Lecture 3 - Viral Hepatitis

Question 1

pl at risk of getting Hep C?

Answer 1

IV drug users
Ppl with HIV
anyone received blood before 1992
Healthcare professionals exposed
Liver disease symptoms
Babies of moms with it
anyone been to prison
anyone getting tattoo/piercing with dirty needles

Question 2

HCV clinical presentation info

Answer 2

latency: 4-12 weeks
~ 30% have initial symptoms
ALT lvls may peak > 10 x ULN

15-50% of those infected will clear HCV

Question 3

To diagnose someone with chronic HC you have to have….

Answer 3

presence of HCV-antibodies, HCV-RNA and have to be detectable at 2 different times atleast 6 months apart

Question 4

Acute HCV treatment goals

Answer 4

no management options for it

Question 5

Chronic HCV treatment goals

Answer 5

SVR: typically 12 weeks after treatment completion

Lack identifiable HCV-RNA at lvl > 15 IU/mL
Transaminase normalization

Question 6

NS3/4A protease inhibitor MOA

Answer 6

inhibit replication of HCV via NS3/4A serine protease, blocks NS3 catalytic site and facilitates viral elimination

Question 7

NS5B RNA dependent RNA polymerase inhibitor MOA

Answer 7

NS5B is necessary for replication of HCV and inhibition acts as a chain terminator

Question 8

NS5A inhibitor MOA

Answer 8

NS5A involved in viral replication and assembly of HCV

Question 9

NS3/4A drugs end in….

Answer 9

-previr

Question 10

NS5B RNA dependent RNA polymerase inhibitors end in…

Answer 10

-buvir

Question 11

NS5A inhibitors end in…

Answer 11

-asvir

Question 12

Who eligible for HCV treatment? DDA regimens

Answer 12

18+ who have to previously been treated with HCV and don’t have cirrhosis

Question 13

1st line HCV treatment therapies?

Answer 13

Mayvret X 8 weeks = Glecaprevir/pibrentasvir

Epclusa X 12weeks = Sofosbuvir/velpatasvir

Question 14

Pediatric HCV management

Answer 14

Eligibility if 3-17 yrs old w/genotrypes 1,4,5 or 6-17 with any

Question 15

Pediatric HCV treatment

Answer 15

Mayvret X 8 weeks = Glecaprevir/pibrentasvir
Epclusa X 12weeks = Sofosbuvir/velpatasvir
Harvoni X 12 weeks = Ledipasvir/Sofosbuvir

pediatric pts do have weight based dosing, reduced

Question 16

CI of Mayvret (Glecaprevir/Pibrentasvir)

Answer 16

CI w/ atazanavir or rifampin

Avoid atorva/simvastatin, limit dose of rosuvastatin to 10

monitor if on Amiodarone for 2 weeks post initiation due to risk of fatal bradycardia

Question 17

CI of Epclusa (sofosbuvir/Velpatasvir)

Answer 17

Limit dose of rosuvastatin 10mg, monitor all others

monitor if on Amiodarone for 2 weeks post initiation due to risk of fatal bradycardia

Question 18

CI of Harvoni (Ledipasvir/Sofosbuvir)

Answer 18

Cardiac monitoring if on amiodarone

avoid concurrent use of acid suppression therapy…if cant then admin together or separate by 12hrs

avoid rosuvastatin, monitor all others***

Question 19

What should Mayvret (Glecaprevir/Pibrentasvir) combo be avoided in

Answer 19

Dabigatran
Aliskiren
Atorva/Lova/Simvastatin

Question 20

common limits for statins?

Answer 20

Atorva = 40mg
rosuvastatin = 10mg

Question 21

Therapeutic monitoring for HCV treatment?

Answer 21

HCV RNA = if detectable or not at weeks 8,12,etc

detectable = fail

Question 22

concern for Ribavirin therapy in females?

Answer 22

Teratogenicity

pregnant people and those trying to become pregnant atleast 6 months after stopping

Question 23

Hep B pre-exposure prophylaxis

Answer 23

Vaccination
can be anywhere from 2-4 doses
anyone who doesn’t have it should get it

Question 24

if get full course of vaccine and get exposed to someones Hep B blood then…

Answer 24

you’re gucci

Question 25

if incomplete vaccine status and get exposed to someones Hep B blood then…

Answer 25

finish up vaccine series at schedules interval

get single dose HBIG = HB immunoglobulin

Question 26

if unvaxxxed and get exposed to someones Hep B blood then…

Answer 26

you need vaccine within 12/24hrs or sooner.

also get single dose of HBIG = HB immunoglobulin

Question 27

HBIG dose

Answer 27

0.6mL/KG IM for 1 dose

Question 28

HBV vaccine

Answer 28

3 doses, 0/1/6 months
vaccines can be interchanged if necessary to complete series
1st dose should be given within 12/24hrs of exposure

Question 29

should pts in immune active stage get treatment?

Answer 29

yup

Question 30

Diagnosis of CHB

Answer 30

HBsAG + at least 6 months
detectable lvls of HBV DNA typically 2,000-20,000
ALT > 2X ULN

Question 31

Monitoring HBV DNA treatment

Answer 31

Sustained virology response
HBeAG- = goal < 2000IU/mL, check every 3 months until undetectable then 3-6 months after

Question 32

HBV viral relapse if…

Answer 32

> 2000 IU/,mL HBV DNA after being undetectable

Question 33

Tenofovir info

Answer 33

MOA: inhibit reverse transcriptase, messes viral DNA

has greater resistance longer pt is on them

used as long as pt has HBV DNA

preferred in pregnancy

Question 34

Interferon highlights

Answer 34

option for pediatric patients
usually for defined period of time, no more than 48 weeks

Question 35

should you use combo therapy for HBV?

Answer 35

no

unless PegIFN + lamivudine

Question 36

Hep A need to know

Answer 36

get vaccine

can give immune globulin depending on how long person traveling for to places with risk of Hep A

Question 37

Post exposure Hep A treatment

Answer 37

1-40- yrs old, vaccine preferred
> 40 yrs old immune globulin > vaccine

if caught within 14 days