Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

pharmacotherapy 4270 > Viral Hepatitis (Final Exam) > Flashcards

Viral Hepatitis (Final Exam) Flashcards

1
Q

this is inflammation of the liver caused by inflammation, medication, or immunologic abnormalities

A

hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

this type of hepatitis has sudden onset (< 6 months). jaundice is present or there is increased serum aminotransferase levels

A

acute hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

this type of hepatitis (> 6 months) includes ongoing hepatocellular necrosis. complications may include cirrhosis and complications of ESLD

A

chronic hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the most common viral causes of chronic hepatitis

A

HBV anf HCV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

this occurs when an individual experiences 1 or more complications of liver disease such as bleeding varies, ascites, encephalopathy, jaundice.

A

decompensated cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

is HAV a DNA or RNA virus

A

RNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how is HAV transmitted

A

fecal-oral (water/food contaminated, direct contact with an infected person)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

is the onset of HAV sudden or insidious

A

sudden

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

can HAV become chronic

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the preventative interventions for HAV

A

pre/post exposure immunization (Hep-A vaccine if no antibodies)
Immune globulin (IG) - esp for those at high risk

  • hand washing and contact precautions
  • boil food that may be contaminated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the tx options for HAV

A

none
- fluid and electrolyte support as needed
- transplantation in rare cases of liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

is HBV a DNA or RNA virus

A

DNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how is HBV transmitted

A
  • percutaneous
  • sexual
  • perinatal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

is the onset of HBV sudden or insidious

A

insidious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

can HBV become chronic

A

yes (5-10% in adults, 90% in infants/children)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the preventative interventions for HBV

A
  • pre/pst exposure immunization
  • Immune Globulin (IG)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the treatment options for HBV

A

IFN
nucleoside analogs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

is HCV a DNA or RNA virus

A

RNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how is HCV transmitted

A
  • percutaneous
  • sexual
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

is the onset of HCV sudden or insidious

A

insidious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

can HCV become chronic

A

yes (70-80%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the preventative interventions for HCV

A

none - risk factor modification
(avoid sharing personal care items which could be contaminated with blood e.g. toothbrush, razor, etc., avoid injection/inhalation drugs, use of condoms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the treatment options for HCV

A
  • IFN
  • Ribavirin
  • DAA’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

is HDV a DNA or RNA virus

A

RNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how is HDV transmitted

A
  • percutaneous
  • sexual
  • perinatal
    (same as HBV)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

is the onset of HDV acute or insidious

A

insidious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

can HDV become chronic

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are the preventative interventions for HDV

A

HBV immunization prevents HDV infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is the treatment options for HDV

A

IFN
(same as HBV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what antigen and antibodies are present in hepatitis serology for HAV

A

antigen - Hep A virus (HAV)

corresponding antibody - Hep A Antibody (anti-HAV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what antigen and antibodies are present in hepatitis serology for HBV

A

antigen - Hep B surface antigen (HBsAg), Hep B core antigen (HBcAg) & Hep B envelope antigen (HBeAg)

corresponding antibody: Hep B surface antibody (anti-HBs), Heb B core antibody (anti-HBc) & Hep B envelope antibody (anti-HBe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what antigen and antibodies are present in hepatitis serology for HCV

A

antigen - Hep C virus (HCV)

corresponding antibody - Hep C antibody (anti-HCV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

this serology antibody for HBV shows that the person probably had the infection before or has immunity from the vaccine

A

anti-HBs (surface antibody)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

this serology antibody for HBV shows the person had the infection previously and probably cleared it

A

anti-HBc (core antibody)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

this serology antibody for HBV is a marker for infectivity e.g. chronic Hep B

A

anti-HBe (envelope)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what are the goals of therapy for ALL viral hepatitis

A
  • prevent transmission
  • prevent disease progression (e.g. fibrosis, cirrhosis, ESLD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what ae the goals of therapy for HBV

A
  • prevent transmission
  • prevent disease progression (e.g. fibrosis, cirrhosis, ESLD)
    +
  • seroconversion or loss of HBsAg
  • seroconversion or loss of HBeAg
  • achieve undetectable HBV DNA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what are the goals of therapy for HCV

A
  • prevent transmission
  • prevent disease progression (e.g. fibrosis, cirrhosis, ESLD)
    +
  • achieve undetectable HCV RNA
  • obtain sustained virology response (AKA cure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is used for acute hepatitis management

A
  • no specific tx
  • supportive care: healthy diet, rest, maintain fluid balance, avoid hepatotoxic drugs (natural health products), abstain from alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

true or false: outbreaks of HAV can occur in daycares, household contacts, food service workers

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what is the incubation period of HAV

A

~ 28 days thus take a goof history and ask about travel is someone showing up with symptoms because could be about a month before they start showing symptoms of HAV

42
Q

what are the first symptoms that are seen in someone with HAV that only last 1-2 weeks

A

nonspecific prodromal symptoms: fatigue, weakness, anorexia, N/V, abdominal pain, elevated ALT

43
Q

what kind of symptoms may develop in someone with HAV after the non-specific prodromal symptoms

A

jaundice & mild hepatomegaly

44
Q

true or false: adults are more likely to be asymptomatic than children

A

false: other way around - children are more likely to be asymptomatic

45
Q

how quickly does HAV usually take to resolve on its own

A

~ 2 months

46
Q

who is the HAV vaccine recommended for

A
  • travel to countries where HAV is endemic
  • children living in communities with high rates of HAV outbreaks
  • high risk sex groups
  • people who use recreational/ilicit drugs as hygiene may be an issue
    -HCPs
  • people with Hep B or C infection
47
Q

who is the HBV vaccine recommended for

A
  • universal neonatal vaccination program
  • healthcare workers
  • travellers to endemic areas
  • all adults and children who have immigrated to canada
  • chronic liver disease
  • haemophiliacs and other receiving repeated infusions of blood or blood products
  • chronic renal disease on dialysis
  • congenital immunodeficiency, transplant, HIV
48
Q

what are some options to prevent perinatal transmission of HBV

A
  • administer combination of HB immunoglobulin and hep B vaccine to infant within 12 hours of birth and revaccinate at 1 and 6 months
  • mother may take nucleoside therapy during 3rd trimester to reduce viremia (Tenofovir disoproxil fumarate (TDF))
49
Q

if a person is exposed to HBV and their current status is HBsAg positive, and they are unvaccinated, what should be done?

A

HB Immunoglobulin x 1 dose and intitiate HBV vaccine series

50
Q

if a person is exposed to HBV and their current status is HBsAg positive and they have been previously vaccinated (known responder), what should be done

A

non treatment

51
Q

if a person is exposed to HBV and their current status is HBsAg positive and they have been previously vaccinated (known-non responder), what should be done

A

HB Immunoglobulin x 1 dose & initiate vaccine series (may not have responded to first vaccine)

52
Q

if a person is exposed to HBV and their current status is HBsAg positive and they have been previously vaccinated but the antibody response is unknown, what should be done

A

test exposed person for anti-HBs. if inadequate, treat as a known non responder

53
Q

if a person is exposed to HBV and their current HBsAg status is negative and they are unvaccinated, what should be done

A

initiate HBV vaccine series

54
Q

if a person is exposed to HBV and their current HBsAg status is negative and they have been previously vaccinated (known responder, known non-responder or antibody response unknown) what should be done

A

no treatment necessary

55
Q

if a persons HBsAg status is unknown or unavailable for testing and they are unvaccinated what should be done

A

initiate HBV vaccine series

56
Q

if a persons HBsAg status is unknown or unavailable for testing and they have been previously vaccinated (known responder), what should be done

A

no treatment

57
Q

if a persons HBsAg status is unknown or unavailable for testing and they have been previously vaccinated (known non-responder) what should be done

A

if known high-risk source, treat as if HBsAg positive (HBIG x 1 dose and initiate vaccine series)

58
Q

if a persons HBsAg status is unknown or unavailable for testing and they have been previously vaccinated but their antibody response is unknown, what should be done

A

test exposed person for anti-HBs. if inadequate, vaccine booster and recheck titre in 1-2 mo

59
Q

true or false: having HBV can increase your risk for developing liver cancer

A

true

60
Q

what serology level persists if someone has chronic HBV

A

HBsAg

61
Q

interpret the following serology:
HBsAg - negative
anti-HBc - negative
anti-HBs - negative

A

susceptible (no infection b/c no surface antigen or no vaccine because no surface antibody)

62
Q

interpret the following serology:
HBsAg - negative
anti-HBc - positive
anti-HBs - positive

A

immune due to natural infection
* if both core and surface antibodies are present than had the infection before

63
Q

interpret the following seorlogy:
HBsAg - negative
anti-HBc - negative
anti-HBs - postive

A

immune due to hep B vaccination
* if only surface antibody present - had vaccine

64
Q

interpret the following serology:
HBsAg - positive
anti-HBc - positive
IgM anti-HBc - positive
anti-HBs - negative

A

acutely infected
* HBsAg being positive shows an infection and IgM shows acute (if it was IgG it would show chronic infection, no surface antibodies therefore did not clear the infection

65
Q

interpret the following serology:
HBsAg - positive
anti-HBc - positive
IgM anti-HBc - negative
anti-HBs - negative

A

chronically infected
* no IgM therefore not acute, no surface antibodies therefore have not cleared the infection

66
Q

what are the HBV-specific outcomes for a chronic HBV infection

A

typically by the end or during therapy:
- loss of HBeA and conversion to anti-HBe
- virological clearance (undetectable HBV DNA)
- normalization of ALT
- normalize patient specific symptoms

67
Q

what are some non-pharmacological advice for chronic hepatitis management (HBV and HCV)

A
  • advise weight loss (reduce progression to fibrosis, cirrhosis)
  • advise blood sugar control in diabetes
  • encourage smoking cessation
  • avoid hepatotoxins (alcohol, acetaminophen use less than 1-2g/day, herbal products)
  • caution with NSAID use
  • to reduce risk of transmission, don’t share personal items (razors, toothbrush, drug use equipment), cover scrapes and cuts, clean blood with bleach and water
68
Q

what is the recommended therapy for HBeAg positive chronic hepatitis where the patient has increased ALT and high viral load of HBV DNA present

A

consider therapy with peginterferon or nucleoside analoogs (entecavir, TDF, TAF) if ALT is >1 ULN and viral load is > 2000. the goal is to suppress HBV DNA replication

69
Q

what is the recommended therapy for HBeAg-negative chronic hepatitis where the patients ALT is fluctuating and has a high viral load of HBV DNA present

A

consider long term therapy with nucleoside analogs (entecavir, TDF, TAF) if ALT is > 1 ULN and viral load is > 2000

70
Q

what is the recommended therapy for someone with decompensated cirrhosis

A

nucleoside (entacavir, TDF, TAF) lifelong

71
Q

this is a first line treatment option for HBV. it should be avoided in those with high DNA levels and low ALT due to low efficacy. usually used for 24-48 weeks

A

interferon (IFN)

72
Q

this is a first line treatment option of HBV. e.g. include entecavir, TDF, TAF. consider d/c 12 mo after seroconversion

A

oral nucleoside/tide inhibitors

73
Q

this first line treatment for HBV can be used when HBV DNA levels are lower; advantage is shorter duration of therapy but adverse effects are more severe (not well tolerated)

A

IFN

74
Q

what is the preferred therapy for treatment-naive patients in HBV

A

tenofovir or entecavir

75
Q

what is the preferred treatment for someone who has HBV and HIV

A

tnofovir and lamuvidine

76
Q

when should peginterferon alfa-2a not be used

A
  • uncontrolled MDD (especially with past suicide attempts)
  • autoimmune hepatitis or other autoimmune disease
  • severe CVD
  • decompensated cirrhosis or liver cancer -> risk of infections and further decompensation
  • uncontrolled seizure disorder
77
Q

when are lamuvidine, adefovir and telbivudine indicaited for HBV

A

not recommended for first-line anti-HBV therapy because of high resistance rates

78
Q

which of TDF or TAF should caution be taken with renal insufficiency

A

TDF

79
Q

what are some s/e of pegylated IFN

A

early - flu-like symptoms (fever, chills, myalgia fatigue) -> administer at bedtime to sleep through symptoms, pre treat with acetaminophen (only one dose)

late - BM suppression, depression, anxiety, thyroid disorders -> monitor CBC after weeks 1 and 2 then months; TSH q 3 months; treat anxiety and depression

80
Q

what are some s/e of Tenofovir

A

nephrotoxicity (less with TAF formulation) -> monitor Screening and phosphate q 3-6 months

81
Q

what should be monitored for HBV treatment

A

HBV DNA until undetectable and ALT (both q 3 months)
serology (measure q 6 months while on treatment and then annually after treatment d/c)
- HBsAg and anti-HBs
- HBeAg and anti-HBe

82
Q

what are some risk factors for HCV

A
  • recreational/illicit drug use
  • blood transfusion, organ transplant (pre-1992)
  • hemodialysis
  • sexual activity (MSM, multiple partners, co-infection with other STI)
83
Q

list some instances where an individual should be screened for HCV

A
  • history of injection drug use (even once)
  • blood transfusion, blood product or organ recipient prior to 1992 in Canada
  • history/current incarceration
  • born or resided in region where HCV prevalence is > 3%
  • born to mother who is HCV infected
  • history of sexual contact or sharing of personal care items with someone who is HCV infected
  • HIV infection, especially in MSM
  • chronic hemodialysis treatment
  • elevated ALT
84
Q

what does a HCV screening test measure in the body

A

anti-HCV; if reactive, confirm with HCV RNA

85
Q

true or false: for patients with prior HCV infection, they may get reinfected with different GT virus, therefore if retesting is done, it must be done with HCV RNA since anti-HCV will remain positive lifelong

A

true

86
Q

interpret the following HCV screening test:
anti-HCV: nonreactive
HCV RNA: not detected

A

no current HCV infection or no prior HCV exposure

87
Q

interpret the following HCV screening test:
anti-HCV: reactive
HCV RNA: not detected (may need to repeat HCV RNA to confirm negative result)

A
  • possible false positive anti-HCV
  • prior HCV exposure
  • no current HCV infection
  • acute HCV with low level viremia
  • possible spontaneous viral clearance
  • possible successful tx
88
Q

interpret the following HCV screening test:
anti-HCV: reactive
HCV RNA: detected

A

acute or chronic HCV infection

89
Q

interpret the following HCV screening test
anti-HCV: non reative
HCV RNA: detected

A
  • early acute HCV infection
  • chronic HCV infection in an immunocompromised patent
90
Q

true or false: someone can live with HCV for 20-30 years without symptoms even though liver damage is still occurring

A

true

91
Q

what are some symptoms of HCV

A

fature, Right upper quadrant pain, N/V, poor appetite

advanced sxs: palmar erythema, splenomegaly, testicular atrophy, spider nevi

extrahepatic: renal failure, insulin resistance

92
Q

what are the tx options for HCV

A

Direct Acting Antivirals (DAAs) (usually combine two drugs that are from different classes)
- well tolerated
- treat for 8-12 weeks
- effective against all genotypes thus don’t need to do genotyping before tx

+/- Ribavirin
- normally added for treatment-experienced pts and those with decompensated cirrhosis

93
Q

what class of DAAs are these drugs?
- Paritaprevir/ritonavir
- Grazoprevir
- Asunaprevir
- Voxilaprevir
- Glecaprevir

A

NS3/4A Protease Inhibitors (-PREVIR)

94
Q

what class of DAAs are these drugs?
- Ledipasvir
-Ombitasvir
- Elbasavir
- Velpatasvir
- Dalclasavir
- Pibrentasvir

A

NS5A inhibitors (-asvir)

95
Q

what class of DAAs are these drugs?
-sofosbuvir
-dasabuvir

A

NS5B RNA polymerase inhibitors (-buvir)

96
Q

chronic HCV treatment is recommended for ALL patients who will accept treatment and have no contraindications. what are some considerations when choosing treatment

A
  • viral genotype (although some tx that cover all genotypes)
  • baseline NS5A resistance associated variants
  • treatment naive vs experienced
  • liver damage (degree of fibrosis, cirrhosis, compensated, decompensated)
  • length of treatment
  • cost and drug coverage
  • comorbidities, drug interactions
  • adherence
  • pregnancy
97
Q

what is the main first line treatment regimen for someone which chronic HCV

A

always at least two DAAs (may include ribavirin if treatment experienced or decompensated cirrhosis)

98
Q

know the first line simplified DAA regimens

A
  • EPCLUSA (sofosbuvir (rNAi) + Velpatasavi (NS5Ai) ~12 weeks
  • MAVIRET (Glecaprevir (protease i) + Pibrentasvir (NS5Ai) ~ 8 weeks
99
Q

what are some drug interactions with Epclusa

A

-PPI, H2RA & antacids
- amiodarone

100
Q

what are some drug interactions with Maviret

A
  • statins
  • ethinyl estradiol
  • PPI
101
Q

true or false: all DAA’s can cause a risk of hepatitis B virus reactivation

A

true - test all patients for HBV infection before HCV treatment initiation

102
Q

true or false: protease inhibitor DAAs can be used in those with signs of hepatic decompensation

A

false - should NOT be used

pharmacotherapy 4270 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions