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NAPLEX - OUR cards > Liver Disease/Hepatitis > Flashcards

Liver Disease/Hepatitis Flashcards

1
Q

Most common causes of viral hepatitis

A

hepatitis viruses A, B, C

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2
Q

Hepatitis A info

A

Acute, self-limiting illness
transmitted via fecal-oral route (improper handwashing, contaminated water/food)
mild, non-specific symptoms

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3
Q

Hep B and Hep C info

A

Can cause acute and chronic disease
Can lead to cirrhosis, liver cancer, liver failure and death
Transmission: via blood, bodily fluids of an infected individual
Requires antiviral therapy

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4
Q

What vaccines are available for hepatitis?

A

Vaccines available for Hep A and Hep B

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5
Q

Available agents used for Hep C treatment

A

NS3/4A protease inhibitor (-previr) p = PI
NS5A replication complex inhibitor (-asvir) A
NS5B polymerase inhibitor (-buvir) B

Combination of 2-3 meds is used for treatment

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6
Q

How many genotypes of HCV are there? And what factors determine drug choice and duration of therapy in HCV>

A 
6 genotypes
Factors:
Which genotype
treatment naiive?
\+/- cirrhosis
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7
Q

Black boxed warning for HCV antiviral therapy

A

reactivating of HBV
Test all pt prior to starting meds

Not recommended to use sofosbuvir and amiodarone (severe bradycardia)

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8
Q

Sofosbuvir monotherapy

A

Sovaldi
400 mg daily
Monotherapy not recommended
SE’s: HA, fatigue, diarrhea, nausea

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9
Q

Sofosbuvir-containing combo therapies

A

Sofosbuvir + ledipasvir (Harvoni)
Sofosbuvir + velpatasir (Epclusa)
Sofosburvir + velpatasvir + voxilaprevir (Vosevi) [w/ food]

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10
Q

Mavyret

A

glecaprevir + pibrentasvir
first med approved for 8 weeks duration (in pts w/o cirrhosis)
3 tabs daily WITH food

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11
Q

Which meds are approved for all genotypes?

A

Epclusa (sofosbuvir + velpatasvir)

Mavyret (glecaprevir + pibrentasvir)

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12
Q

Which meds are approved for HCV/HIV co-infection?

A

Epclusa (sofosbuvir + velpatasvir)
Mavyret (glecaprevir + pibrentasvir)
Harvoni (sofosbuvir + ledipasvir)

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13
Q

What other drugs are available as a single drug tablet? [2]

A 
Simeprevir (Olysio)
Take WITH food
NS3 Q80 K polymorphism testing might be recommended in some pts (consider different med if +)
Daclatasvir (Daklinza)
take in combo with sofosbuvir
3A4 metabolsim
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14
Q

Technivie notes

A

Paritaprevir + ritonavir + ombitasvir
2 tabs QAM WITH FOOD
Warning in pts with cirrhosis (liver failure)
3A4 metabolism
women should avoid taking ethinyl estradiol

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15
Q

Viekra notes

A

Paritaprevir + ritonavir + ombitasavir + dasabuvir
Pak: comes with 2 separate tabs (1 taken qam and 1 BID)
XR: 3 tabs daily
both take WITH FOOD
Warning in pts with cirrhosis (liver failure)
3A4 and 2C8 metabolism
women should avoid taking ethinyl estradiol (3A4 inhibition)

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16
Q

Zepatier notes

A

elbasvir + grazoprevir
risk of incr LFTs
avoid with strong 3A4 inhibitors
significant drug interaction potential

17
Q

Common drug interactions with all HCV antivirals

A

avoid use with strong 3A4 inducers (carbamazepine, phenytoin, rifampin, st johns wort)
Most antivirals incr the levels of statins
Recommend to avoid use with most acid-suppressing agents
Many HIV protease inhibitors
Ethinyl estradiol containing BC

18
Q

Ribavirin info

A

inhibits replication of RNA and DNA viruses
used in combo to treat HCV
Virazole: aerosolized used for RSV
teratogenic (most not get pregnant for 6 months after d/c; includ women partners)
SE’s: hemolytic anemia (do not use in unstable CV disease), HA, n/v/d
incr tolerability if taken with food

19
Q

Interferon alfa info

A

used for HBV and HCV treatment
regular: SC given 3x/week
pegylated: given weekly
SEs: fatigue, depression, GI upset, incr LFTs, myelosupression
flu-like syndrome (pretreat with APAP and antihistamine)
Very poorly tolerated

20
Q

Drug class used to treat HBV

A

NRTI’s

inhibit HBV replication

21
Q

Boxed warning for all HBV NRTIs

A

decr dose if crcl < 50
lactic acidosis and severe heptomegaly
exxacerbations of HBV upon d/c

22
Q

tenofovir notes

A 
disoproxil fumarate (Viread):
300 mg daily
SEs: n/v/d, HA, renal impairment, decr BMD
alafenamide (Vemlidy):
25 mg daily WITH food
less renal impairment and BMD
Can be used in HIV co-infection
23
Q

Entecavir notes

A

Baraclude
0.5 mg (treatment naive), 1 mg (resistance)
Take On EMPTY STOMACH
SEs: peripheral edema, ascites, incr LFTs, incr SCr

24
Q

Other NRTI’s used for HBV

A

Adefovir (Hepsera)
caution in renal inpairment
Lamivudine (Epivir HBV)
Epivir HBV used for HBV only: 100 mg daily
take 150 mg BID or 300 mg daily if HIV co-infection
Telbivudine (Tyzeka) - can incr CPK

25
Q

NRTI’s that cover HIV and HBV

A

emtricitabine
lamivudine
both tenofovir formulations

26
Q

Cirrhosis

A

advanced, usually irreversible fibrosis (scarring) of the liver
definitively diagnosed via liver biopsy
also incr LFTs, decr albumin

27
Q

Tools used to assess the severity of liver disease

A

Child-Pugh score (mild, mod, severe)

MELD score

28
Q

Natural product used for liver disease

A

Milk thistle

can cause mild diarrhea

29
Q

Drugs that can cause liver damage

A 
APAP (high doses)
isoniazid
nevirapine
NRTIs
Tipranavir
Valproic acid
30
Q

Most common cause of drug-induced liver injury

A

alcohol

31
Q

Drugs used for alcohol dependence

A

BZDs (for withdrawal)
Naltrexone, acamprosate, disulfiram to prevent relapse
Support groups
vitamins and minerals
Vit B1 = prevents (Wernicke-Korsakoff syndrome)

32
Q

Esophageal varices

A

caused by a back up blood that cannot easily pass through the liver
can be fatal
requires surgical intervention if actively bleeding (bands, shunts, etc)
Short-term antibiotic prophylaxis is recommended (ceftriaxone/quinolone x 7 days)

33
Q

Drugs used to vasoconstrict the GI circulation and minimize variceal bleeding:

A 
Octreotide (Sandostatin)
selective for GI vessels
Bolus + continuous infusion x 2-5 days
Vasopressin (Vasostrict)
non-selective, not 1st line
antidiuretic hormone analog
34
Q

Drugs used for primary/secondary prevention of variceal bleeding

A 
non-selective beta blockers
decr cardiac output (beta-1)
decr splanchinic blood flow via vasoconstriction (beta-2)
titrate to max dose (HR 55- 60 bpm)
Nadolol (Corgard) start at 40 mg QD
Propranolol (inderal) start at 20 mg BID
35
Q

Hepatic encephalopathy

A

symptoms: musty breath odor, confusion, forgetfullness, poor concentration, etc
caused by a build-up nitrogenous substances that are usually cleared by the liver (ammonia, etc)
Protein intake = 1 - 1.5 g/kg (protein contains Nitrogen)

36
Q

Drug used for hepatic encephalopathy

A

Lactulose (1st line): converts ammonia to ammonium =, which can be excreted in feces
titrate dose to 2-3 soft bowel movements/day
SEs: flatulence, diarrhea, dyspepsia, abd discomfort
Antibiotics:
Rifaximin (Xifaxan) - 550 mg BID
Neomycin
Metronidazole (do not use long term)

37
Q

Ascites

A

fluid accumulation in the peritoneal cavity
restrict sodium intake to < 2g/day
Use spironolactone +/- furosemide (lasix ineffective alone)
Spironolactone: start 50-100 mg (max 400 mg)
preferred ratio: 100 mg spironolactone: 40 mg lasix

38
Q

Other complications of liver disease

A 
Spontaneous Bacterial peritonitis
ceftriaxone, quinolones preferred
secondary prophylaxis might be needed
Hepatorenal syndrome
leads to kidney failure
albumin, octreotide, midodrine can be used.

NAPLEX - OUR cards (83 decks)

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