Liver disease Flashcards
which hepatitis dont have vaccine
HEP C
which HEP is only acute
HEP A
which HEP is fecal oral
HEP A
which HEP is body fluid and blood
HEP B and C
hep C treatment
2-3 direct acting antivirals with diff MOA for 8-12 weeks
what are the protease inhibitors for HEP C
-Previr
what are the replication complex inhibitors for HCV
-asvir
A for NS5A
what are the polymerase inhibitors
-buvir
B for NS5B
for DAA what is tested before starting
HBV
Epclusa
Sofusbuvir-Velpatasivir
not a protease inhibitor - with or without food
- all 6 genotype, HCV HIV co infection
mavyret
Glecaprevir/ pibrentasvir
*PI= with food
* all 6 genotypes, HIVHCV co infection, approved for 8 week therapy and also salvage therapy as well
what are some interactions of DAAs
Acid suppresion
CYP3A4 inhibitors
can ribavirin be used as monotherapy
NO
IFNA can be used to treat with HEP
B and C
PEG INF lasts longer (3 times weekly)
what is a mono-therapy approved for HEP B
INF A
Nucleoside reverse transferase inhibitors (NRTIs)
** test for HIV first so that therapy is chosen to cover both
what are some NRTIs
preferred NRTI therapy includes:
TDF (Viread)
TAF (Vemlidy)
Entecavir (baraclude)
Lamivudine (EPIVIR) do not use in HIV results in HIV resistance)
**CRCL>50
** ribavirin can increase hepatic AE
what is the most common cause of cirrhosis
alcohol and HEP C
increase in BILI rubin, PT INR, ALT and AST
what are child class pugh levels
determines severity of Cirrhosis
Class A mild <7
class B 7-9 and
class C 10-15 severe
what natural products can cause liver damage
Milk thistle is good
KAVA is bad
DILI- drug induced liver injury
these drugs are stopped if AST >3 times
- tylenol
- amiodarone
- isoniazid
- ketoconazole
- MTX
- NNRTIs
- NRTIs
- Propylthiouracil
- valporic acid
acute variceal bleed
increase in portal hypertension can be fatal
- blood products, mechanical ventilation, endoscopy
- medications include octreotide (sandostatin), vasoconstrictor selective
- vasopressin is non selective
- non selective BB- nadalol, propranolol, titrated to the max and used indefenitely
what are some symptoms of hepatic encephalopathy
breath smell +urine
- confusion, fatigue, drowsiness
- accumulation of nitrogen in the blood
what are the treatment options for hepatic encephalopathy
reducing ammonia levels- lactulose , 1st line
reduce protein intake
ABX- rifaximin- xifaxan q8 5-10 days , 2nd line
zinc supplement s
ascities treatment
sodium restriction <2 grams
avoid sodium retention like bicarbs, NSAIDS
use diuretics unless na is <120- spironolactone mono or furosemide + spironolactone in a 4:10 ratio to balance potassium
paracentesis >5L requires addition of albumin 6-8g added per L removed after 5L
