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PHRM 865 > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

transmission of hep A

A

fecal-oral

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2
Q

transmission of Hep B

A

blood
sexual
perinatal

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3
Q

is Hep B spread through food, coughing, touching?

A

no

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4
Q

hep C transmission

A

blood

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5
Q

risk factors for Hep A

A

direct contact with infected person

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6
Q

risk factor for hep B

A

born to infected mother

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7
Q

risk factor for hep c

A

injection drug use

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8
Q

potential for chronic infection hep a, b ,c

A

a - no chronic
b - acute then chronic depending on age
c - acute then 50% will get chronic

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9
Q

single greatest risk factor for chronic infection

A

age
90% of infants infected will get it

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10
Q

prevention of Hep B

A

screen all adults 18+ at least once in their lifetime with triple panel test, screen during each pregnancy

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11
Q

HBsAg on triple panel test is what

A

hep B surface antigen
if positive then patient has infection presently

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12
Q

anti-HBs on triple panel is what

A

antibody to hepatitis B surface antigen
shows if patient is immune

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13
Q

anti-HBc

A

antibody to hep B core antigen
shows if patient was exposed ever

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14
Q

IgM anti-HBc means what

A

immunoglobulin M class of antibody to hepatitis B core antigen
shows if patient was infected recently or exposed within past 6 months

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15
Q

HBsAg -
anti-HBs +
antiHBc +

A

resolved infection
counsel about reactivation

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16
Q

HBsAg -
anti-HBs +
antiHBc -

A

immune from vaccination
vaccinate if not completed series

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17
Q

HBsAg +
anti-HBs -
antiHBc +
IgM anti-HBc +

A

acute infection
give care

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18
Q

HBsAg +
anti-HBs -
antiHBc +
IgM-anti HBc -

A

chronic infection
link to care

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19
Q

hep B goals of therapy

A

achieve sustained suppression of HBV replication
remission liver disease
prevent cirrhosis, hepatic failure, HCC
HBsAg loss maybe
anti-HBe gain

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20
Q

goals of therapy hep C

A

obtain virological cure by achieving a sustained virological response (SVR)
- 12 weeks after completion of therapy re-test viral load and if undetectable than sustained

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21
Q

does treatment for Hep B cure?

A

no not completely

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22
Q

is combination therapy used in hep B?

A

no!

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23
Q

how long is therapy in hep B

A

indefinite usually

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24
Q

how did we used to do hep c therapy

A

interferon + ribavarin

25
do we use combination therapy in hep c
yes!
26
who should get treatemnt in hep C?
everyone infected unless <12 months left due to another disease
27
risk with hep c drugs
hep B reactivation
28
treatment eligibility in general for hep b
ALT > 2xULN or cirrhosis HBV DNA > 2,000 IU/mL
29
ULN for ALT males and females
35 U/L in males 25 U/L in females
30
e+ immune tolerant
normal ALT elevated HBV DNA++++ monitor
31
e+ immune active
elevated ALT elevated HBV DNA +++ if ALT > 2x ULN and HBV DNA > 20,000 IU/mL then initiate treatment
32
e+ cirrhosis
elevated ALT elevated HBV DNA ++ low albumin, low platelets if HBV DNA >2,000 IU/mL initiate treatment
33
e- inactive (carrier)
normal ALT low/undetectable HBV DNA +/- monitor
34
e- immune reactivation
elevated ALT elevated HBV DNA +++ if ALT > 2xULN and HBV DNA > 2,000 IU/mL treat indefinitely
35
e- cirrhosis
ALT elevated elevated HBV DNA++ low albumin, low platelets if HBV DNA >2,000 IU/mL treat indefinitely
36
HBV treatment options
tenofovir (TDF): 300 mg PO daily tenofovir (TAF): 25 mg PO daily entecavir: 0.5 mg PO daily if naive, 1 mg PO daily if exper on empty stomach peginterferon alfa: 180 mcg subq weekly x 48 weeks
37
monitoring for Hep B treatment immune tolerant
ALT q3-6 months eAg q6-12 months
38
monitoring for hep B e- inactive
ALT q6-12 months
39
monitoring for Hep B pts on therapy
HBV DNA q 3 months until undetectable then q3-6 months after
40
monitoring for hep B in pts that have stoppped therapy
q3 months x 1 year looking for increased viral load, ALT flare, eAg
41
who should get HCC monitoring
HBsAt+ patients with cirrhosis and first degree relative with it asian/black men over 40 asian women over 50 every 6 months
42
pregnant women treatment with nucleoside analogs
if 28-32 weeks and HBV DNA >200,000 use tenofovir DF
43
patient with HIV and HBV should get what
three drug therapy
44
how long is hep C treatment
12 weeks usually
45
monitoring for patients with hep C
hypoglycemia if diabetes INR if on warfarin LFTs if cirrhosis
46
post treatment monitoring hep C
HCV RNA 12 weeks after to check for SVR
47
adverse effectes peg interferon alfa
flu like symptoms fatigue mood changes autoimmune disease anorexia (bad side effects)
48
adverse effects entecavir
lactic acidosis
49
adverse effects tenofovir DF
nephropathy Fanconi syndrome osteomalacia lactic acidosis
50
adverse effects tenofovir AF
lactic acidosis
51
adverse effects ribavarin
hemolytic anemia!! pancreatitis pulmonary dysfunction insomnia pruritis teratogenic CrCl < 50 contraindicated
52
hep C guidelines are where
hcvguidelines.org
53
-previr drugs class
NS3/4A protease inhibitors
54
-buvir drug class
NS5B polymerase inhibitors
55
-asvir drugs class
NS5A replication complex inhibitors
56
pre treatment testing for elbasvir
genotype test for patients with genotype 1A to screen for resistant substitutions
57
which Hep c drugs require pre testiing
elbasvir velpatasvir grazoprevir
58
pre treatment testing for velpatasvir
NS5A genotype performed in patients with genotype 3 to screen for Y93H substitution
59
grazoprevir on treatment monitoring
ALT checked at 8 weeks d/c if > 5x ULN

PHRM 865 (31 decks)

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