Term
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Definition
inflammation of the liver;
- caused by viruses (HAV, HBV, HCV, HDV, HEV) or toxic injury |
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Term
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Definition
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Term
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Definition
duration >6 months;
- may be lifelong;
- caused by HBV, HCV, & HDV;
- may lead to cirrhossis --> ESLD & HCC |
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Term
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Definition
| spread through fecal-oral contamination |
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Term
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Definition
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Term
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Definition
"infectious", responsible for ACUTE disease;
Incubation period = 28 days;
Transmission: mainly Fecal-oral (poor sanitation, poor hygiene);
S/Sx:
- Preicteric (abrupt onset): influenza-like (malaise, anorexia, nausea);
- Icteric: fever, JAUNDICE, DARK URINE, PALE STOOLS, abd pain, pruritus;
Hepatomegaly;
<6 yr: ASYMPTOMATIC;
>6 yr: Classic Presentation;
Diagnosis:
- clinical suspicion, Sx;
- elevated AST/ALT x 2 ULN;
- elevated bilirubin;
- (+) IgM anti-HAV |
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Term
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Definition
| implies Hepatitis A infection |
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Term
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Definition
| indicates host has immunity to Heptatitis A virus |
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Term
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Definition
| indicates host has ACUTE Hepatitis A DISEASE |
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Term
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Definition
No Pharm treatment, typically self-limiting dx;
Supportive care is mainstay --> pushing fluids |
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Term
| Hepatitis A Vaccine (Havrix or VAQTA) |
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Definition
used for prevention of Hepatitis A;
2-dose series known to have protective levels of anti-HAV for ~5-8 yrs; |
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Term
| Hepatitis A Immunoglobulin |
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Definition
used for prevention of Hepatitis A;
Concentrated passive transfer of antibodies - provides protection for 3 MONTHS;
- indicated for those EXPOSED to HAV;
- may be given concomitantly with HAV vaccine (Havrix, VAQTA) |
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Term
| Prevention of Hepatitis A |
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Definition
Avoid contaminated water or food:
- avoid uncooked shellfish, fruits, & veggies;
- avoid drinking water or beverages with ice of unknown purity;
Good hand hygiene; |
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Term
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Definition
leading cause of CHRONIC hepatitis, cirrhosis, & HCC;
Incubation period = 120 days;
Transmission: Parenteral (Percutaneous - IVDA, transfusions, piercings, tattoos);
S/Sx:
- Typical: fever, anorexia, N/V, jaundice, dark urine, pale stools, abdominal pain;
Diagnosis:
- clinical suspicion, Sx;
- elevated AST/ALT 2x ULN;
- (+) HBsAg > 6 months;
- Liver biopsy;
Known Risk Factor for ESLD & HCC; |
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Term
| HBsAg - Hep B SURFACE antigen |
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Definition
GOLD STANDARD in diagnosing Hep B
(+) = INFECTED, can pass virus to others;
(-) = susceptible to infection |
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Term
| HBsAg (+) - Hep B SURFACE Antigen |
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Definition
| infected w/ Hep B virus, can pass virus to others |
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Term
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Definition
| susceptible to Hep B infection |
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Term
| HBeAg - Hep B ENVELOPE Antigen |
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Definition
- found on viral core of HBsAg particle;
- detected immediately prior to liver cell injury;
- detected in early phase of chronic HBV along with HBV DNA;
(+) = indicative of VIRAL REPLICATION, high degree of infectivity; |
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Term
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Definition
| indicative of Hep B viral replication; high degree of infectivity |
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Term
| Anti-HBs - Antibodies to Hep B SURFACE antigen |
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Definition
| (+) = Indicative of protective immunity OR resolved infection |
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Term
| Anti-HBc - Antibodies to Hep B CORE antigen |
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Definition
| detected after acute injury & throughout HBV infection |
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Term
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Definition
| (+) = ACUTE Hep B infection |
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Term
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Definition
| (+) = CHRONIC Hep B infection |
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Term
| Susceptible to Hep B Infection |
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Definition
HBsAG = (-);
Anti-HBc = (-);
Anti-HBs = (-) |
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Term
| Immune to Hep B due to Hep B Vaccine |
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Definition
HBsAg = (-);
Anti-HBc = (-);
Anti-HBs = (+); |
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Term
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Definition
HBsAg = (+);
Anti-HBc = (+);
IgM Anti-HBc = (+);
Anti-HBs = (-); |
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Term
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Definition
HBsAg = (+);
Anti-HBc = (+);
IgM Anti-HBc = (-);
Anti-HBs = (-); |
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Term
1) Resolved Hep B Infection (most common);
2) False-Positive Anti-HBc --> Susceptible;
3) Low-level Chronic Hep B Infection;
4) Resolving Acute Hep B Infection; |
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Definition
HBsAg = (-);
Anti-HBc = (+);
Anti-HBs = (-); |
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Term
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Definition
NOT CURABLE;
ACUTE: supportive care; severe cases - Interferon, lamivudine, or entecavir;
CHRONIC: interferon, lamivudine, adefovir, entecavir, telbivudine
Treat when ALT 2x ULN & (+) HBV DNA levels; |
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Term
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Definition
Hepatitis B vaccine:
- most effective strategy;
Single-Ag Products: Recombivax HB & Engerix-B;
Combo products too;
Hep B Immunoglobulin: only used for post-exposure prophylaxis;
Safe sex practices;
Do not share household items with infected persons; |
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Term
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Definition
most common BLOOD-BORNE pathogen;
75-85% of acute dx --> chronic dx;
80% of chronic dx --> active liver dx;
Incubation Period: 50 days;
Transmission: Percutaneous/Parenteral (IVDA, transfusions, transplants, inadequately sterilized equipment, healthcare workers/needlestick injuries);
S/Sx:
ACUTE: 80% are asymptomatic, fatigue, malaise, jaundice, abdominal pain;
CHRONIC: fatigue (most common);
PhEX: hepatomegaly;
Diagnosis:
- clincal suspicion, Sx;
- elevated AST/ALT (ALT > AST & elevated >6 months = CHRONIC);
- elevated HCV RNA, anti-HCV;
- low WBC & Plts; |
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Term
| Anti-HCV - Antibodies to Hep C antigen |
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Definition
confirms diagnosis of chronic HCV;
(+) = indicates HCV |
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Term
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Definition
ACUTE: mostly supportive
CHRONIC: PegInterferon & Ribavirin
- vaccinations against Hep A & B;
Who should be treated??
- HCV (+);
- persistently elevated ALT;
- INFLAMMATION present on biopsy; |
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Term
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Definition
No vaccine available;
REDUCE RISK of virus exposure:
- avoid sharing personal items w/ infected person;
- universal precautions for healthcare workers; |
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Term
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Definition
requires HBV to cause infection;
- self-limited;
- worsens course of HBV pt;
Diagnosis:
- HDV RNA (+);
Prevention: Hep B Vaccine;
Treatment: Interferon |
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Term
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Definition
Transmitted: Fecal-Oral (enterically);
- contaminated water & food;
Self-Limited;
Anti-HEV IgM (+) = acute infection;
Anti-HEV IgG (+) = IMMUNITY/resolved infection;
Prevention: reduce risk exposure;
Treatment: infection resolves on its own |
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Term
| Desired Outcomes for Hepatitis |
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Definition
Prevent & tx symptoms;
Suppress viral replication;
Normalize LFTs;
Improve histology on liver biopsy;
Decrease morbidity & mortality by preventing cirrhosis, ESLD, & HCC; |
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Term
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Definition
Seroconverion or loss of HBsAg;
Seroconversion or loss of HBeAg;
Achieve undetectable levels of HBV DNA levels; |
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Term
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Definition
| Achieve undetectable HCV RNA levels 6 months post-Hepatitis C therapy |
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Term
| entecavir, tenofovir, or pegylated interferon alfa-2a |
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Definition
recommended 1st line fot treatment of chronic Hepatitis B;
- if inadequate response, add another Hep B antiretroviral; |
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Term
| pegylated interferon alfa-2a (Pegasys) & pegylated interferon alfa-2b (PEG-Intron) |
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Definition
preferred treatments for chronic Hepatitis C;
- add ribavirin --> sustained virologic response |
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Term
| Pegylated interferon + Ribavirin |
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Definition
| drug regimen of choice for Chronic Hepatitis C |
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Term
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Definition
Indication: HBV;
MoA: cytosine nucleoside analogue; inhibits syntheis of HBV DNA & suppresses viral replication;
ADRs: fatigue, N/V/D, HA, cough; Rare: pancreatitis, LACTIC ACIDOSIS, ANEMIA, NEUTROPENIA;
Monitor: LFTs, CBCs, markers of efficacy;
RENAL DOSE ADJUSTMENT if CrCl <50 ml/min;
Resistance is biggest concern - no longer 1st line;
Duration: up to a year, may be up to 5 yrs for seroconversion; |
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Term
| tenofovir disoproxil fumarate (Viread) |
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Definition
Indication: HBV;
MoA: nucleoside reverse transcriptase inhibitor; inhibits HIV & HBV viral replication;
ADRs - Common: asthenia, ALT increase, hematuria, GI upset, rash; Rare: pancreatitis, lactic acidosis;
Monitor: renal fcn (NEPHROTOXIC), LFTs, markers of efficacy;
RENAL DOSE ADJUST if CrCl <50 ml/min;
1st line in chronic HBV;
Duration: at least 1 yr; |
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Term
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Definition
Indication: HBV-resistant HBV;
MoA: Guanosine nucleoside analogue; inhibits synthesis of HBV DNA;
ADRs - Common: ALT increase, amylase/lipase increase, GI upset, HA; Rare: HYPOALBUMINEMIA, THROMBOCYTOPENIA, lactic acidosis, hepatomegaly;
Monitor: LFTs, renal function;
RENAL DOSE ADJUST if CrCl <50 ml/min;
BBW: Monotherapy of drug SHOULD NOT be used in pts coinfected w/ HIV & HBV b/c of resistance to HAART;
Duration: up to 1 yr |
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Term
| adefovir dipivoxil (Herpsera) |
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Definition
Indication: HBV;
MoA: prodrug, inhibits both HBV reverse transcriptase & DNA polymerase;
ADRs - Common: ASTHENIA, ALT increase, HEMATURIA, GI upset, rash; Rare: pancreatitis, lactic acidosis;
Monitor: Renal fcn (dose-related nephrotoxicity, >60mg), LFTs, markers of efficacy;
2nd line to tenofivir --> less potent;
RENAL DOSE ADJUSTMENT (CrCl <50 ml/min);
Effective against LAMIVUDINE-RESISTANT HBV;
Duration: 1 yr |
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Term
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Definition
Indication: HBV;
MoA: L-nucleoside analogue; inhibits synthesis of HBV DNA;
ADRs: Abd pain, HA, nasopharyngitis, URTI, malaise, fatigue;
Monitor: LFTs, renal fcn;
Myopthy --> Check CK level;
RENAL DOSE ADJUST if CrCl <50 ml/min;
Duration: 1 yr |
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Term
| ribavirin (Rebetol, Copegus, RibaPak) |
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Definition
Indication: HCV;
MoA: inhibits RNA virus replicatoin;
ADRs - fatigue, HA, fever, depression, cough, pulmonary infiltrates, rash, alopecia, nausea, anorexia, dose-related hemolytic anemia;
Monitor: CBC at wks 2, 4 & q4 wks after; Pregnancy tests; CXR baseline & if S/Sx of pulmonary infiltrates;
**MONOTHERAPY NOT EFFECTIVE - must use with INTERFERON**
**ALWAYS use 2 forms of CONTRACEPTION**
**C/I in pts w/ CrCl <50 ml/min**
Duration:
- Genotypes 1 & 4: 48 wks
- Genotypes 2 & 3: 24 wks |
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Term
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Definition
Indication: HBV & HCV;
- much shorter half-life;
- dosed daily or multiple times/wk;
- decreased efficacy compared to other interferon;
MoA: inhibits viral replication & cell proliferatoin;
Monitor: CBC, LFTs, TSH, eye exam, depression/psychiatric symptoms, baseline ECHO, HCV RNA;
**Drug may make pt FEEL WORSE than actual disease for 1st 3-4 doses** |
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Term
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Definition
MoA: inhibits viral replication & cell proliferatoin;
- attached molecule increases size & T1/2;
- dosed once/week;
- increased efficacy compared to other interferon
Monitor: CBC, LFTs, TSH, eye exam, depression/psychiatric symptoms, baseline ECHO, HCV RNA;
**Drug may make pt FEEL WORSE than actual disease for 1st 3-4 doses** |
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Term
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Definition
Look for:
- fever, chills, malaise, muscle pain, HA occurs 6-8 hrs after injection;
Tx:
- Nothing, usually subsides by 4th dose |
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Term
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Definition
Look for:
- aggressive behavior, suicidal ideations, depression, mood swings, anxiety;
Tx:
- Check for baseline Sx --> CANNOT start if baseline problems;
- Monitor closely;
- Medicate with SSRIs |
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Term
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Definition
Look for:
- Check Absolute Neutrophil Count (ANC) at baseline, q2 wks x 1 month, then monthly;
Tx:
- decrease dose if significant drop;
- D/C interferon if SEVERE drop; |
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Term
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Definition
Look for:
- Check Plt count at baseline, q2 wks x 1 month, then monthly;
Tx:
- decrease dose if significant drop;
- D/C interferon if SEVERE drop; |
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Term
| Autoimmune Problems associated w/ Interferon use |
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Definition
Look for:
- Hypo- or Hyperthyroidism; DM; lupus;
Tx:
- Check TSH at baseline & q3 months;
- Monitor fasting blood glucose;
**CANNOT START INTERFERON IF UNCONTROLLED*** |
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Term
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Definition
Look for:
- cough, pulmonary infiltrates;
Tx:
- Monitor for Sx;
- D/C if lung function is impaired |
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Term
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Definition
Look for:
- erythema, warm to touch, signs of infection;
Tx:
- rotate injection sites |
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Term
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Definition
Look for:
- tiredness, frequent naps;
Tx:
- drink 8 glasses of water daily; |
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Term
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Definition
Look for:
- inability to fall asleep;
Tx:
- Pharmacological interventions |
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Term
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Definition
Look for:
- anorexia;
Tx:
- supplemental drinks (Ensure, Boost) |
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Term
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Definition
Look for:
- psoriaris, pruritis;
Tx:
- Monitor & treat w/ steroid creams/pills; |
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Term
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Definition
Look for:
- floaters, retinal hemorrhages;
Tx:
- Eye exams (especially High Risk Pts (uncontrolled BP, DM)) |
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Term
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Definition
Look for:
- arrhythmias, hypotension, angina;
Tx:
- Monitor BP, EKG, ECHO |
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Term
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Definition
provides passive immunity to Hep A & B;
Used for post-exposure prophylaxis;
HAV: exposed during international travel;
HBV: exposed through perinatal exposure, sexual exposure, or percutaneous exposure; |
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