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Therapeutics IV Final Subjects > Viral hepatitis and Drug Induced Liver disease > Flashcards

Viral hepatitis and Drug Induced Liver disease Flashcards

1
Q

What is inflammation of liver caused by immune respnse called

A

Acute Viral Hepatitis

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2
Q

What are some symptoms of Acute Viral Hepatitis?

A

Fatigue, mild fever, nausea, vomiting, diarrhea, anorexia, abdominal pain, dark urine, jaundince

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3
Q

What is Fulminant hepatitis?

A

Encephalopathy, coagulapathy, cerebral edema and mutliple organ failure (end line of sudden liver inflammation)

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4
Q

Inflammation of the liver and persistently abnormal liver enzymes for at least ____ months is known as ________.

A

6 months; chronic viral hepatitis

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5
Q

If you have chronic viral hepatitis what are you at risk for involving the liver?

A

Cirrhosis of the liver and liver cancer

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6
Q

What are some complications of cirrhosis?

A

portal hypertension, ascites, encephalopathy, variceal bleed, spontaneious bacterial peritonitis, Liver cancer

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7
Q

What is the target organ of injury of hepatitis A virus?

A

Liver

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8
Q

Who has the highest rates of infection of Hep A and why?

A

Children, fecal oral route

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9
Q

Is hep A self-limiting or fulminant?

A

self limiting, only 2% become

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10
Q

Can hep A cause chronic infection?

A

no

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11
Q

What are some risk factors of hep A?

A

international travel, sexual/household contaction/ homosexual activity, food or waterborne outbreaks, injection drug use

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12
Q

Does acute hepatitis A have descrete onset of symptoms or does it take a long time?

A

Discrete

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13
Q

Is there a vaccine for Hep A?

A

Yes

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14
Q

What is the post exposure tx for Hep A?

A

Immune Globulin

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15
Q

How soon after infection must immune globulin be given for Hep A? What is the dose and route?

A

14 days; IM into deltoid or gluteal muscle and its 0.02ml/kg

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16
Q

What is the pre-exposure dose for short and long term?

A

Short-term: 1-2 months - 0.02ml/kg

long-term: 3-5 months - 0.06ml/kg

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17
Q

What type of virus is Hep B?

A

Double strand DNA

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18
Q

What are some risk factors for hep B

A

IVDA, multiple sex partners, inamtes, pregnancy, MSM, high HBV rates, receiving dialysis

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19
Q

What is the tx of hep B for an acute infection?

A

Supportive therapy

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20
Q

What is the tx for HBV infection for chronic infection?

A

I LATTE Interferon, Lamivudine, Adefovir, Telbivudine, Tenofovir, Entacavir

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21
Q

What is the end line tx for HBV?

A

Liver Transplant

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22
Q

What drug tx for HBV is SQ?

A

IFN

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23
Q

What two drugs are well tolerated side effects?

A

Lamivudine and Entecavir

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24
Q

What are some benefits of IFN?

A

no resistance, urable response

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25
Q

What are some negatives of IFN?

A

many side effects, CI in decompensated liver disease

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26
Q

What is the side effect profile for Lamivudine?

A

Low

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27
Q

What are some benefits and negatives of Lamivudine?

A

low cost, well tolerated;

negatives: High resistance

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28
Q

What is a side effect of Adefovir

A

potential renal toxicity

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29
Q

What is the benefit of Adefovir?

A

effective when lamivudine resistnace

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30
Q

What are some negatives of Adefovir?

A

Renal toxicity, slower supporesion

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31
Q

What is the cost like on Adefovir?

A

Intermediate

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32
Q

What are some side effects of Telbivudine?

A

Myopathy

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33
Q

What are some benefits of Telbivudine?

A

More effective than Lamivudine

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34
Q

What are some negatives of Telbivudine?

A

limited long term, not effective for Lam resistance

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35
Q

What are some side effects of Tenofovir?

A

dec bone mineral dnsity, renal toxicity

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36
Q

What are some benefits of Tenofovir?

A

more effective than Adefovir, effective for Lam resistance

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37
Q

What are some negatives of Tenofovir

A

Decreased bone mineral density and renal toxicity

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38
Q

What are some side effects of Entecavir?

A

well-tolerated

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39
Q

What are some benefits of Entecavir?

A

Dec resistance, dec side effects, effective when Lamivudine resistnace

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40
Q

What are some negatives?

A

limited long term data, high cost

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41
Q

What are the two with renal toxicity?

A

Adefovir and Tenofovir

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42
Q

What is one side effect of Telbivudine?

A

Myopathy

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43
Q

What is used for Hep B prevention?

A

Vaccines: Recombivax HB, Engerix-B, Twinrix (Combination of HAV and HBV)

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44
Q

What populations are indicated for Hep B vaccines

A

all newborns and adolescents, Healthcare workers, Hemodyalsis pts, increased risk due to sexual practices, post-exposure prophylaxis

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45
Q

What is Hepatitis B Immune Globulin (HBIG) indicated for? What are some brand names?

A

HepaGamB
HyperHEP B S/D
Nabi-HB

Indicated for passive immunity post exposure prophylaxis and prevention of viral recurrence after liver transplantation

46
Q

When a pt has muscle pain and renal problems and has tried Lamivudine what anti-viral would you try?

A

Entecavir

47
Q

What does all the vaccines have at the end of their name? What about the immune globulin how do you tell those?

A

X, Its HHN (first letters of all them)

48
Q

What type of information is in the HCV?

A

RNA

49
Q

What is the leading cause of cirrhosis HCC and liver transplantiation?

A

HCV

50
Q

What are the three biggest reasons for HCV?

A

IV Drug Use, Sexual, Tranfusion

51
Q

What must you do before you tx HCV?

A

genotype the virus

52
Q

What is the gold standard of tx for Genotype 1?

A

pegylated IFN + ribavirin + protease inhibitor

53
Q

What is the gold standard of tx for Genotype 2,3,4?

A

peglyated IFN + ribavirin

54
Q

What are the different types of pegylated interferons?

A

alfa-2a (pegasys)

alfa-2b (peg-Intron)

55
Q

What are the two protease inhibitors used for HCV genotype 1 infections?

A

Telaprevir, boceprevir

56
Q

What is the end stage of HCV infection?

A

Liver transplantation

57
Q

What are some predictors of response?

A

HCV genotype, baseline viral load, race

58
Q

What is the dosage and frequency for Pegylated IFNs for HCV infection?

A

Dosed once weekly: 2a (pegasys) - 180mcg

2b (peg-intron) - weight based

59
Q

How long to you tx?

A

based on genotype

60
Q

What are some adverse effects of Pegylated IFNs?

A

Fever, chills, HA, myalgia, fatigue, rash, alopcia, retinopath, bone marrow suppression, N/D/V, depression, thyroid disorder

61
Q

Is Ribavirin effective as monotherapy?

A

No

62
Q

What is the preg category of Ribabirin?

A

X

63
Q

How many forms of contraception should you use when using Rivavirin?

A

2 non-estrogen forms

64
Q

What are some side effects of Ribavirin?

A

hemolytic anemia (reduce dose), nasal stuffiness, sinusitis, cough, pruritis and rash and fatigue

65
Q

What is the dose of ribavirin?

A

depends on genotype and pt weight, reduce dose if hemolytic anemia presents

66
Q

What type of HCV is protease inhibitors for?

A

Genotype 1

67
Q

Is it effective as monotherpay?

A

no, must be used with Peg-interferon + Ribavirin

68
Q

What CYP does protease inhibitors act on?

A

CYP3A4

69
Q

Regimen and duration of tx based on prior _______. Can you select for resistance in viral infections?

A

Tx status; yes

70
Q

What are the two protease inhibitors?

A

Telaprevir and boceprevir

71
Q

Can Telaprevir or Boceprevir be used in tx naive, prior relapsers, prior partial or null responders?

A

Yes

72
Q

What are the differences in side effects of the two protease inhibitors?

A

Telaprevir: Rash, pruritis, anemia: BBW of Serious Skin reactions
Boceprevir: anemia, neutropenia, thrombocytopenia

73
Q

What is the difference in dose of the Protease inhibitors?

A

Telaprevir: 750mg PO TID
Boceprevir: 300mg PO TID

74
Q

What is the duration of Tx for genotype 1 HCV?

A

Peg-interon + Ribavirin + PI = depends onf prior tx
Peg-INF + Ribavirin = 12 months
Peg-INF = 12 months

75
Q

What is the duration of Tx for genotype 2,3,

A

Peg-INF + Ribavirin = 6 months

Peg-INF = 12 months

76
Q

Stop after ____ months of no virologic response

A

6 months

77
Q

Early virologic response at ___ and ___ wks predictive of therapy success

A

4wks and 12 wks

78
Q

Contraindications to HCV tx?

A

Pregnancy and 6 months after cessation of therapy, decompensated cirrhosis, uncontrolled depression, active alcohol use or drug abuse, severe leukopeia or thrombocytopenia, uncontrolled thyroid disease, autoimmune disease

79
Q

What pts does HDV occur in?

A

HBV pts

80
Q

Can HBV-HDV be more severe than HBV alone?

A

Yes

81
Q

How does you contract HDV?

A

IVDA or sexual contact

82
Q

How do you get HEV?

A

enterically transmitted hepatitis

83
Q

Is there tx or prevention for HEV?

A

No

84
Q

What is the transmission route of HEV?

A

fecal oral route

85
Q

How do you manage DILD?

A

Stop the offending agent

86
Q

What is the most common cause of acute liver failure?

A

DILD

87
Q

WHere is AST found?

A

Liver and Heart

88
Q

Where is ALT found?

A

Liver

89
Q

Where is AP found?

A

liver and bone

90
Q

Where is GGT found

A

liver and several other organs

91
Q

What are some acute hepatitis indications or labs?

A

Jaundice
Serum bilirubin >2x ULN
Serum ALT > 3x ULN (upper limit of normal)

92
Q

Who is at risk for DILD?

A

older pts; chronic ingestions of alcohol and acetaminophen and other liver toxic drugs; female gender, familial predispostition

93
Q

What is the difference between idiosyncratic and intrinsic depatotoxic drug reactions?

A

Unpredictable vs predictable

94
Q

Does Acetaminophen have intrinsic hepatotoxicity?

A

yes (big large single toxic dose)

95
Q

Which drug has an onset of symptoms as soon as hours to days?

A

ACetaminophen

96
Q

How do you diagnose DILD?

A

rule out other causes of liver injury, examine medication time line

97
Q

Can you rechallenge someone if they had liver disease?

A

Yes if u are uncertain about etiology or the medication is essential to well-being of pt

98
Q

What type of liver damage will be okay to rechallenge a pt in and which will be bad?

A

Cholestatic is okay but hepatocellular is bad

99
Q

What is the tx of DILD?

A

supportive care, remove agent, antidote/protectant, corticosteroids, Ursodiol and referrel for liver transplantation

100
Q

What is the antidote for APAP overdose?

A

N-acetylcysteine

101
Q

What is the toxic dose of APAP in adults and children?

A

10-15g or 150mg/kg in children leads to hepatic necrosis

102
Q

How does APAP liver toxicity occur?

A

APAP metabolized to N-acetyl-p-benzoquinoneimine and gets conjugated with glutathione which causes depletion of glutathion and leads to hepatic necrosis

103
Q

What pts populations will a lower dose of APAP cause liver damage?

A

the young and elderly

104
Q

What effect does 1g QID for 2wks have on your ALT levels?

A

39% of pts had ALT >3x ULN

105
Q

Can APAP for long term use cause liver damage and reduce GSH and compromise antioxidant defense capacity?

A

Yes!!

106
Q

Who limit APAP to 325mg/tab

A

FDA

107
Q

What is the max APAP /day?

A

4g/day

108
Q

What is the manufactures max?

A

3g/day

109
Q

Is a BBW required on APAP products?

A

Yes: acetaminophen may cuase severe hepatotoxicity, potentially requiring liver transplant or resulting in death

110
Q

What is the clinical presentation of APAP hepatotoxicity?

A

N/V/lethargy, elecated LFTs after 24hrs, jaundice at 72 hours

111
Q

If ___________ is administers within __ hours after APAP overdose, hepatotoxicity is uncommon.

A

acetylcysteine; 8 –> be careful of anaphylaxis from acetylcysteine

112
Q

Can you give it IV or oral?

A

Yes and Yes

Therapeutics IV Final Subjects (10 decks)

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