- Inflammation of the Liver [caused by alcohol, drugs, autoimmune diseases, or viruses]

Hepatits & Liver Disease Flashcards by Emily Byford

What is Hepatitis?

Inflammation of the Liver [caused by alcohol, drugs, autoimmune diseases, or viruses]

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What are the different types of Hepatitis?

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What is Hepatitis A and what is important to know about it?

Acute, self-limiting disease transmitted via fecal-oral route
There IS a vaccine
Supportive care is first line treatment

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What is Hepatitis B and what is important to know about it?

Causes acute illness but can become chronic [infections, cirrhosis, cancer, death]
Transmitted via Blood or Body Fluids
There is a vaccine
PEG-IFN or NRTIs first line

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What is Hepatitis C and what is important to know about it?

Causes acute illness but can become chronic [infections, cirrhosis, cancer, death]
Transmitted via Blood or Body Fluids
NO vaccine for it
DAA combo it the treatment [+/- RBV]

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What is the recommended drug treatment for Hepatitis C?

for all 6 genotypes?

2 - 3 Direct Acting Anti-virals (DAA) with different mechanisms for 8 - 12 weeks

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What are the 3 different DAA classes that are used for treatment of Hepatitis C?

N53/4A Protease Inhibitor
NS5A Replication Complex Inhibitors
NS5B Polymerase Inhibitors

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What are the NS3/4A Protease Inhibitors and what is a “clue” for their naming?

Glecaprevir
Grazeoprevir
Voxilaprevir
PI = P so…. -previr

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What are the NS5A Replication Complex Inhibitors and what is a “clue” for their naming?

Elbasvir
Ledipasvir
Pibrentasvir
Velpatasvir
NS5A = A so…. -asvir

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What are the NS5B Polymerase Inhibitors and what is a “clue” for their naming?

Sofosbuvir
NS5B = B so…. -buvir

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What are some of the DAA treatments that are used for treating Hepatitis C?

Glecaprevir/Pibrentasivr [Mavyret]
Sofosbuvir/Velpatasvir [Epclusa]
Sofosbuvir/Ledipasvir [Harvoni]
Sofosbuvir/Velpatasivr/Voxilaprevir [Vosevi]
Sofosbuvir [Sovaldi]
Elbasvir/Grazoprevir [Zepatier]

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What are some of the Boxed Warnings for all of the DAAs for Hepatitis C?

Risk of reactiving Hep B [MUST test before starting]

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What are the warnings for Mavyret & Epculsa in treating Hepatitis C?

Those with sofoubvir: DO NOT use aminodarone

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What are some of the important notes about Marvyet & Epclusa in treating Hepatits C?

Sofoubvir solo NOT recommended
Epculsa: dispense in OG container
Epculsa: avoid or minimize acid suppressives (mostly PPIs) [decrease concentration]

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What are some of the drug interactions for all of the DAA in treating Hepatitis C?

AVOID 3A4 inducers [i.e.; Carbamazepine, Oxcarbazepine, Phenobarbital, Phenyton, Rifapin, Rifabutin, St. John’s Wort…]

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What is Ribavirin and how it is used during the treatment of Hepatitis C?

Oral antiviral that inhibits RNA/DNA replication
Used as combo therapy NEVER as monotherapy

What are the boxed warnings for Ribavirin?

Tertaogenic [AVOID pregnancy during treatment and for 6 - 9 months after completed]
Monotherapy NOT effective for Hep C
Hemolytic Anemia

What drug class is used for the treatment for Hepatitis B and what is the MOA for them?

Nucleoside/tide Reverse Transcriptase Inhibitors [NRTIs]
MOA: inhibits Hep B replication [inhibits Hep B Polyermase] = DNA chain termination

Can be used a monotherapy

Before starting an NRTI, what is one thing that should be tested for and why?

ALL should be tested for HIV [NRTIs can be used for treating HIV too - should use 2 NRTIs]

What are the NRTIs that are used in the treatment of Hepatitis B?

Tenofovir Disoproxil Fumarate [TDF]
Tenofovir Alafenamide [TAF]
Entecavir [Baraclude]
Lamivudine
Adefovir

What are some of the boxed warnings for ALL NRTIs?

Possible lactic acidosis & servere hepatomegaly w/ steatosis = fatal?
Exacerbation of Hep B

What are some of the warnings for TDF and TAF for treatment of Hep B?

Tenofovir Disoproxil Fumerate [TDF]
Tenofovir Aladenamide [TAF]

Renal toxicity
Fanconi Syndrome
Decrease bone density

Higher risk in TDF than TAF

What are some of the side effectsfor TDF and TAF for treatment of Hep B?

Nausea & Vomiting
Lipid issues
Headache, Ab pain, Fatigue, Depression

What are some inportant notes to know when taking Entecavir?

Take on an empty stomach

What are the **side effects** and **boxed warnings** for Lamivudine?

- BW: DO NOT take for HIV treatment [HIV resistance] - SE: Headache, N/V

What is Interferon Alfa [PEG-IFN] and what is important to know about it?

- Cytokine with antiviral, antiproliferative and immunomodualtory effects - Approved for monotherapy

What are some of the **warnings** about PEG-IFN?

- Myelosuppression

What are some of the **side effects** of PEG-IFN?

- **Fatigue, Depression**, GI issues, Increased LFTs **Flu like symptoms** [pre-treat with Tylenol & benadryl]

What is **Cirrhosis** and what are some of the most common causes of it?

- Cirrhosis: Scarring of the liver [irreversible] - Commonly caused by Hep C & Alcohol

What are some of the clinical presentations of someone with Cirrhosis?

- Nauseous, Decrease Appetite, Vomiting - **Yellow Skin and/or whites of eyes** [Jaundice]

What are some of the objective criteria when diagnosing someone with cirrhoisis?

- Liver Biopsy is the best - **AST/ALT** [higher values = liver disease] - Decreased **Albumin** - Increased **Total Billi** - Increased **PT/INR** [Liver makes anticoag] ## Footnote These are also **LFTs**

What are some of the ways that we assest the severit of liver disease?

- Child-Pugh - MELD

What drugs have a **boxed warning** for liver disease

- **Tylenol** - Aminodarone - Isonizad - Ketoconazole - Methotrexate - Nefazodone - Nevirapine - Propylthiouracil - Valproic Acid - Zidovidine

What is the treatment options for someone that has **Alcoholic Fatty Liver**

- **Alcohol Cessation** - Benzos can help control the withdrawl symptoms [Lorazepam] - **Naltrexone, Acamprosate, Disulfram** prevent prelapse - Thaimine helps with stopping brain damages

What is one of the more severe **complications** of Liver Disease & Cirrhosis?

- Portal HTN [Fibrotic tissues cause decrease blood flow = increase BP] which causes small blood vessels in the Esophagus to balloon out = **Esophageal Varices** ## Footnote THIS CAN BE FATAL

What are some of the supportive ways that we can prevent/treat variceal bleeding? ## Footnote Sugerical and Medications?

- Band Ligation [putting band around to vessel] - Sclerotherapy [injecting solutions into vessel] - Medications [Octreotide or Vasopressin] ## Footnote Non-selective beta blockers can be used for secondary prevention

What are the **side effects** for Octreotide?

- Bradycardia, Cholelithiasis, Billi Sludge

What is the purpose for using Non-Selective Beta Blockers in the treatment for Portal HTN and which ones are used??

- **Decrease cardio output** [via beta 1] and can **splanchnic vasoconstriction** [via beta 2] causing **decreased Portal Pressure** - Propranolol and Nadolol are commonly used