viral hepatitis

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viral hepatitis
2014-04-07 13:49:03
exam 3
dr cheung
Show Answers:

  1. how is HAV spread
    • fecal-oral route
    • person to person
    • by ingestion of contaminated food/water
  2. which genus does HAV belong to
    hepatovirus of the picornaviridae family
  3. what is the only know reservoir for the HAV
  4. s/s of HAV
    n/v, fatigue, malaise, RUQ pain, anorexia, pruritis
  5. what are the positive serum tests for HAV
    • anti HAV (antibodies)
    • IgM
  6. what prophylaxis vaccines are used for HAV and what is the dosing
    • Havrix <18 0.5 ml 6-12mths apart (>19 1.0 ml)
    • Vaqta
    • twinrix >=18 1.0ml 0,1,6 mths
  7. which vaccine can be given for HAV postexposure prophylaxis
  8. how is HBV transmitted
    • sexually¬†
    • parenterally
    • perinatally
  9. HBV belongs to which family
  10. which HBV genotype is associated with more severe liver injury
    genotypes C
  11. when is HBsAg detectable
    at the onset of clinical symptoms
  12. what does anti HBsAg confer
    immunity to the virusand clearance of HBsAg
  13. what is HBeAg
    marker of HBV replication and infectivity
  14. what is HBcAg
    promotes immune mediated cell death when expressed on hepatocytes
  15. what are the diagnostic criteria for HBV
    • HBsAg positive for > 6 mths
    • elevated liver enzymes and HBV DNA > 20,000
    • liver biopsy shows fibrosis or cirrhosis
  16. what are the vaccines used to prevent HBV
    • recombivax
    • comvax
    • twinrix
    • pediarix
    • Hep B Ig
  17. which HBV vaccines are for pediatric use only
    • comvax
    • pediarix
  18. Twinrix vaccines is used in which age groups
    adults only
  19. agents used for tx of chronic HBV
    • INF alpha
    • pegINF alpha
    • lamivudine
    • adefovir
    • entacavir
    • telbivudine
    • tenofovir
  20. lamivudine
  21. adefovir
  22. entecavir
  23. telbivudine
  24. tenofovir
  25. which INF has a more convenient dosing and sustained viral response
  26. in which pts should INF not be used in
    pts with decompensated cirrhosis
  27. when might a pt be switched from lamivudine tx to prevent resistance
    after 2 yrs
  28. how long should epivir tx last
    until HBeAg seroconversion for HBeAg positive pts
  29. epivir is not a first line tx for which type of HBV
    HBeAg negative chronic HB
  30. adefovir dose adjustments for pts with renal insufficiency
    dosing interval should increase with renal insufficiency
  31. adefovir should not be used in which age groups
    in children
  32. when should lamivudine be continued indefinitely
    after the additioin of adefovir or tenofovir
  33. what should be monitored in pts with renal insufficiency
    serum creatinine q3 mths and in pts on adefovir over 1 yr
  34. telbivudine has a limited role in treating HB because
    cases of myopathy and peripheral neuropathy have been reported. Also has a high rate of resistance
  35. AE of tenofovir
    • fanconi syndrome
    • osteomalacia
    • renal insufficiency
  36. if a pt is on lamivudine or telbivudine and adds entacavir what should happen
    lamivudine or telbivudine should be stopped to avoid entacavir resistance
  37. how often should pts have their liver panel monitored when on antiHBV tx
    q3 mths and HBV DNA every 3-6 mths
  38. when should HBsAg be tested in pts who are HBeAg negative with persistently undetectable serum HBV DNA
    q 6-12 mths
  39. which HCV pts are ineligible for IFN tx
    • decompensated hepatic disease
    • hx of depression
    • ANC < 1500, platelet < 90, Hgb < 10
    • preexisting cardiac disease
  40. what is the best predictor of long term response to HCV tx
    sustained virologic response
  41. what is a relapser
    pt who has achieved an undetectable level of virus during a prior tx course of PEG/RBV and relapsed after tx was stopped
  42. drugs used for the tx of HCV
    • sofosbuvir (sovaldi)
    • simeprevir (olysio)
    • ribavirin (copegus, rebetol, ribasphere)
  43. what is the black box warning for ribavirin
    • hemolytic anemia
    • teratogenicity (category X)
  44. simeprevir is a substrate and weak inhibitor of which enzyme
    • substrate of 3a4
    • weak inhibitor of 1a2
  45. which antiviral medication is not metabolized by p450 enzymes