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GI > Module 8: Viral Hepatitis > Flashcards

Module 8: Viral Hepatitis Flashcards

Dr. Covert EXAM VI (Final)

1
Q

How is Hep A (HAV) treated?

A

Symtoms: N/V, flu-like symtoms

Self-limited

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2
Q

What are the lab signs to diagnose HAV?

A

-Immunoglobulin M antibody to HAV
-elevation of LFTs

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3
Q

Name the HAV vaccines
KNOW the vaccines

A

-Pre-Exposure prophylaxis

-HAV: Havrix, Vaqt
-HAV + HBV: Twinrix

Candidates: anyone older than 1; those at risk
MSM, IVDU, Occupational risk of
exposure, Patients with chronic liver disease

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4
Q

Hep B vaccines

A

-3 dose series
-HBV: Energix-B, Recombivax HB, Pediarix
-HBV + HAV: Twinirix

Candidates:
Infants, Adolescents/ children previously unvaccinated
-IVDU (IV drug use)
-At risk of infection by sexual exposure
-Healthcare workers
-Dialysis patients, Patients with DM
-Patients with HCV

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5
Q

Which of the Hepatitis types require 3 dose series?

A

Hep B

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6
Q

All HCV patients should receive HAV and HBV vaccines. T/F

A

True

There is no Hep C vaccine -> it heavily damages the liver, HBV and HAV vaccines to prevent other liver infections

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7
Q

What should be considered in patients with chronic liver diseases?

A

Pneumococcal vaccination PPSV23
1st dose at diagnosis
2nd dose at 65 yo (if > 5y from 1st dose)

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8
Q

Can HBV transmitted from perinatal (from mom to baby)?

A

Yes

other ways
-sex with an infected partner
-injection drug use
-contact with blood
-needle sticks

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9
Q

When is HBV considered chronic?

A

detectable surface antigen 6 months after initial infection

Signs and symptoms:
-Jaundice!
-Fever
-Fatigue
-N/V, abdominal pain, decreased appetite

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10
Q

Which antigen is detected first in the acute phase of an HBV infection?

A

Surace antigen HBsAg
-remains detectable in chronic infections

-gives information about the presence or absence of HBV

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11
Q

Which antigen gives information about the ongoing replication of HBV?

A

E antigen HBeAg

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12
Q

When should antiviral treatment for an HBV infection be considered?

A

if the infection becomes chronic (no cure, life-long treatment) -> not all chronic patients get treatment though

-no treatment available for the acute phase

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13
Q

Factors that determine HBV treatment or no treatment

A

-Age (if too old, probably die due to other conditions)
-HBV DNA load (also HBeAg)
-ALT levels
-disease progression

*not all chronic HBV patients are candidates for treatment

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14
Q

Guideline to decide on HBV antiviral treatment

E-antigen positive

A
  1. HBsAg positive? -> always (+) in chronic patients
  2. HBeAg positive? -> Yes
  3. ALT >2XULN (ALT is an early sign of cytotoxic injury of the liver)
  4. treat if HBV DNA is > 20.000 IU/ml

if ALT < ULN. Do not treat. monitor ALT and HBV DNA every 3-6 months and HBeAg every 6-12 months

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15
Q

When to initiate treatment for HBV in patients who are E-antigen negative?

A

-the virus replicates slower
-positive for HBsAg and HBeAg
-ALT > 2XULN
-HBV DNA > 2000 IU/ml

Do not treat if: ALT > ULN and HBV DNA < 2000 IU/ml and monitor ALT and HBV DNA for 3-6 months, HBsAg annually

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16
Q

Pharmacologic Treatment

A

-Entecavir ETV (Baraclude)
-Tenofovir dipovoxil fumarate TDF (Viread)
-Tenofovir alafenamide TAF (vemlidy)

Interferons: often used when ETV/TDF/TAF failed
-Interferon alfa-2b (Intron A)
-Peginterferon alfa-2b (pegasys)

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17
Q

What is the first-line treatment for HBV?

A

Interferons (Entecavir and tenofovir are also 1st line)
-MOA: enhances host immune system

-INF alfa-2b: 5 million IU SQ daily or 10 million IU 3x weekly X 16-24 weeks

-Peg-INF: 180 mcg SQ once weekly X 48 weeks
Peg-INF (same as INF-alfa2b) is more lost-lasting

18
Q

What are the ADE for Interferons?

A

-flu-like symptoms
-suicidal ideation
-depression
-anxiety
-anemia
-GI intolerance
-bone marrow suppression

19
Q

Contraindication for Interferons
KNOW when NOT to prescribe

A

-current psychosis
-severe depression
-neutropenia
-thrombocytopenia
-seizures
-decompensated liver disease
-symptomatic heart disease

20
Q

MOA and dose of Entecavir

A

-Guanosine nucleoside analog: inhibits HBV replication at 3 steps

-0.5-1 mg PO daily (don’t need to know)
-more potent than adefovir or lamivudine with minimal resistance

ADR: headache, cough, abdominal pain

21
Q

MOA and dose of Tenofovir

A

-Nucleotide analog: inhibits DNA polymerase
-highly potent, minimal resistant

-ADR: nephrotoxicity with TDF
-TDF IS preferred in pregnancy

-co-formulated in several HIV regimens
*Complera, Genvoya, Descovy, Odefsey

22
Q

What prophylactic interventions for HCV?

A

There is no vaccine
-patients should get HBV and HAV vaccine

23
Q

HCV Symptoms

A

-Jaundice
-dark urine!
-fatigue
-fever
-abdominal pain, N/V
-poor appetite
-weakness

24
Q

Which patients should be considered for HCV treatment?

A

-all patients with chronic HCV

Exception: Short-life expectancies secondary to comorbidities

25
Q

Meaning of SVS

A

Sustained viral response (SVR) = virologic cure

-presence of HCV antibodies
-absence of detectable HCV RNA 12 weeks after antiviral therapy

26
Q

Suffixes for HCV antivirals

A

Protease inhibitors (pr):
-Grazoprevir, Glecaprevir, Voxilaprevir

NS5A inhibitor (asvir)
-Ledipasvir, Pibrentasvir, Velpatasvir

NS5B inhibitor (busvir)
-Sofosbuvir, Dasabuvir

27
Q

MOA of HCV antivirals

A

Protease inhibitors (pr):
-inhibits the enzyme that cleaves NS4B + NS5A (replication complex), NS5B

NS5A inhibitor (asvir)
-replication complex (NS4B + NS5A) cant form

NS5B inhibitor (busvir)
-NS5B = polymerase complex, blocks the complex

28
Q

Harvoni

A

Sofosbuvir/Ledipasvir

DDI: amiodarone (Sofosbuvir) and antiacids (Ledipasvir)

29
Q

Epclusa

A

Sofosbuvir/ Velpatasvir

DDI: amiodarone (Sofosbuvir) and antiacids (Velpatasvir)

30
Q

Vosevi

A

Sofosbuvir/ Velpatasvir/ Voxilaprevir

31
Q

Zepatier

A

Elbasvir/ Grazoprevir

32
Q

Mavyret

A

Glecaprevir/ Pibrentasvir

33
Q

Which HCV antiviral causes symptomatic bradycardia when taken with amiodarone?

A

Sofosbuvir (NS5B inhibitor)
*Harvoni
*Epclusa
*Vosevi

34
Q

Which HCV antiviral has a DDI with PPIs?

A

Velpatasvir (decreased absorption)
*Epclusa
*Vosevi

with antiacids:
Ledipasvir (decreased absorption)
*Harvoni

35
Q

Which HCV may increase LFTs and can be used in ESRD-HD patients?

A

Elbasvir/Grazoprevir (Zepatier)

36
Q

Which HCV antiviral can be used for all genotypes?
!!!

A

Glecaprevir/ Pibrentasvir (Mavyret)
(+) first 8-week treatment option (the others ones are at least 12 weeks)
(+) all genotypes
(+) option for a simplified regimen

(-) contraindicated: Child-Pugh C, rifampin, atazanavir
(-) DDIs -> reduce concentration of: statins, carbamazepine, cyclosporine, ethinyl estradiol (oral contraceptives)

37
Q

Which other antiviral covers all genotypes?

A

Sofosbuvir/ Velpatasvir (Epclusa)
(+) option for a simplified regimen
(+) all genotypes

Sofosbuvir/ Velpatasvir/ Voxilaprevir (Vosevi)
(+) all genotypes

38
Q

What are common ADEs in HCV antivirals?

A

-Fatigue
-h/a
-nausea
-diarrhea

39
Q

What is the role of Ribavirin in HCV therapy?

A

-for patients who developed HCV drug resistance
-severe cirrhosis (as a result of the resistance)

-BBW: not effective alone, combined with other oral HCV antivirals!

-contraindicated in pregnancy, lots of side effects

40
Q

Simplified treatment

A

-can be started after treatment: other need to determine genotypes and resistance
Mavyret X 8 weeks
Epclusa X 12 weeks

patients should not have:
End-stage renal disease (only with Zepatier)
HIV
history of HCV treatment (may have resistance to Mavyret or Epclusa)
pregnancy
prior liver transplant
cirrhosis

41
Q

Which of the antivirals offering simplified treatment has a DDI with carbamazepine, cyclosporine, statins, and oral contraceptives?

A

Mavyret (Glecaprevir/ Pibrentasvir)

change to Epclusa: Sofosbuvir/ Velpatasvir
-> DDI with amiodarone and antacids (PPIs)

42
Q

Which HCV antiviral combo is similar to Epclusa but does not cover all genotypes?

A

Harvoni (Sofosbuvir/Ledipasvir)

DDI: amiodarone (Sofosbuvir) and antiacids (Ledipasvir)

GI (19 decks)

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