Tx, Viral Hep

Front 1

which hep?

source of virus: feces

Back 1

Hep A

Hep E

Front 2

source of virus: blood/blood-derived body fluids

Back 2

Hep B

Hep C

Hep D

Front 3

route of transmission: fecal-oral

Back 3

Hep A

Hep E

Front 4

route of transmission percutaneous permucosal

Back 4

Hep B

Hep C

Hep D

Front 5

chronic infection:

Back 5

Hep B

Hep C

Hep D

Front 6

t/f

hep A and E are chronic infections

Back 6

f

Front 7

prevention:

ensure safe drinking water

Back 7

Hep E

Front 8

prevention: pre/post exposure immunization:

Back 8

Hep A

Hep B

Hep D (risk behavior modification)

Front 9

prevention :

blood donor screening

risk behavior modification

Back 9

Hep C

Front 10

hep A can be received via --- contact

Back 10

person to person via oral fecal contact

oral-anal contact

Front 11

what's is hep a inactivated by

Back 11

high temp

formalin

chlorine

Front 12

infectious time of hep a

Back 12

2 weeks prior to illness to 1 week after onset of symptoms

Front 13

who's usu asymptomatic

Back 13

kids < 6 yrs

usu carriers

Front 14

t/f

hep a usu self limiting

Back 14

t

and conferes lifelong immunity upon recovery

Front 15

s/s of hep a

Back 15

flu like symptoms (n, anorexia, fatigue, fever, ha)

acute illness (worsening of symptoms)

icteric hepatitis

mild wieght loss

ruq pain

Front 16

icteric hepatitis s/s

Back 16

dark urine

light stools

icteric sclera, secretions, skin

Front 17

why ruq pain w/ hep a

Back 17

due to hepatomegaly

Front 18

in hep a what comes first IgM or IgG

Back 18

1st: IgM . . . acute infection

if you see IgG. .. past infection

Front 19

hep A

--- if n/v present

Back 19

hydration

Front 20

what do you limit in hep a

Back 20

meds that may cause liver damage

APAP 2 g/day

Front 21

prevention of transmission:

Back 21

proper hygiene

vaccinations ~ 2-4 weeks prior to exposure

IgG w/in 2 weeks of exposure (protects for 4-5 months)

Front 22

hep a: routine vaccination for kids -- yr old

Back 22

1 year old

Front 23

routine hep A vaccination for kids > 2 yres of age in -- areas

Back 23

endemic

Front 24

routine hep A vaccine for men:

Back 24

who have sex w/ men

Front 25

routine hep A vaccination for:

Back 25

illegal drug use

occupational risk

have chronic liver disease

receive bl products for clotting

adopt kids from endemic areas

travel to endemic areas

Front 26

symptoms of hep E similar to

Back 26

hep A

Front 27

hep E can be fatal in:

Back 27

pregnant women

greatest in 2nd and 3rd trimester

Front 28

t/f

there's a vaccine for hep E

Back 28

f

Front 29

modes of transmission of hep E

Back 29

parenterally

sexually

perinatally

rarely bl transfusion

Front 30

highest conc of hep B

Back 30

blood

serum

wound exudates

Front 31

mod conc of hep B

Back 31

semen

vag fluid

saliva

Front 32

low/not detectable conc of hep b

Back 32

urine

feces

sweat

tears

breast milk

Front 33

the --- --- to the hep b virus is cytotoxic hepatocytes. . .esp over long periods

Back 33

immune response

Front 34

risk factors for disease progression:

hbv dna levels:

Back 34

> 10^3 to 10^4 virions/mL

Front 35

risk factors for disease progression

genotype:

Back 35

C infection

Front 36

risk factors for disease progression

HBeAg neg ----

Back 36

mutants. .. change virus. .. . toxic to liver

Front 37

risk factors for disease progression

co----

--- age

--- sex

Back 37

coinfections

older

male

Front 38

risk factors for disease progression

severity of --- ---

Back 38

liver disease at diagnosis

Front 39

risk factors for disease progression

frequency of --- ---/ ab --- ---

Back 39

hepatic flare

liver function

Front 40

risk factors for disease progression

--- use and ---

Back 40

etoh

smoking

Front 41

if positive active viral infection:

Back 41

HBsAg

(acute or chronic)

Front 42

w/ chronic hep b virus what's not present

Back 42

no antiHBs

Front 43

if positive: immunity is present (via vaccination or infection)

Back 43

HBsAb

Front 44

if present it indicates exposure to HBV (not vaccine)

core antigen cannot be detected

Back 44

HBcAb

only seen in infection

Front 45

derived from HBV pre-core and serves as a marker of HBV replication and infectivity

Back 45

HBeAg

Front 46

if ABsAg - and antiIIBs-

what do u do

Back 46

give vaccine

Front 47

if ABsAg - and anti-IIBs +

what do you give

Back 47

nothing

immune

Front 48

HBeAg +

alt < 1 uln?

Back 48

monitor

q 3-6 months ALT

q 6-12 month HBeAg

Front 49

HBeAg +

ALT 1-2 x ULN

Back 49

Q 3 mo ALT

q 6 mo HBeAg

bx persistent or more than 40 yrs

treat

Front 50

HBeAG +

ALT > 2 x ULN

Back 50

q 1-3 mo ALT, HBeAg

Bx optional

Treat! (jaundice, decompensated or persistent)

Front 51

HBeAg-

ALT > 2 x ULN

HBV DNA 2000 IU/L

Back 51

bx optional

treat if persistent

Front 52

HBeAg-

ALT 1-2 x ULN

HBV DNA 2000-20,000

Back 52

q 3 mo ALT

consider Bx

treat prn

Front 53

HBeAg-

ALT < 1 x ULN

HBV DNA < 2,000 U/mL

Back 53

Q 3 mo ALT x 3

then

6-12 mo if stable

monitor

Front 54

goasl of tx:

reduction in ---- ---


limit --- disease

improve or control the extent of -----

Back 54

HBV replication

progressive disease

damage

Front 55

surrogate endpoints of tx:

--- reduction

biochemical ------

---- improvements

---- loss or seroconversion

Back 55

virological reduction ( dna undetectable or suppression)

biochemical normalization (ALT)

histological improvements (dec inflammation and stage of fibrosis)

HBeAG adn HBsAg loss or seroconversion

Front 56

interferon/pegylated interferon
has better responses in genotype:

Back 56

A and B

Front 57

interferon/pegylated interferon

not recommened for

Back 57

decompensated cirrhosis

Front 58

interferon/pegylated interferon

HBeAg+: increased -------

lower level -----

give to -- and ---- if inc in ALT's

Back 58

ALT's

DNA

asians

kids

Front 59

interferon/pegylated interferon

does not respond well to high --- ---

Back 59

viral loads > 200, 000

Front 60

frequency of interferon

Back 60

3 x week

Front 61

how long should you give interferon HBeAg +

Back 61

4-6 months

Front 62

how long should you give interfereon HBeAg-

Back 62

1 yr

Front 63

benefits of interferon

Back 63

no drug resistance and set duration

Front 64

ae of interferon

Back 64

flu like symptoms

leukopenia

thrombocytopenia

depression

anxiety

irritability

hair thinning

hypo/hyper thyroidism

visual disturbances

Front 65

interferon should not be used w/

Back 65

cirrhosis . . .due to flares

Front 66

the least potent nucleoside/nucleotide analogs

Back 66

adefovir

~30% resistance at 4 yrs

Front 67

what are not cross resistant

Back 67

adefovir

tenofovir

Front 68

what's x resistant

Back 68

lamivudine

telbivudine

entecavir

Front 69

nucleoside/nucleotide analogs

which do you monitor for nephrotoxicity

Back 69

tenofovir

adefovir

Front 70

telbivudine increases --- and --- ---

Back 70

CK

peripheral neuropathy

Front 71

nucleoside/nucleotide analogs

prob w/ hiv pos patients

Back 71

increase risk of HIV drug resistance w/ monotx

Front 72

duration of nucleoside/nucleotide analogs tx

Back 72

> 1 yr

additional 6 mo after eAg conversion

Front 73

benefits of nucleoside/nucleotide analogs

Back 73

oral meds can be used in decompensated disease or thos waiting transplant