Week 205 - Hepatitis

Question 1

What are the routes of hepatitis transmission?

Answer 1

Oral Faecal
Parenteral
Blood

Question 2

Which hepatitis viruses are transmitted via the oral faecal route?

Answer 2

A & E

Question 3

Which hepatitis viruses are transmitted via the parenteral route?

Answer 3

B & C, E (and D in the presence of B)

Question 4

What are prodrome symptoms of hepatitis?

Answer 4

Flu like (anorexia, nausea, vomiting, fatigue, malaise, low-grade fever)

Question 5

What viruses other than the hepatitis viruses, cause hepatitis?

Answer 5

Adenovirus, EBV, CMV, Herpes simplex

Question 6

What is the incubation period of Hep E virus?

Answer 6

15-60 days (avg. 40)

Question 7

What is the treatment available for HBV?

Answer 7

Peg interferon
Entecavir
Tenofovir
Lamivudine
Adebovir
Telbivudine

Question 8

What are the hotspots of HBV?

Answer 8

Central + South Africa, China

Question 9

What are the hotspots for HBC?

Answer 9

Egypt, Ukraine, Brazil

Question 10

What are side-effects of Interferon?

Answer 10

Flu like symptoms (+ bone marrow suppression, thyroid dysfunction, exacerbation of autoimmune diseases)

Question 11

What are side-effects of Ribavirin?

Answer 11

Teratogenic, haemolytic anaemia, skin rash, cough, insomnia

Question 12

What are side-effects of Telaprevir?

Answer 12

Rash
DRESS (drug reaction with eosinophilia and systemic symptoms)
Bleeding PR

Question 13

What are side-effects of Boceprevir?

Answer 13

Anaemia

Rash

Question 14

Who’s at risk of HBC?

Answer 14

Recepients of clotting factors before 1987
IV drug users
Long term haemodyalisis pts

Question 15

What is the natural history of HCV?

Answer 15

15% Resolve

85% ⇒ Chronic Infection (20% of these ⇒ cirrhosis)

Question 16

What is the treatment available for HCV?

Answer 16

Peg interferon
Ribavirin
+/- telaprevir or boceprevir

Question 17

Describe the route of a drug from the sinusoid to the hepatocytes

Answer 17

Sinusoids ⇒ drug passes through fenestrae in the endothelium
Through the space of Disse
In the hepatocytes the enzymes may convert them into more polar compounds

Question 18

What is the phase I reaction (Drug Metabolism)?

Answer 18

Processing that creates/exposes functional groups (done my P450)

Question 19

What is the phase II reaction (Drug Metabolism)?

Answer 19

Products are coupled with endogenous substrates such as glycine, acetic acid and sulphuric acid (conjugation)

Question 20

Describe the first pass metabolism of Ethanol?

Answer 20

Ethanol ⇒ Acetaldehyde (Alcohol dehydrogenase)

Acetaldehyde ⇒ Acetyl CoA (acetylaladehyde dehydrogenase + NAD+)

Question 21

What are the actions of alcohol?

Answer 21

Depressant
Inhibits NMDA receptors
Inhibition of neurotransmitter release
Enhancement of GABA transmission

Question 22

What auto-antibodies would you look for in primary biliary cirrhosis?

Answer 22

anti-mitochondrial antibodies

Question 23

What auto-antibodies would you look for in autoimmune hepatitis?

Answer 23

Smooth muscle antibodies

Question 24

What auto-antibodies would you look for in primary sclerosing cholangitis?

Answer 24

Anti-nuclear cytoplasmic antibodies

Question 25

What are the characteristic features of Wilson's Disease?

Answer 25

Kayser Fleischer rings ↑Copper ↓Ceruloplasmin

Question 26

How can you diagnose haemochromatosis?

Answer 26

↑Ferritin | Gene test for HFE gene

Question 27

What are the symptoms of haemochromatosis?

Answer 27

``` 30-50 yrs Weak, tired Pain in joints, tummy Hepatomegaly, liver cirrhosis Bronzing of skin Cardiomyopathy ```

Question 28

What comprises the portal triad?

Answer 28

Bile Duct Portal Vein Hepatic Artery

Question 29

What is the function of stellate cells in the liver?

Answer 29

Store fat + vit A Produce collagen IV Role in liver regeneration Control blood flow through sinusoid

Question 30

List the causes of splenomegaly

Answer 30

``` Infection Congestion (portal hypertension) Haemolytic anaemia Autoimmune (RA, SLE) Haematological malignancy Amyloid Rare storage disorders ```

Question 31

What does prophylaxis for splenectomy consists of?

Answer 31

Pneumococcus, Meningococcus, Haemophilus | Prophylactic Penicillin V

Question 32

What is the definition of TOLERANCE?

Answer 32

Decreased response to the effects of a set drug concentration after continued use (compensatory homeostatic mechanisms)

Question 33

What is the definition of DEPENDENCE?

Answer 33

Need to take a drug to avoid withdrawal symptoms produced by compensatory homeostatic mechanisms

Question 34

What is the definition of ADDICTION?

Answer 34

Continued drug use despite known despite know adverse consequences

Question 35

What are treatments available for alcoholism?

Answer 35

Naltrexone + Nalmefene (opiod receptor antagonists) Acamprosate (NMDA receptor antagonist) Behavioural Therapy

Question 36

What is the basis of replacement therapy?

Answer 36

Replacing a fast acting drug with a slow one

Question 37

Name some psychostimulant drugs

Answer 37

amphetamines, methamphetamine, cocaine Put dopamine transporter into reverse MDMA (ecstasy), MMC (mephedrone)

Question 38

What is the neurobiology behind addiction?

Answer 38

VTA releases dopamine which goes to Nucleus Accumbens (via the mesolimbic dopamine system)

Question 39

What is the benzodiazepine used in alcohol withdrawal?

Answer 39

Chlordiazepoxide or Diazepam (Valium)

Question 40

What receptor does caffeine work on?

Answer 40

Adenosine (receptor antagonist) Adenosine triggers sleep Theophylline (tea) & theobromine (cocoa) have similar effects

Question 41

How does ketamine act?

Answer 41

NMDA receptor antagonism | Dissociative narcotic

Question 42

Name some Hallucinogens?

Answer 42

LSD, Psilocybin (magic mushrooms)

Question 43

How does acute intoxication with cannabis present?

Answer 43

``` Confusion Depersonalization Paranoid delusions Hallucinations Anxiety, Agitation ```

Question 44

Where is the CB1 receptor found?

Answer 44

In the brain - binds cannabis and endocannaobinoids

Question 45

Where is the CB2 receptor found?

Answer 45

``` Immune system (esp. B cells) Also brain stem & cerebellum ```

Question 46

What is the net effect of CB1 receptor?

Answer 46

Local hyperpolarisation

Question 47

To what state in the mesolimbic system are schizophrenic symptoms attributed to?

Answer 47

Hyperdopaminergic state in the mesolimbic system

Question 48

What are Type A drug reactions?

Answer 48

Predictable, more common,mostly dose related

Question 49

What are Type B drug reactions?

Answer 49

Not predictable, less common + tend to be more severe

Question 50

What substances will go up in liver damage (relating only to what is stored in the liver)

Answer 50

↑CRP ↑α-1-antitrypsin ↑B12

Question 51

Which Hepatitis antigen is elevated in Acute HBV infection?

Answer 51

HBcAg

Question 52

Which Hepatitis antigen is elevated in Chronic HBV infection?

Answer 52

HBsAg

Question 53

Which Hepatitis antigen indicates replicative form of HBV infection?

Answer 53

HBeAg