liver 2 Flashcards
What is the definition of acute hepatitis?
Infection for less than 6 months
What is the definition of chronic hepatitis?
Infection for more than 6 months
What is the incubation period for Hepatitis A Virus (HAV)?
14–50 days
What are some general symptoms of HAV infection?
- Nausea
- Vomiting
- Diarrhea
- Myalgia
- Fever
- Abdominal pain
- Jaundice
How is Hepatitis A primarily transmitted?
Through the fecal–oral route
What is the mortality rate associated with HAV?
Less than 1%
What is the main management approach for acute HAV infection?
Supportive care; avoid hepatotoxic medications
What antibody indicates recent HAV infection?
IgM antibody to HAV (anti-HAV)
What populations require preexposure prophylaxis with HAV vaccine?
- All children older than 1 year
- People experiencing homelessness
- International travelers
- Men who have sex with men
- Injection or non-injection drug users
- People with occupational risk of exposure
- Patients with chronic liver disease or HIV infection
- Pregnant women at risk
- Individuals with close contact with international adoptees
What is the postexposure prophylaxis recommendation for unvaccinated individuals after HAV exposure?
Administer HAV vaccine or immune globulin within 2 weeks of exposure
What is the main mode of transmission for Hepatitis B Virus (HBV)?
- Parenteral
- Bodily fluids
- Sexual contact
- Perinatal
What is the risk of developing chronic HBV infection after an acute infection in adults?
2%–6%
What are the serologic markers for HBV infection?
- HBsAg
- HBcAg
- HBeAg
- Anti-HBs
- Anti-HBc IgM
- Anti-HBc IgG
- Anti-HBe
- HBV DNA
What is the first detectable serum antigen during acute HBV infection?
HBsAg
What does the presence of Anti-HBs indicate?
Protective immunity against HBV
What are the treatment recommendations for patients with chronic HBV infection?
- Monitor for spontaneous conversion
- Consider antiviral treatment if ALT is elevated and HBV DNA is high
- Treat patients meeting chronic infection criteria
Name two preferred antiviral medications for HBV treatment.
- Tenofovir
- Entecavir
What is the significance of HBeAg-positive disease in HBV?
Indicates ongoing active viral replication
What is a major side effect associated with reverse transcriptase inhibitors?
Lactic acidosis and severe hepatomegaly with steatosis
What are the preferred antiviral therapies for HBV in patients with decompensated cirrhosis?
- Tenofovir disoproxil fumarate
- Tenofovir alafenamide
What is the dosing recommendation for Entecavir in treatment-naive patients?
0.5 mg orally once daily for patients older than 16 years
What is the recommended monitoring for patients on Tenofovir?
Periodic monitoring of renal function and liver function tests
What is the association of Tenofovir alafenamide in terms of renal and bone toxicity?
Associated with less renal and bone toxicity
This is significant in managing patients with chronic HBV infection.
What are the best predictors of response to Pegylated interferon treatment?
- High pretreatment ALT
- Low serum HBV DNA
- Presence of active inflammation on biopsy
- Acquisition of infection
What serious adverse effects are associated with interferon treatment?
- Bone marrow suppression
- Leukopenia
- Thrombocytopenia
- Depression
- Pulmonary hypertension
What is the recommended dosing for Pegasys (pegylated-α-2a)?
180 mcg subcutaneously once weekly for 48 weeks
What are the treatment options for HBeAg positive HBV?
- Entecavir
- Tenofovir
What are the adverse effects of oral agents for HBV?
- Predisposition to infections
- CNS effects (depression, psychosis, anxiety)
- Flulike symptoms
- Anorexia, alopecia, thyroid dysfunction
What is the duration of treatment with PEG-IFNα for HBeAg negative HBV?
≥ 1 year
What are the vaccination schedules for Hepatitis B vaccines for individuals aged 18 and older?
- Heplisav-B: Two doses (0 and 1 month)
- PreHevbrio: Three doses (0, 1, and 6 months)
- Twinrix: Three doses (0, 1, and 6 months)
What is the postexposure prophylaxis for children born to HBsAg-positive mothers?
First dose of vaccine plus HBV immune globulin within 12 hours of birth
What are the main risk factors for Hepatitis C Virus (HCV) infection?
- HIV infection
- Current or former injection drug use
- Maintenance hemodialysis
- Prior transfusions or organ transplants
What is defined as chronic Hepatitis C infection?
Presence of viral RNA in the serum for 6 months or more
What are the clinical signs and symptoms of Hepatitis C infection?
- Nausea
- Abdominal pain
- Jaundice
- Fever
- Malaise
What is the significance of sustained virologic response (SVR) in Hepatitis C treatment?
SVR is the absence of detectable HCV RNA 12 weeks after treatment, considered a virologic cure
What are the adverse effects associated with Ribavirin treatment?
- Hemolytic anemia
- Teratogenicity
- Pancreatitis
- Pulmonary dysfunction
What is the weight-based dosing of Ribavirin for patients weighing 75 kg or less?
1000 mg daily
What are the testing recommendations for HCV?
- One-time testing for all individuals aged 18 and older
- Pregnant women with each pregnancy
- Individuals with HCV risk factors
What is the primary method for initial screening of HCV?
Serum anti-HCV antibodies
What is the recommended monitoring for patients receiving DAA therapy?
Monitor for HBV reactivation
What is the recommended action if hemoglobin drops more than 2 g/dL during treatment?
Decrease the dose to 600 mg/day.
What should be done if hemoglobin drops to less than 12 g/dL after dose reduction?
Discontinue treatment.
What medications can be used to stimulate red blood cell production?
Epoetin or darbepoetin.
Which HCV genotypes does sofosbuvir treat?
HCV genotypes 1–6.
What is the dosing for sofosbuvir?
400 mg tablet once daily with or without food.
What are the adverse effects of sofosbuvir?
Fatigue, headache.
Which drug interactions should be avoided with sofosbuvir?
- Potent P-glycoprotein inducers
- Amiodarone
- Acid-suppressive therapy
What is the indication for the combination of velpatasvir and sofosbuvir?
Genotype 1–6 infection.
What is the dosing for velpatasvir/sofosbuvir?
Velpatasvir 100 mg / sofosbuvir 400 mg fixed-dose combination tablet once daily for 12 weeks.
What are the adverse effects of the combination velpatasvir/sofosbuvir?
Headache and fatigue.
What is the indication for glecaprevir/pibrentasvir (Mavyret)?
Genotype 1–6 infection with or without compensated cirrhosis.
What is the dosing for glecaprevir/pibrentasvir?
Three tablets once daily with food.
What are the adverse effects associated with glecaprevir/pibrentasvir?
Headache, fatigue, nausea.
What should be monitored when using Grazoprevir and Elbasvir?
ALT elevations and testing for NS5A resistance-associated substitutions.
What is the indication for the combination of velpatasvir, sofosbuvir, and voxilaprevir?
Genotypes 1–6 infection in treatment-experienced patients.
What are the adverse effects of velpatasvir, sofosbuvir, and voxilaprevir?
Headache, fatigue, diarrhea, nausea.
What is the recommended treatment for treatment-naive patients without cirrhosis?
Glecaprevir/pibrentasvir daily with food for 8 weeks.
What tests are performed at baseline for HCV monitoring?
- HCV RNA
- Genotype
- Quantitative HCV RNA
- CBC
- Liver function tests
- Calculated GFR
What should be checked after HCV treatment to assess for SVR?
HCV RNA at 12 weeks.
True or False: There is a vaccine available for HCV.
False.
What modifications can reduce the risk of HCV transmission?
- Intravenous drug abuse prevention
- Appropriate barrier contraception
- Avoid blood exposure
Fill in the blank: Sofosbuvir should not be coadministered with _______ due to symptomatic bradycardia.
Amiodarone
