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x F2: IPCS > ID exam 4 > Flashcards

ID exam 4 Flashcards

1
Q

Abacavir MOA

A

inhibits the activity of HIV-1 reverse transcriptase by competing with the natural substrate leading to chain termination

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2
Q

Abacavir DDIs

A

co admin with ethanol

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3
Q

Abacavir ADE

A

hypersensitivity syndrome
maculopapular rash
respiratory

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4
Q

Lamivudine MOA

A

inhibits reverse transcriptase competitively and acts as a chain terminator of viral DNA synthesis

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5
Q

Lamivudine DDIs

A

co admin with sorbitol

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6
Q

Lamivudine ADRs

A

headache, nausea, malaise

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7
Q

Tenofovir Disoproxil Fumarate MOA

A

competitive inhibitor of viral reverse transcriptase and chain termination

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8
Q

Tenofovir Disoproxil Fumarate ADME

A

low protein binding
take with high fat food

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9
Q

Tenofovir Disoproxil Fumarate DDI

A

Didanosine
Atazanavir
Lopinavir/ritonavir

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10
Q

Tenofovir Disoproxil Fumarate ADR

A

rash, diarrhea, headache, pain, nausea

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11
Q

Emtricitabine MOA

A

inhibit HIV-reverse transcriptase and chain terminates

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12
Q

Emtricitabine ADME

A

low protein bound

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13
Q

Emtricitabine DDIs

A

CYP3A4 and many others

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14
Q

Emtricitabine ADEs

A

hyperpigmentation of skin

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15
Q

Tenofovir Alafenamide MOA

A

competitive inhibitor of viral reverse transcriptase and cause chain termination

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16
Q

Tenofovir Alafenamide ADME

A

high protein bound
hydrolyzed within cells
uncleaved prodrug

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17
Q

Tenofovir Alafenamide ADRs

A

headache, ab pain, fatigue, cough, nausea, back pain

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18
Q

Zidovudine MOA

A

inhibit reverse transcriptase via chain termination

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19
Q

Zidovudine ADME

A

hepatic glucuronidation

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20
Q

Zidovudine DDIs

A

ganciclovir
doxorubicin
ribavirin

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21
Q

Zidovudine ADE

A

myalgia, bone marrow suppression, myopathy

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22
Q

Etravirine MOA

A

non-competitive inhibitor of reverse transcriptase

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23
Q

Etravirine AMDE

A

high protein bound
administer following a meal

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24
Q

Etravirine DDIs

A

CYP3A4

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25
Q

Etravirine ADR

A

rash
peripheral neuropathy

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26
Q

Rilpivirine MOA

A

non-competitive inhibitor of reverse transcriptase

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27
Q

Rilpivirine DDI

A

do not co admin with other NNRRIs
CYP3A4

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28
Q

Rilpivirine ADR

A

depression, insomnia, headache, rash
QT prolongation

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29
Q

Doravirine MOA

A

non-competitive inhibitor of reverse transcriptase

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30
Q

Doravirine ADE

A

nausea, dizziness, headache, fatigue, diarrhea, ab pain, abnormal dreams

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31
Q

Ritonavir MOA

A

prvent proteolytic cleavage of HIV polypeptides and maturation of viral particles

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32
Q

Ritonavir ADME

A

high protein bound
rapid absorption

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33
Q

Ritonavir DDIs

A

midazolam, triazolam, fentanyl, ergot derivatives

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34
Q

Ritonavir ADRs

A

GI, neurologic disorders, rash, fatigue

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35
Q

Atazanavir MOA

A

prevent proteolytic cleavage of HIV precursor polypeptides and maturation of viral particles

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36
Q

Atazanavir DDIs

A

PPIs

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37
Q

Atazanavir ADRs

A

GI, insomnia, peripheral neurologic symptoms, myalgia, depression, fever

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38
Q

Darunavir MOA

A

prevent proteolytic cleavage of HIV precursor polypeptides and maturation of viral particles

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39
Q

Darunavir ADME

A

high protein bound

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40
Q

Darunavir ADR

A

GI, headahce, ab pain

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41
Q

Raltegravir MOA

A

inhibit viral integrase enzyme blocking viral DNA into host genome

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42
Q

Raltegravir DDI

A

rifampin

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43
Q

Raltegravir ADE

A

insomnia, headache, nausea, asthenia, fatigue

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44
Q

Elvitegravir MOA

A

inhibit viral integrase enzyme blocking viral DNA into host genome

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45
Q

Elvitegravir ADME

A

high protein bound

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46
Q

Elvitegravir DDI

A

protease inhibitors
ritonavir

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47
Q

Elvitegravir ADRs

A

N/D

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48
Q

Dolutegravir MOA

A

inhibit integrase enzyme by binding to amino acids in active site and block strand of transfer step

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49
Q

Dolutegravir ADME

A

high protein bound
UGT1A1 metabolization

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50
Q

Dolutegravir DDIs

A

metabolic inducers
2 hours before or 6 hours after cations

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51
Q

Dolutegravir ADRs

A

insomnia and headache

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52
Q

Bictegravir MOA

A

targets HIV integrase and prevents strand transfer activity and integration of provirus into host genome

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53
Q

Bictegravir ADME

A

not for severe hepatic impairment

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54
Q

Bictegravir DDIs

A

rifampin
antacids

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55
Q

Bictegravir ADRs

A

lactic acidosis, liver problems, new or worsening kidney problems

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56
Q

Cabotegravir MOA

A

integrase strand transfer inhibitor

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57
Q

Cabotegravir ADME

A

IM slow absorption
high protein bound

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58
Q

Cabotegravir DDIs

A

other antiretroviral HIV meds
UGT1A1 or 1A9 inducers
-rifampicin, carbamazepine, oxcarbazepine, phenytoin, phenobarbital
Cabenuva

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59
Q

Cabotegravir ADRs

A

IM: inj site rxn, headache, fever
Oral: headache, hot
both: depressive, insomnia, rash

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60
Q

Cobicistat MOA

A

inhibit P450 3A4

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61
Q

Cobicistat ADME

A

high protein bound

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62
Q

Cobicistat DDI

A

CYP3A4, CYP2D6

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63
Q

Cobicistat DDIs

A

atazanavir causes jaundice and rash

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64
Q

Lenacapavir MOA

A

interfere with essential steps in viral replication by binding between viral capsid protein subunits and hexamers

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65
Q

Lenacapavir ADME

A

sub q: long absorption
high protein bound

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66
Q

Lenacapavir DDI

A

p-gp, UGT1A1

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67
Q

Lenacapavir ADR

A

itching, swelling, redness, pain, hardened skin, small mass/lumps at injection site

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68
Q

Enduvirtide MOA

A

disrupt gp41 rendering it incapable of mediating membrane fusion to allow viral entry into host cell

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69
Q

Enduvirtide ADME

A

sub q inj
high protein bound
undergoes catabolism

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70
Q

Enduvirtide DDI

A

lots of CYPs
ritonavir, rifampin

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71
Q

Enduvirtide ADR

A

inj site rxn
pneumonia
hypersensitivity rxn
respiratory, nephritis, guillain-barre syndrome

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72
Q

Maraviroc MOA

A

block HIV outer envelope binding of gp120 to CCR5

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73
Q

Maraviroc DDIs

A

CYP3A4 and Pgp

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74
Q

Maraviroc ADRs

A

pyrexia, upper rti, rash, musculoskeletal, ab pain, dizziness

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75
Q

Ibalizumab MOA

A

block HIV from binding to CCR5 and CXCR4 on CD4 cells

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76
Q

Ibalizumab ADME

A

need loading dose

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77
Q

Ibalizumab ADR

A

diarrhea, dizziness, nausea, rash

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78
Q

Fostemsavir MOA

A

dephosphorylated product that binds directly to gp120 and inhibits viral interaction with CD4 receptors

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79
Q

Fostemsavir ADME

A

hydrolysis, oxidation, and UGT

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80
Q

Fostemsavir DDIs

A

temsavir increase plasma concentration of grazoprevir and voxilaprevir
rifampin

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81
Q

Fostemsavir ADR

A

n/v/d
ab pain
dyspepsia
fatigue
sleep disturbance
immune reconstitution inflammatory syndrome

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82
Q

PrEP

A

TDF, FTC
TAF, FTC (M, TGF only)
Cabotegravir (IM q8w)

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83
Q

Lenacapavir

A

capsid inhibitor
purpose-1 (cis-women)
purpose-2 (MSM and trans-women)
sq 6 months

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84
Q

PrEP indications

A

All sexually active adults and adolescents should be informed about PrEP
For sexually active adults and adolescents

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85
Q

Goal of therapy for HIV

A

reduce acquisition of HIV infection with resulting morbidity, mortality and cost to individuals and society

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86
Q

What to monitor every 3 months for PrEP

A

HIV and HIV RNA test
sign/symptoms
pregnancy test
STI testing

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87
Q

What to monitor every 6 months for PrEP

A

renal toxicities
STI testing

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88
Q

What to monitor every 12 months for PrEP

A

Cr/CrCl

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89
Q

Follow up and monitoring for cabotegravir IM 1 month and 2 months

A

1: HIV, HIV RNA, signs, administer CAB
2: HIV, HIV RNA, signs, administer CAB

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90
Q

Follow up and monitoring for cabotegravir IM 4, 6, 12 months

A

4: STI
6: STI
12: evaluate need for PrEP

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91
Q

PEP HIV treatment

A

ART to prevent HIV infection after a potential exposure
medical emergency
HIV - baseline, 4-6 wk, 3 months
Pregnancy test for women

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92
Q

Who to consider for PEP

A

HIV-negative or HIV status unknown within the last 72 hours
May have a known or known exposure to HIV through:
-sex/sexual assalt
-shared needles
-occupational exposure

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93
Q

Therapy for PEP

A

TDF/FTC 1 tab daily + raltegravir 400 mg twice daily
TDF/FTC 1 tab daily + dolutegravir 50 daily

94
Q

Opportunistic Infections (OIs) main cause

A

Main cause of mortality in HIV and patients
Prophylaxis and HAART led to decrease incidence

95
Q

What are OIs

A

CD4 count surrogate marker for risk
PCP rare at CD4 200-250
MAC rare at CD4 >50

96
Q

When to start therapy in HAART-naive patient with acute OI

A

lead to immune reconstitution syndrome
affect adherence or absorption of meds
may hold off

97
Q

OI pathogens

A

Influenced by degree of immunosuppression and potentially environment
OIs may be more likely in HIV immuno-suppressed vs. those w/ transplants, SCID

98
Q

OI pathogens

A

Pneumocystis jirovecii
M. tuberculosis
Mycobacterium-avium Complex (MAC)
Toxoplasma gondii
Cryptococcus neoformans
Histoplasma capsulatum
Candida

99
Q

OI viral pathogens

A

Varicella zoster virus
Cytomegalovirus
Hep B and Hep C
Herpes simplex virus

100
Q

Pneumocystis jirovecii Pneumonia (PCP) clinical presentation

A

Usually insidious and subacute presentation
Fever
Dyspnea
Tachypnea +/- rales or rhonchi
Non-productive or mildly productive cough

101
Q

PCP diagnosis

A

CD4
CXR (bilateral, florid, subtle infiltrates)
ABG (abnormal PaO2)
Culture
Elevated LDH

102
Q

PCP treatment

A

may worsen before it improves
If worsening after 4 days or lack of improvement after 7-10 days = reassess or change therapy

103
Q

PCP monitoring

A

ADR
ABG
Labs

104
Q

PCP treatment drugs

A

TMP/SMX (IV,PO) 15-20 mg/kg/d tid
Alternatives
-pentamidine IV
-Trimethoprim PO+ dapsone PO
-Atovoquone PO
-Clindamycin IV/PO + primaquine PO
Adjunct
-Steroids IV/PO w/ PaO2 < 70 and within 72 hours

105
Q

PCP ADRs: Pentamidine, Dapsone, Atovoquone, Primaquine

A

Pentamidine - azotemia, nephrotoxicity, glycemia, LFT
Dapsone - rash, nausea
Atovoquone - n/v/d, ha, rash
Primaquine - methemoglobinemia, rash, anemia, LFT

106
Q

Primary PCP prophylaxis

A

Initiate: CD4 < 200
DC: CD4 > 200 ≥ 3 months

107
Q

Secondary PCP prophylaxis

A

Continue after treatment
DC: CD4 > 200 ≥ 3 months
Restart: CD4 < 200

108
Q

PCP prophylaxis drugs

A

TMP/SMX 1 DS QD
Alternatives: Dapsone 100 mg QD, aerosolized pentamidine 300 mg qmonth, atovaqone 1500 mg qd

109
Q

Cryptocococcus

A

Contract by inhalation (lung 1st infected site)
Most common life-threatening fungal infection

110
Q

Cryptococcal meningitis: clinical presentation

A

Subtle presentation
Fever, HA, malaise, mental status changes
-Should consider in all HIV + patients w/ advanced disease or low CD4 counts and non-specific symptoms or pulmonary or CNS symptoms

111
Q

Cryptococcal meningitis: diagnosis

A

Serum and CSF testing for cryptococcal antigen
-antigen > 1:8 equals infection
Fungal culture
India ink exam of CSF or from culture may be used to diagnose if antigen unavailable

112
Q

Cryptococcal meningitis: non-pharm treatment

A

Stabilize CSF (LP if required)

113
Q

Cryptococcal meninigitis: treatment

A

Induction ( 2 weeks )
-Liposomal Ampho IV + 5-fluorouracil PO
-Amphotericin B IV + 5-fluorouracil PO
Consolidation (≥ 8 weeks)
-Fluconazole 400-800 mg daily
Chronic maintenance
-Fluconazole 200 mg daily
- ≥ 12 months w/ CD4 > 100 and asymptomatic

114
Q

Cryptococcal meningitis ADR: 5-FC, Azoles

A

5-FC: Serum levels, renal function, bone marrow toxicity
Azoles: GI, LFT, drug interactions

115
Q

Mycobacterium avium complex (MAC)

A

-disseminated infection
-common in soil and water
-oral or respiratory route

116
Q

Major risk factors for Mycobacterium avium complex (MAC)

A

Advanced immunosuppression, CD4 < 50; rare in CD4 > 100
Poor long-term prognosis w/o therapy

117
Q

MAC clinical presentation

A

fever, diarrhea, sweats, ab pain
GI infections

118
Q

MAC diagnosis

A

Culture organism from blood
Biopsy of liver, BM, lymph nodes also sensitive and specific

119
Q

MAC treatment

A

Resistant to standard TB drugs
Clinical response w/i 2-8 weeks of initiation
Macrolide (azi or clari) + ethambutal +/- rifabutin, ciprofloxacin or amikacin

120
Q

MAC duration

A

usually up to 1 year if asymptomatic and CD4 > 100 x 6 months

121
Q

MAC ADRs: macolides, ethambutol, rifabutin

A

macolides: GI, LFT
ethambutol: eye exam, renal dose adj
rifabutin: uveitis, discoloration of body fluid

122
Q

MAC monitoring

A

Symptom resolution may take 2-8 weeks
Monitor bacterologic eradication (follow-up blood cx at 4-8 weeks)

123
Q

MAC Primary prophylaxis

A

Initiate: CD4 < 50 and not starting ART
DC: CD4 > 100 for ≥ 3 months

124
Q

MAC Secondary prophylaxis

A

DC: CD4 > 100 ≥ 6 months AND completed 1 year MAC therapy and asymptomatic for MAC
Restart: CD4 < 100

125
Q

MAC prophylaxis drug

A

Azithromycin 1200 mg weekly

126
Q

Candidal Infections

A

most common OI
treat to improve quality of life
overgrowth of normal flora w/ breakdown of local defenses instead of acquisition of new strain

127
Q

Esophageal candidiasis is what defining illness

128
Q

Candidal Infections clinical presentation for Oral candidiasis (thrush)

A

mouth pain, difficulty eating
mild to severe symptoms
white placques on buccal surfaces

129
Q

Candidal Infections clinical presentation for Esophageal candidiasis

A

severe symptoms
dysphagia
odynophagia
esophageal ulceration
anorexia

130
Q

Candidal Infections diagnosis

A

Visually with oral plaques
May need bronch for esophageal candidiasis

131
Q

Candidal Infections treatment options

A

Local vs. systemic
Systemic required for esophageal candidiasis

132
Q

Candidal Infections treatment options

A

nystatin
clotrimazole
fluconazole
ampho b
itraconazole
caspofungin

134
Q

HIV virus

A

Use host to replicate virus

135
Q

Human retrovirus for HIV virus

A

RNA to DNA via reverse transcriptase
Primary infects CD4 T cells
Also infect macrophages and dendritic cells

136
Q

Difference between HIV 1 and HIV 2

A

1: accounts for majority of infections
2: spread through heterosexual contact

137
Q

How is HIV virus sexually transmitted

A

MSM, heterosexual
Behavior and bio factors affect transmission
Could happen orally

138
Q

IV transmission of HIV

A

IV drug use
Occupational exposure

139
Q

HIV transmission by blood and other tissues

A

Whole blood, plama, Ig, albumin

140
Q

HIV perinatal transmission (vertical or mother to child)

A

Gestation
During delivery
Breast feeding
Decreased with AZT treatment

141
Q

In home HIV testing

A

Mouth swab OTC
Home access HIV1 test system (send results in for testing)

142
Q

Cellular targets of HIV infection

A

CD4 cells mainly

143
Q

Immune response to HIV

A

Resolve symptoms of early infection, delay progression
Start with low antibodies at first
Can cause decrease in viremia

144
Q

Viral mutation and latent reservoirs of cell mediate responses in HIV

A

Viral: change epitopes
Latent: proviral DNA, in resting cells, provide stable viral reservoir

145
Q

What is AIDS

A

HIV infected people with CD4 cells <200 or CD4 count <14%

146
Q

Main AIDS indicator conditions

A

Herpes, ulcers, bronchitis, pneumonia, esophagitis
MAC
Pneumocystis pneumonia
Cryptococcus, extrapulmonary

147
Q

What is viral load for AIDS

A

Measure rate of HIV destructive potential immune system
High baseline:
More rapid decline in CD4 cells, more rapid disease progression, decreased survival

148
Q

CD4 count and viral load

A

Give best prognostic estimator of clinical course
Train Wreck: viral load-speed CD4-distance

149
Q

Goal of HIV therapy

A

Max and suppress of viral load (RNA)
Restore and preserve immune function
Reduce HIV associated morbidity and prolong duration and quality of survival
Prevent transmission

150
Q

DHHS initiation of therapy

A

Increase urgency:
OI or AIDS
Pregnancy
Low CD4 (<200)
Early HIV infection
Co infection with HBV/HCV

151
Q

Initial regimen for most people with HIV

A

Dolutegravir + TDF/Emtricitabine OR TAF/Emtricitabine
Bictegravir/TAF/Emtricitabine (Biktarvy®)
Dolutegravir/Lamivudine (Dovato®)

152
Q

Bictegravir/TAF/Emtricitavine

A

1 pill per day
GI, insomnia, SCr, renal, bone
DDI with Ca, Mg, Fe, take with food

153
Q

Dolutegravir + TDF or TAF/Emtricitavine

A

2 pills per day
GI, insomnia, SCr, renal, bone
DDI with Ca, Mg, Fe, take with food

154
Q

Dolutegravir/Lamivudine

A

1 pill per day
need another agent if VL <500 at baseline
GI, insomnia, SCr
DDI with Ca, Mg, Fe, take with food

155
Q

DHHS recommended initial regimen for people with hx of CAB-LA PrEP

A

DRV/c or DRV/r with TAF or TDF plus (FTC or 3TC)

156
Q

When to use cabotegravir/rilpivirine

A

Simplify virologic suppression
Check HBV status and resistance prior to starting
1 month lead in then every 1 or 2 months IM, gluteal, 2 injections

157
Q

Therapy considerations for decreased AIDS and non-AIDS m/m

A

HIV nephropathy
CV disease
Malignancies
Neurocognitive decline

158
Q

Monitoring for therapy of HIV

A

LFTs, lipids, CBC, STD
VL/CD4:
Decreased dramatically at 4-6 weeks
<50 copies by 16-24 weeks
CD4 stable
Recheck q3-6 months

159
Q

Virologic failure, virologic rebound, incomplete virologic response, virologic blip

A

Virologic failure: inability to achieve maintain VL suppression
virologic rebound: detectable VL
incomplete virologic response: 2 consecutive VL>200 after 24 wks of ART
virologic blip: isolated detectable VL followed by virologic suppression

160
Q

Immunologic failure of HIV

A

Failure to maintain CD4 response
Initial increase of 150
Causes:
Nadir <200
Age
Coinfection
Meds

161
Q

Peginterferon MOA

A

Activate Jak-STAT signal transduction pathway and lead to translocation of a cellular protein

162
Q

Peginterferon ADME

A

pt w/ ESRD require dose reductions

163
Q

Peginterferon DDI

A

CYP1A2
methadone**

164
Q

Peginterferon ADE

A

pyrexia, myalgia

165
Q

Entecavir MOA

A

competes with endogenous deoxyguanosine triphosphate and inhibits the HBV polymerase interfering with reverse transcriptase

166
Q

Entecavir therapeutic use

A

children over 2 and adults

167
Q

Entecavir ADME

A

administered on an empty stomach

168
Q

Lamivudine MOA

A

competitively inhibits HIV1 and 2 reverse transcriptase and HBV reverse transcriptase

169
Q

Lamivudine ADME

A

rapidly absorbed
longer half life in adults than children

170
Q

Lamivudine DDI

A

bactrim
sorbitol

171
Q

Telbivudine MOA

A

phosphorylated by cellular kinase and inhibits HBV DNA polymerase (reverse transcriptase) and causes DNA chain termination

172
Q

Telbivudine ADME

A

hemodialysis pt need dose adj

173
Q

Telbivudine DDI

A

INF-alpha cause peripheral neuropathy

174
Q

Sofosbuvir MOA

A

compete with uridine triphosphate for incorporation into HCV RNA by NS5B polymerase

175
Q

Sofosbuvir ADME

A

take with high fat meal

176
Q

Sofosbuvir DDI

A

another DDA results in bradycardia
P-gp inducers

177
Q

Harvoni (ledipasvir and sofosbuvir) MOA

A

L: inhibit HCV NS5A protein
S: inhibit HCV NS5B RNA dependent RNA polymerase

178
Q

Harvoni (ledipasvir and sofosbuvir) ADME

A

pH dependent oral absorption
highly protein bound

179
Q

Harvoni (ledipasvir and sofosbuvir) DDI

A

amiodarone
p-gp

180
Q

Epclusa (sofosbuvir and velpatasvir) MOA

A

S: inhibit HCV NS5B RNA dependent RNA polymerase
V: inhibit HCV NS5A protein

181
Q

Epclusa (sofosbuvir and velpatasvir) DDI

182
Q

Zepatier (elbasvir and grazoprevir) MOA

A

E: inhibit HCV NS5A which is essential for RNA replication and virion assembly
G: viral replication

183
Q

Zepatier (elbasvir and grazoprevir) ADME

A

high protein bound
wide distribution
oxidative metabolism

184
Q

Zepatier (elbasvir and grazoprevir) DDI

185
Q

Mavyret (glecaprevir and pibrentasvir) MOA

A

G: viral replication
P: inhibit RNA replication and virion assembly

186
Q

Mavyret (glecaprevir and pibrentasvir) DDI

A

carbamazepine, efavirenz, st. johns wort

187
Q

Vosevi (sofosbuvir, velpatasvir, voxilaprevir) MOA

A

S: inhibit RNA polymerase by HCV NS5B RNA
Ve: inhibit HCV NS5A protein
Vo: reversible inhibitor of NS3/4A protease

188
Q

Vosevi (sofosbuvir, velpatasvir, voxilaprevir) DDI

189
Q

What is hep A caused by

A

fecal-oral: contaminated food or water

190
Q

What is hep B caused by

A

sexual, mother-to-child, blood exposure (transdusion, IDU, tattoo)

191
Q

What is hep C caused by

A

blood exposure (transfusion, IDU, tattoo); sexual, mother-to-child

192
Q

Acute viral hepatitis

A

<6 months
HBV > HAV > HCV
increase LFT
can progress to liver failure

193
Q

Chronic viral hepatitis

A

> 6 months
HBV DNA increased
ALT/AST elevations
hepatocellular necrosis, inflammation, fibrosis
HBV, HCV
alcohol, drugs, autoimmune

194
Q

Hepatitis pathophysiology

A

hep b/c virus replicates in liver cells
immune system responds w/ inflammation
inflammation leads to fibrosis and sometimes cirrhosis

195
Q

Chronic viral hepatitis pathophysiology

A

HBV/HCV not directly cytopathic
immune response to virus-infected hepatocytes by CTL

196
Q

Chronic viral hepatitis clinical features

A

asymptomatic = carriers or inactive disease
severe:
compensated cirrhosis: asymptom, fatigue, jaundice
decomp cirrhosis: fatigue, jaundice, wt loss, ascites, edema

197
Q

Complications of cirrhosis

A

impairment of liver function
cancer (hepatocellular carcinoma)
blockage of portal vein blood flow though liver leading to ascites

198
Q

Chronic viral hepatitis clinical features

A

Labs: increase ALT/AST, decrease bilirubin, increase INR/PT, hypersplenism
Histopathology: absence of necrosis or inflammation, necrosis, fibrosis, cirrhosis

199
Q

Liver biopsy provides info regarding what and helps determine what

A

Provides information regarding:
-degree of inflammation
-stage of fibrosis or scarring
-presence/absence of cirrhosis
Help determine:
-prognosis
-cause of liver disease
-need for treatment

200
Q

Transmission of HBV infection

A

transfusion (blood)
fluids (blood, semen)
organ and tissue transplant
mother to baby
contaminated needles/syringes
child to child

201
Q

Acute hep B virus infection w/ recovery typical serologic course

A

HBeAG for a little than mainly anti-HBe
w/ symptoms

202
Q

Progression to chronic hep B virus infection typical serologic course

A

HBeAG mainly than anti-HBe for a little
acute 6 months, chronic years

203
Q

Acute HBV infection diagnosis test positives

A

HBsAg
HBeAg
anti-HBc IgG
anti-HBc IgM
HBV DNA (PCR)

204
Q

Past exposure (immunity) diagnosis test positives

A

Anti-HBs
Anti-HBc IgG

205
Q

Vaccine responder diagnosis test positives

206
Q

Chronic HBV infection diagnosis test positives

A

HBsAg
HBeAg
Anti-HBc IgG
HBV DNA (PCR)

207
Q

Hep C is the leading cause of what 3 things

A

liver cirrhosis
hepatic cancer
liver transplantation

208
Q

Hep C diagnosis tests

A

antibody test (EIA): indicate past or active infection, presence of antibodies does not confer immunity (follow up with viral load)
HCV RNA test (PCR): confirm active infection, RNA exist but not as useful

209
Q

What are the other extrahepatic manifestation of hep c

A

hematologic
rheumatologic
renal
derm
CNS
systemic

210
Q

Acute HCV

A

generally asymptomatic
fatigue, loss of appetite, nausea, right upper quadrant pain, jaundice

211
Q

Chronic HCV

A

viremic after 6 months
may also be asymptomatic
slow progression to chronic liver morbidity/mortality

212
Q

HCV genotypes

A

1-6 serotypes
does not predict progression of infection
can predict likelihood of treatment response

213
Q

Factors associated with disease progression of HCV infect patients

A

> 50 yo
duration of infection
male
iron overload
steatosis
alcohol
coinfection with HBV or HIV

214
Q

What are the signs of chronic hep b

A

Serum HBV DNA >20,000
persistent or intermittent elevation in ALT/AST levels
liver biopsy showing chronic hepatitis with moderate or severe necroinflammation

215
Q

Treatment goals of hep B

A

increase chance of seroconversion
sustained suppression of HBV replication
prevent disease progression to cirrhosis and HCC
minimize further injury in patients with ongoing liver damage

216
Q

When to treat HBV

A

ALT >2x ULN
ALT > 2x ULN HBV DNA >20,000 IU/mL

217
Q

Monitoring parameters for hep b treatment

A

AST/ALT q3 months (goal=normal)
HBV DNA q3-6 months (goal=undetect)
monitor disease progression q1-3 months 6 months after drug disc. and q3-6 months after
HBeAg q6 months if positive
HBeAb q6 months if negative
HBsAg annual (goal=negative)

218
Q

Non pharm treatments for hepatitis b

A

counsel on prevention of disease transmission
avoid alcohol

219
Q

Pegylated interferon-alpha-2a dosing and black box warning dosing and block box warning for hep b treatment

A

adults: 180 mcg subq wk x48ek
neuropsychiatric disorders, autoimmune disorders, infections, ischemic disorders
pregnancy category c

220
Q

Tenofovir disoproxil fumarate (TDF) dosing for hep b treatment

A

300 mg qd w/ normal reanal (>50 ml/min)
pregnancy category B

221
Q

Tenofocir alafenamide (TAF) dosing for hep b treatment

A

25 mg qd (NO CrCl <15 ml/min)

222
Q

Entecavir dosing for hep b treatment

A

> 16 yo: 0.5 mg qd (CrCl >50 ml/min)
pregnancy category C

223
Q

What pts to HCV test at least once

A

baby boomers (1945-1965)
IVDA
long term dialysis
tat in unregulated settings
HCW or public safety after exposure
children of HCV+ moms
prior transfusion or organ recipients
HIV infection or unexplained chronic liver disease

224
Q

HCV testing positive and negative meaning for anti-HCV

A

(+): confirm w/ sensitive RNA test
(-): recheck if exposure occurred w/in 24 wks
positive anti-HCV and negative HCV RNA = no active disease

225
Q

When to measure sustained viroligic response (SVR) in hep c patients

A

HCV viral load >12 wks after end of therapy
no SVR required retreatment

226
Q

What is needed prior to treatment of HCV

A

HCV antibody, viral load, genotype
Test for progression
-serologic
-radiologic
-biopsy

227
Q

Who to treat for HCV

A

all patients with chronic HCV, except those w/ short life expectancy that will not benefit from treatment or transplant

228
Q

Group/reason for additional considerations for hep c treatment

A

advanced liver disease
person with transplant
co-infections: HIV, HBV, other liver disease
extrahepatic manifestations of HCV
IVDAs
decrease transmission
HIV-infected MSM
incarcerated persons
hemodialysis pts

229
Q

Simplified HCV treatment

A

Velpatasvir/sofosbuvir 1 po qd 12 wk (not for 3)
glecaprevir/pibrentasvivr 3 po qd 8 wk

230
Q

Who is not eligible for simplified HCV cirrhosis treatment

A

prior treatment
decomp cirrhosis (child-pugh B,C), ascites, hepatic encephalopathy)
ESRD
HBV+
pregnancy
HCC
prior liver transplant

231
Q

Post therapy for HCV

A

SVR >12 wks after end of treatment
liver function tests
depending on baseline fibrosis score (cirrhosis - test for HCC)
check for reinfection if continued risk - HCV viral load

232
Q

GT HCV treatment 1-4

A

glecaprevir/pibrentasvir 3 po qd 8 wks
velpatasavir/sofosbuvir 1 po qd 12 wks
(ledipasvir/sofosbuvir 1 po qd 8 wk 1a/1b/4)
(elbasvir/grazoprevir 1 po qd 12 wks no cirrhosis)

x F2: IPCS (10 decks)

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