are CI or too expensive

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16
Q

Treatment options for treatment-naive patients without cirrhosis

A

glecaprevir/pibrentasvir

sofosbuvir/velpatasvir

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17
Q

Three types of DAA mechanisms

A
  1. NS3/4A Protease inhibitor
  2. NS5A Replication Complex Inhibitor
  3. NS5B Polymerase Inhibitor
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18
Q

list of Ns3/4A PIs

A 
"-previr" P for PI 
glecaprevir
grazoprevir
paritaprevir
voxilaprevir
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19
Q

list of NS5A replication complex inhibitors

A 
"-asvir" A for NS5A 
ledipasvir 
ombitasvir 
pibrentasvir
velpatasvir
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20
Q

list of NS5B Polymerase inhibitors

A

“-buvir” B for NS5B
dasabuvir
sofosbuvir

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21
Q

Protease Inhibitors should be taken with or without food?

A

with food! PIG (PIs and Grub)

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22
Q

What do patients need to be tested for before starting a DAA

A

HBV - risk of reactivating

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23
Q

Sofosbuvir specific warnings

A
  • do not take with amiodarone -> serious symptomatic bradycardia possilbe
  • risk of hypoglycemia when used with insulin
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24
Q

Side effects of DAAs

A

typically well tolerated

- HA, fatigue, diarrhea, nausea

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25
Q

What to monitor with DAAS

A

LFTs (bilirubin)

HCV-RNA

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26
Q

Sovaldi

A

Sofosbuvir
400mg daily
*dispense in original packaging

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27
Q

Epclusa

A

Sofosbuvir/velpatasvir
1 tablet daily
*dispense in original packaging
avoid acid-suppressive therapy

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28
Q

Harvoni

A

sofosbuvir/ledipasvir
1 tablet daily
*dispense in original packaging
avoid acid-suppressive therapy

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29
Q

Vosevi

A

sofosbuvir/velpatasvir/voxilaprevir
*dispense in original packaging
avoid acid-suppressive therapy

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30
Q

Mavyret

A

glecaprevir/pibrentasvir
3 tablets daily

*Take with food (glecaprevir)
CI: mod-severe hepatic impairment or decompensation

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31
Q

Technivie

A

paritaprevir/ritonavir/ombitasvir

*take with food (paritaprevir)

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32
Q

Viekira Pak

A

paritaprevir/ritonavir/ombitasvir+ dasabuvir
Tri - 2 tablets in the morning
dasabubvir - twice daily with meals

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33
Q

Zepatier

A

elbasvir/grazoprevir

34
Q

Contraindication for Mavyret

A

mod-severe hepatic impairment or history of hepatic decompensation

35
Q

Sofosbuvir monotherapy role

A

not effective/not recommended

36
Q

Which drugs should be dispensed in original packaging?

A

Sovaldi, Epclusa, Harvoni, Vosevi

37
Q

which drugs are approved for all 6 HCV genotypes (pan-genotypic)

A

Epclusa and Mavyret

38
Q

Which drugs are approved for salvage therapy?

A

Vosevi and Mavyret

39
Q

which drugs are approved for 8-week course of therapy?

A

Mavyret

40
Q

which are approved for HCV/HIV co-infection

A

Epclusa, Harvoni, and Mavyret

41
Q

which are approved for children 12 or older with certain genotypes

A

Sovaldi and Harvoni

42
Q

Major warning with DAAs

A

LOTS OF DRUG INTERACTIONS

43
Q

CI with strong ______ inducers

A

CYP3A4

-carbamazepine, oxcarbazepine, phenobarb, phenytoin, rafampin, rifabutin, St. John’s Wort

44
Q

DAAs can increase the concentration of ______ leading to increased ________ risk

A

statins = increased MYOPATHY risk

45
Q

Which drugs should Mavyret specifically not be used with

A

efavirenz
HIV PIs
ethinyl estradiol products
cyclosporine products

46
Q

Which DAAs should not be used with PPIs

A

Epclusa

47
Q

Ribavirin (RBV) MOA

A

inhibits replication of RNA and DNA viruses

48
Q

RBV place in therapy

A

HCV in combo, never monotherapy

aerosolized has been used in RSV

49
Q

boxed warnings for RBV

A
  • teratogenic effections
  • not effective monotherapy
  • hemolytic anima (can worsen cardiac disease)
50
Q

CI with RBV

A

pregnancy
women of childbearing age without reliable contraceptive use
men with pregnant female partners
CrCl <50
didanosine concomitant use (hepatic failure)

51
Q

what limits use of interferons

A

toxicities

lab abnormalities

52
Q

List of NRTIs used in HBV

A 
TDF (Viread) 
TAF (Vemlidy) 
Entecavir (baraclude) 
Adefovir
Lamivudine (Epivir HBV)
53
Q

Which NRTIs should not be used with a HIV co-infection

A

lamivudine (Epivir), TAF, and TDF

- lower dose for HBV could lead to resistance in HIV treatment)

54
Q

Presentation of cirrhosis

A

jaundice, dark urine, pain in upper right quad of abdomen, loss of appetite

55
Q

Which labs indicate acute liver toxicity due to drugs or otherwise

A

elevated AST ALT

56
Q

which lab indicate chronic liver disease

A

increase ast/alt, alk phos, tbili, ldh, pt/inr

decreased albumin

57
Q

which lab indicates alcoholic liver disease

A

elevated ast about double the alt

increased ggt

58
Q

which lab indicateds hepatic encephalopathy

A

increased ammonia

59
Q

normal range for ast/alt

A

10-40 u/L

60
Q

increased alk phos and Tbili indicates cholestatic or hepatocellular liver disease?

A

cholestatic

alt and ast = hepatocellular

61
Q

increased alk phos, tbili, ast, and alt indicates what type of liver disease?

A

mixed!

62
Q

primary treatment for drug-induced liver injury

A

Stop the drug!

63
Q

When do we d/c a hepatotoxic drug?

A

when lfts are >3x upper limit of normal

64
Q

Major hepatotoxic drugs

A
  • APAP
  • amiodarone
  • isoniazid
  • ketoconazole
  • methotrexate
  • nefazodone
  • nevirapine
  • NRTIs
  • propylthiouracil
  • tipranavir
  • valproic acid
65
Q

steatosis meaning

A

fatty liver

reversible if offending agent stopped (alcohol)

66
Q

Inpatient alcohol withdrawal treatment

A

bzds

67
Q

Medications meant to prevent alcohol relapses

A

naltrexone
acamprosate
disulfiram

68
Q

Why is thiamine used in alcoholics?

A

prevent/treat Wernicke-Korsakoff syndrome - encephalopathy

69
Q

Recommended first line treatment for esophageal varices

A

band ligation

sclerotherapy

70
Q

Octreotide

A

selective vasoconstrictor for splanchnic vessels

used in varices to stop/slow bleeding

71
Q

Vasopressin

A

non-selective vasoconstrictor used in varices to stop/slow bleeding

72
Q

Secondary prevention of variceal bleeding

A

Non-selective beta-blockers

titrate to maximum tolerated dose

73
Q

side effects of octreotide

A

bradycardia, cholelithiasis, biliary sludge

74
Q

Which beta blockers are non-selective

A

nadolol

propranolol

75
Q

how to beta-blockers prevent variceal bleeding

A

reduce portal pressure by decreasing CO and decreasing splanchnic blood flow via vasoconstriction

76
Q

What causes symptoms of hepatic encephalopathy

A

accumulation of ammonia

77
Q

symptoms of hepatic encephalopathy

A

musty odor of breath, changes in thinking, confusion, forgetfulness, asterixis

78
Q

drug therapy for hepatic encephalopathy

A

lactulose

antibiotics like rafaximin

79
Q

how does lactulose work

A

first line therapy for encephalopathy and prevetion

converts ammonia produced by intestinal bacteria to ammonium which cannot diffuse into the blood due to not being polar.

80
Q

How do antibiotics help hepatic encephalopathy

A

decrease ammonia production by inhibitions activity of urease producing bacteria

81
Q

lactulose treatment dosing

A

30-45 mL every hour until bowel movement then 30-45 mL 3-4 times daily titrated to produce 2-3 soft bowel movements dialy

NAPLEX 2021 (28 decks)

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