Health And Medicine- Viral Hepatitis Knowledge Test

This is one of the downsides to peg-IFN

There actually is NO specific treatment for hepatitis A. If a patient was not tolerating their symptoms, they would simply receive supportive care.

IFN is a SC injection once a week

This is one of the benefits of IFN over NA. If it works, the patient is at a lower chance of relapse compared to NA.

Vaccines confer ACTIVE immunity, while directly giving a patient anti-bodies is known as passive immunity. There is no such thing as a hepatitis C vaccine.

Ribavirin requires two forms of contraception during treatment and 6 months after treatment. This is because Ribavirin can cause birth defects or death in an unborn baby. Therefore, it is crucial for both men and women who are taking Ribavirin to use two effective forms of contraception to prevent pregnancy during treatment and for 6 months after treatment to ensure the safety of the baby.

Because the patient is traveling to a high endemic area (South America) in less than 2 weeks, they would receive BOTH the vaccine and IgG. IgM is not an antibody that is administered to patients.

Phase 2 and 4 are the only two phases where liver damage is occurring. This is why treatment is given for both of these phases.

Note that the question asked about Anti-HBc, which is specific to hepatitis B. In hepatitis B, the patient would only develop IgG after acute infection phase is done. So a patient who has recovered from HBV will have IgG Anti-HBc, and also a patient who has advanced to chronic illness will also have IgG Anti-HBc.

The correct answer is 1, 4, 5, 6. This indicates that the genotype indications for Harvoni include genotypes 1, 4, 5, and 6. Genotype refers to the genetic makeup of an individual, specifically the combination of alleles for a particular gene. In the context of Harvoni, genotype indications refer to the specific genotypes of the hepatitis C virus that Harvoni is effective in treating.

Remember that IgM comes first and indicates current infection in hepatitis A. IgG would only come after a patient has recovered.

Most phase 1 patients do not need to treated. The exception is patients >30 years of age since they will very likely advance to phase 2 soon. Technically if a patient has elevated ALT, they are no longer in phase 1 (no liver damage) and are now in phase 2.

An ALT flare can be see with interferon, which actually signifies a better chance at efficacy.

NA's have significantly less ADRs compared to IFN.

There is no such thing as resistance to IFN. Several NA's have high rates of resistance, however entecavir and tenofovir have the lowest risk.

If you missed any, be sure to go back and review each phase and what they mean

If you missed any of these, be sure to go back and review all the Antigens and Antibodies for hepatitis B.

NA's are more effective at lowering HBV DNA and ALT (Bronze medal) than IFN.

The correct answer is 1, 4. This means that the genotype indications for Zepatier are indicated by the presence of genotypes 1 and 4.

Elbasvir and Grazoprevir do not require any adjustment with acid-reducing agents.

Mavyret should be taken with food because it contains a medication called glecaprevir, which is better absorbed when taken with a meal. Taking Mavyret with food helps to increase its effectiveness and ensures that the body can properly absorb the medication. This is why it is important to follow the instructions and take Mavyret with food.

Check ALT at week 4 of treatment; Prompt d/c of therapy recommended 10-fold increase in ALT at any time during treatment

IFN is contraindicated in severe cardiac disease since it can worsen ischemia. The patient had a very recent MI, so now would not be a good time to start IFN. While renal adjustments for CrCl

Interferon, entecavir, and tenofovir are all considered first line in hepatitis B management. Treatment choice depends on outcomes desired, patient preference, cost, ADR profile, etc.

Anti-histamines are the class of medications that will have minimal drug interactions with hepatitis C treatments. This is because anti-histamines primarily work on histamine receptors in the body and do not significantly interact with the liver enzymes that metabolize hepatitis C medications. On the other hand, anti-hypertensives, anti-convulsants, and anti-arrhythmics may have a higher likelihood of drug interactions with hepatitis C treatments due to their potential effects on liver enzymes or drug metabolism.

SVR is when there is undetectable viral load 12 weeks after the end of treatment.

Phase 3 has stopped replication (seroconversion of E antigen) and therefore stopped liver damage. These patients are still "sick" though, so there has not yet been seroconversion of S antigen.

Phase 2 looks very similar to Phase 1 on lab work, EXCEPT you will now see elevated ALT. Remember that phase 2 sees liver damage.

This is the "honeymoon" phase. So you are sick, replicating, but there is no liver damage.

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Phase 4 is the trickiest one. This is the variant of virus that no longer produces E antigen. But the virus is still very much there, replicating, and causing liver damage.

Not much here! This is the first and only phase where S Antigen is negative, which signifies functional cure. Notice that I did not give Anti-HBs as an option. That's because not everyone develops this antibody in phase 5, so Anti-HBs can be positive or negative in phase 5.

Phase 3 (remission) and phase 5 (functional cure) patients do not usually need to continue treatment. The exception is if they have already advanced to cirrhosis. In this case, these patients are still at risk for developing further complications of advanced liver disease. Plus, stopping a nucleoside analog can cause rebound hepatitis and the risk is worse in cirrhosis.

Glecaprevir/Pibrentasvir, Velpatasvir and Sofosbuvir, and Sofosbuvir/Velpatasvir/Voxilaprevir are all indicated in all six genotypes of hepatitis C infection. These medications are direct-acting antivirals (DAAs) that target specific proteins involved in the replication of the hepatitis C virus. By targeting multiple genotypes, these medications provide a broad spectrum of coverage and are effective in treating hepatitis C regardless of the specific genotype of the virus present in the patient.

All first line agents for hepatitis C cover genotypes 1 and 4.

Vosevi is the only drug that is used in re-treatment for hepatitis C infection. This means that if a patient has previously been treated for hepatitis C but the infection returns, Vosevi is the drug that can be used again to treat the infection. The other options, Harvoni, Epclusa, Mavyret, and Zepatier, are not specifically indicated for re-treatment of hepatitis C.

The question asks which medications are safe to use with birth control containing ethinyl estradiol. The correct answer options are Ledipasvir/sofosbuvir, Elbasvir and Grazoprevir, and Velpatasvir and Sofosbuvir. These medications do not interact with ethinyl estradiol and can be safely used together. However, Glecaprevir/Pibrentasvir and Sofosbuvir/Velpatasvir/Voxilaprevir may interact with ethinyl estradiol and are not safe to use together.

All of these tests should be done before treatment begins

Mavyret is glecaprevir and pibrentasvir. Remember that the "previr" drugs cannot be used in moderate to severe liver impairment.

Harvoni and Zepatier do not cover genotype 2. Mavyret should not be used due to its potential interaction with quetiapine, which is an anti-psychotic. Epclusa can be used safely with anti-psychotic. There are no drug interactions with metformin or thyroid hormone.