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Phar 761 > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

If HCV and decompensated cirrhosis

A

No protease inhibitors!

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2
Q

If HCV and CKD state 4 or 5 (eGFR < 30)

A

Elbasvir/grazoprevir
Glecaprevir/pibrentasvir
Mavyret

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3
Q

SE’s of HCV drugs

A

<5%
Nausea
Fatigue
Headache

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4
Q

HCV drugs and amiodarone

A

avoid if possible

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5
Q

HCV drugs and statins

A

just stop the statin unless recent MI

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6
Q

HCV drugs and acid-reducers

A

just stop them

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7
Q

HCV diagnosis

A

HCV antibody
AND
HCV RNA detectable

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8
Q

What if HCV and HBV?

A

Test for HBV
Negative - vaccinate
Positive - risk fulminant hepatitis
- HCV drugs can cause acute flares of HBV

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9
Q

NS3/NS4 (-pre-) drugs mechanism

A

protease inhibitors

block proteolytic processing of hcv polyprotein

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10
Q

NS5 (-bu-) drugs mechanism

A

polymerase inhibitors

block formation of replication complex

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11
Q

NS5B (-as-) drugs mechanism

A

polymerase inhibitors

block viral RNA replication

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12
Q

HCV drugs for all gentotypes

A

sofosbuvir/ velptasvir - Epclusa
sofosbuvir/velpatasvir/voxilaprevir - Vosevi
Glecaprevir/pibrentasvir - Mavyret

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13
Q

Which viruses are acute vs. chronic?

A

Acute: A and E
Chronic: B (D) and C

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14
Q

Biggest risk factor for HepA

A

International Travel - ingestion of contaminated food/water

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15
Q

HepA diagnosis

A

IgM (anti-HAV) will be elevated. ***
Acute sickness
Mild elevations in LFTs

Resolved if IgG elevated, but IgM not.

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16
Q

HAV treatment

A

None.

Prevention and vaccination.

17
Q

HAV vaccinations

A

Havrix - 2 dose
Vaqta - 2 dose
Twinrix (A/B) - 3 dose

18
Q

HAV postexposure management

A

Single dose of vaccine or immunoglobuline ASAP.
Immunoglobulin for higher risk.
Recommended for contacts as well.

19
Q

HAV and travel

A

First dose vaccine as soon as travel is considered.

High risk traveling in less than 2 weeks: vaccine + IG.

20
Q

Hepatitis B (HBV) stage classifications

A

Immune tolerance: DNA present, normal LFTs.
Active Infection: DNA present, high LFTs.
Inactive carrier: DNA absent, normal LFTs.

21
Q

HBV diagnosis and classification

A

HBsAg - elevated acutely if infected, but recovered.

HBsAg - elevated > 6months if chronic infection.

22
Q

HBV vaccination

A 
At birth as of today.
Adults (major considerations):
- DM
- ESRD
- Chronic liver disease
- HCV
23
Q

Newborn HBV guidelines

A

Over 2,000g (4lbs) at birth, mother HBsAg negative: give right away.
- If mother is +: also give HBIG.

Under 2,000g, and mother -: give dose @ 1 month.
- If positive: give three additional doses @ 1 month.

24
Q

Vaccination differences b/w A and B

A

A: 1st dose -> 96% immunity.
B: Need all three

25
Q

Acute treatment of HBV

A

Supportive care

26
Q

Who should be treated for chronic HBV

A

1 - Anyone with liver problems.
2 - Inactive, during chemo/immunosuppression.
3 - Active

27
Q

Who should not be treated for chronic HBV?

A

Immune tolerant.

Inactive carriers.

28
Q

Treatment methods for chronic HBV

A

Antiviral agents indefinitely.*
Pegylated interferon for 48 weeks.
Looking for HBeAg “seroconversion”

29
Q

First-line treatment for treatment naive chronic HBV patients

A

Entacavir (2 or older)
- not if HDV co-infection
Tenofovir (12 or older)

30
Q

When to use Peg-interferon alfa in HBV

A

If HDV co-infection

  • Bad toxicities
  • NOT in decompensated cirrhosis
  • 180 mcg SQ weekly for 48 weeks.
31
Q

Resistance to HBV antivirals:

A

Switch to tenofovir

- unless adefovir-resistance; go to entacavir.

32
Q

What if pregnant and HBV?

A

If HBV DNA > 200k

  • give tenofovir
  • @ 28-32 weeks gestation until 3months postpartum.
33
Q

HEV Key Points

A 
More dangerous in pregnant women.
Usually just an acute thing.
Contaminated water.
International travel.
No vaccine.
Just prevention.
34
Q

Progression of HCV

A

75% will develop chronic infection.
25% of them will develop cirrhosis.
A few of them will develop ESLD.
This can take 25-30 years.

35
Q

HCV presentation

A

Majority are asymptomatic!

You don’t know until they have liver disease.

Phar 761 (5 decks)

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