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PHAR 255 > Liver 2 > Flashcards

Liver 2 Flashcards

1
Q

What will be elevated with asymptomatic hepatitis (infection without disease?

A

AST and ALT

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2
Q

Presentation of acute hepatitis

A

Flu-like symptoms
Abdominal pain
Jaundice
Scleral icterus
Pale stools
Dark urine

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3
Q

What is acute fluminant hepatitis?

A

Rare, but may be fatal

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4
Q

What is chronic persistant hepatitis?

A

Delayed recovery with minimal liver damage but failure to develop antibody (carrier state)

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5
Q

What is chronic active hepatitis?

A

Progressive liver damage, failure to develop antibody, may be asymptomatic

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6
Q

What type of virus is hepatitis A?

A

RNA virus

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7
Q

How is hepatitis A transmitted?

A

Fecal-oral
- can occur from travel to countries with poor hygiene conditions - contaminated food or water

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8
Q

What are the vaccines for hepatitis A?

A

Havrix
Avaxim
Vaqta
Twinrix

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9
Q

Symptoms of hepatitis A

A

Fever, jaundice, scleral icterus
Hepatomegaly on physical exam

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10
Q

What is the time from exposure to clinical manifestations for hepatitis A?

A

30 days (range 15-50)

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11
Q

How long do hep A symptoms usually last?

A

~3 months

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12
Q

Is hepatitis A chronic?

A

No - cured once you recover

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13
Q

Treatment for hepatitis A virus?

A

Supportive
- healthy diet, rest, hydration, avoiding hepatotoxic drugs and alcohol

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14
Q

Post exposure prophylaxis for hep A virus?

A

Hep A vaccine given within 14 days of exposure might help
Ig given ASAP if vaccine unavailable (purified antibodies from someone who is immune)

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15
Q

What are the serologic markers of HAV?

A

IgG (immunity from vaccine or exposure)
IgM (indicates acute infection)

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16
Q

What kind of virus id hep B virus?

A

DNA virus

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17
Q

How is HBV transmitted?

A

Perinatal, sexual, blood (IVDU)

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18
Q

What are the vaccines for HBV?

A

Twinrix (for A and B)
- antibody response decreases with age

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19
Q

How many doses is the HBV vaccine?

A

3 doses

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20
Q

How many doses for the HAV vaccine?

A

2 doses, 6 months apart

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21
Q

Symptoms of HBV

A

~70% are asymptomatic
Jaundice
Dark urine
White stool
Abdominal pain
Fatigue, fever, chills, loss of appetite
Pruritis possible

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22
Q

Is HBV chronic?

A

Depends on groups
90% in neonatal infection
25-50% children aged 1-5
10% in adults

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23
Q

What can HBV lead to?

A

Cirrhosis (20-25%)
Hepatic carcinoma (5%)

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24
Q

What are the serological markers of HBV?

A

HBsAg (HBV surface antigen): + indicates acute or chronic infection
Anti-HBs (antibody to HBV surface antigen): marker of HBV immunity
HBV-DNA: marker of viral replication - acute infection - used to monitor treatment for chronic HBV infection

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25
Q

When do we treat HBV?

A

Active HBV infection (increased HBV-DNA & ALT; liver inflammation)

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26
Q

What is the treatment for HBV?

A

Interferon
- peginterferon alfa-2a
OR
Nucleoside analogues
- iamivudine
- tenofovir, entecavir
- adefovir

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27
Q

Is elimination the goal of HBV treatment?

A

Yes but its not always possible so permanent suppression is also the goal

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28
Q

Advantages to interferons (IFN) for HBV

A

Shorter course of therapy
Absence of resistance
A chance at full seroconversion

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29
Q

Disadvantages to interferons for HBV

A

Contraindicated in decompensated cirrhosis
Subcutaneous injection
Many side effects!
30% successful in developing immunity

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30
Q

Advantages of nucleoside analogues for HBV

A

Safer
Fewer side effects
Oral admin
High response >90% but does not provide immunity (seroconversion)

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31
Q

Disadvantages of nucleoside analogues in HBV

A

Chronic therapy
- seroconversion can take years and some may require treatment indefinitely
Drug resistance
Adjust in renal dysfunction

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32
Q

What is lamivudines (heptovir) place in therapy for HBV?

A

Main use: prohylaxis for those on immunosuppression
- not DOC due to high resistance rates
*was the first oral agent approved

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33
Q

What is adefovirs place in therapy for HBV?

A

Used as an add on in lamivudine resistance

34
Q

What is tenofovirs place in therapy for HBV?

A

*DOC!!
TAF and TDF are available but TAF produces higher levels in cells and can be administered at lower doses
- MOST POTENT and low chance of resistance

35
Q

What is entecavirs place in therapy for HBV?

A

*DOC!!
Low rates of resistance

36
Q

What are examples of combo therapy for HBV?

A

Lamivudine + tenofovir
Tenofovir + entecavir

37
Q

What type of virus if hepatitis c Virus (HCV)?

A

Single-stranded RNA virus

38
Q

How is HCV transmitted?

A

Perinatal, sexual(very low), blood(common)

39
Q

What is the vaccine for HCV?

A

There isn’t one available

40
Q

How longe can HCV live off the body?

A

9 weeks

41
Q

Symptoms of HCV

A

~70% are asymptomatic
Jaundice
Dark urine
White stool
Abdominal pain
Fatigue, fever, chills, loss of appetite
Pruritis possible

42
Q

What can HCV lead to?

A

Chronic disease, cirrhosis, hepatocellular cancer

43
Q

How long after exposure will you see clinical presentation with HCV?

A

Could be as late as 20-30 years post exposure

44
Q

What % of HIV patients in SK are coinfected with HCV?

A

~70%

45
Q

What are the most common genotypes of HCV?

A

Genotypes 1-6
1a, 1b, 2 and 3 are most common in Canada

46
Q

What are the serological markers of HCV?

A

Anti-HCV (antibody to HCV): indicates acute or chronic infection *test remains positive for life
Do this test next:
HCV RNA by PCR: indicates virus replication; appears at start of acute infection - + indicates active virus ; - indicates no active infection

47
Q

What was the traditional treatment for chronic HCV?

A

SVR 12 - sustained virological response is the goal
Interferon and ribavirin in combo

48
Q

What is ribavirin?

A

Nucleoside analogue
Broad spectrum anti-viral

49
Q

Common side effects for IFN based therapy for HCV

A

Flu-like symptoms
Decreased blood counts
Weight loss
Anorexia
Alopecia

50
Q

What drugs have all been used for HCV treatment but aren’t as important anymore?

A

Boceprivir or telaprevir
Simeprevir
Sofosbuvir - no longer needed IFN injection

51
Q

What does “previr” mean at the end of drug name?

A

It’s a protease inhibitor and cant be used in decompensated cirrhosis

52
Q

What is in harvoni?

A

Ledipasvir & sofosbuvir

53
Q

What genotypes can harvoni be used for?

A

HCV g1,4,5,6

54
Q

Side effects of harvoni?

A

Mild to moderate in severity
Fatigue
Headache
Insomnia
Nausea

55
Q

What DI does harvoni have?

A

Decreased absorption if administered with acid-suppressing drugs; with PPI

56
Q

What is in zepatier?

A

Grazoprevir + elbasavir

57
Q

What genotypes can zepatier be used for?

A

G1,4

58
Q

What are the drugs in epclusa?

A

Sofosbuvir + velpatasvir

59
Q

Which genotypes can epclusa be used for?

A

Pan-genotypic (used across all genotypes), some exceptions with g3

60
Q

What DI does epclusa have??

A

Watch with acid suppressing drugs

61
Q

What are the drugs in maviret?

A

Glecaprevir + pibrentasvir

62
Q

Which genotypes can maviret be used for?

A

All genotypes 1,2,3,4,5,6

63
Q

What drugs are in vosevi?

A

Sofosbuvir + velpatasvir + voxilaprevir

64
Q

Which genotypes can vosevi be used for?

A

All genotypes 1,2,3,4,5,6
*used in treatment failures

65
Q

Which drug has a cure rate (SVR) of 99-100%?

A

Epclusa

66
Q

Which hepatitis c drugs need to be taken with food?

A

Maviret and vosevi

67
Q

What are the two most common hepatitis c drugs?

A

Epclusa and maviret

68
Q

Which hepatitis c drugs can not be used in decompensated cirrhosis?

A

Zepatier
Maviret
Vosevi

69
Q

Which hepatitis c drug may be used in severe kidney failure (even dialysis)?

A

Maviret

70
Q

How long is treatment for hep c typically?

A

8-12 weeks

71
Q

What are the common drug interactions for epclusa?

A

Acid reducing agents
Anti-arrhythmics
Anticonvulsants
Rifampin
Antiretroviral
Statins
St. John’s wort

72
Q

What are the common drug interactions for maviret?

A

Digoxin
Anticonvulsants
Anticoagulants
Rifampin
Antiretroviral
Statins
Immunosuppressants
Oral contraceptives
St. John’s wort

73
Q

Differences between epclusa and maviret

A

Equally effective
Epclusa: OD, no food requirement, 12 week therapy
Maviret: TID, with food, 8,12, or 16 week therapy

74
Q

Who should be tested for hepatitis c?

A

People born between 1945-75 (5x baseline risk)
CDC suggest everyone over 18 at least once and during each pregnancy

75
Q

What are the screening tests for hepatitis c?

A

Hepatitis C antibody. If positive:
- hepatitis c antigen. If positive:
-> hepatitis c RNA PCR (HCV RNA) - shows replication

76
Q

What are the ending for the current hep c drugs?

A

“..previr”
“..buvir”
“..asvir”

77
Q

What kind of virus is hepatitis D?

A

RNA virus, occurs simultaneously with HBV

78
Q

Is there a vaccine for hepatitis D?

A

The hep B vaccine

79
Q

What kind of virus is hepatitis E?

A

RNA virus

80
Q

How is hepatitis E transmitted?

A

Fecal-oral -> contaminated water

81
Q

Is there a vaccine for hepatitis E?

A

No but its like hep a and most people recover

PHAR 255 (8 decks)

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