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Renal/Hepatic

Hepatitis & Liver Disease

TermDefinition
Comparison of Hepatitis Viruses A: acute, via fecal-oral route, has vaccine, supportive tx only B: acute & chronic, via blood/body fluids, has vaccine, 1st line tx is PEG-IFN or NRTI (tenofovir or entacavir) C: acute and chronic, via blood, no vaccine, DAA combo or DAA combo + RBV
Comparison of Hepatitis Viruses A: acute, via fecal-oral route, has vaccine, supportive tx only B: acute & chronic, via blood/body fluids, has vaccine, 1st line tx is PEG-IFN or NRTI (tenofovir or entacavir) C: acute and chronic, via blood, no vaccine, DAA combo or DAA combo + RBV
DAA Mechanisms and Regimens NS3/4A Protease inhibitors: end in -previr; "P for PI"; (glecaprevir) NS5A Replication Complex Inhibtors; end in -asvir; "A for NS5A";(pibrentasvir, velpatasvir) NS5B Polymerase Inhibitors: end in -buvir; "B for NS5B"; (sofosbuvir)
DAA Mechanisms and Regimens NS3/4A Protease inhibitors: end in -previr; "P for PI"; (glecaprevir) NS5A Replication Complex Inhibtors; end in -asvir; "A for NS5A";(pibrentasvir, velpatasvir) NS5B Polymerase Inhibitors: end in -buvir; "B for NS5B"; (sofosbuvir)
Recommended regimens for treatment-naive Glecaprevir/pibrentasvir (Mavyret) x 8 weeks Sofosbuvir/velpatasvir (Epclusa) x 12 weeks **BBW for HBV reactivation. Test all pts before initiation**
Recommended regimens for treatment-naive Glecaprevir/pibrentasvir (Mavyret) x 8 weeks Sofosbuvir/velpatasvir (Epclusa) x 12 weeks **BBW for HBV reactivation. Test all pts before initiation**
Mavyret counseling points Do not use with select statins (atorvastatin, lovastatin, simvastatin) Take with food
Mavyret counseling points Do not use with select statins (atorvastatin, lovastatin, simvastatin) Take with food
Epclusa counseling points Do not use with amiodarone for risk of bradycardia Antacids (separate by 4 hours), H2RAs(take at same time or separate by 12 hours), & PPIs (not recommended) can decrease concentrations Dispense in original container
Ribavirin Can be used in combination with DAA, but never monotherapy. BBWs for teratogenicity and hemolytic anemia
Drug Treatment for Hepatitis B TDF (Viread)- preferred; renal & bone tox > TAF TAF (Vemlidy) - preferred Entecavir (Baraclude) - preferred; take on empty stomach Lamivudine (Epivir) **BBWs for lactic acidosis & hepatomegaly w/ steatosis**
Interferon Alfa Pegylated form is approved as HBV monotherapy Has multiple toxicities (BBW for neuropsychiatric, autoimmune, ischemic, or infectious disorders) AE =
Ribavirin Can be used in combination with DAA, but never monotherapy. BBWs for teratogenicity and hemolytic anemia
Drug Treatment for Hepatitis B TDF (Viread)- preferred; renal & bone tox > TAF TAF (Vemlidy) - preferred Entecavir (Baraclude) - preferred; take on empty stomach Lamivudine (Epivir) **BBWs for lactic acidosis & hepatomegaly w/ steatosis**
Interferon Alfa Pegylated form is approved as HBV monotherapy Has multiple toxicities (BBW for neuropsychiatric, autoimmune, ischemic, or infectious disorders) AE = Myelosuppression, CNS effects, GI upset, LFT increase, flu-like symptoms
Most common causes of cirrhosis Hepatitis C and alcohol consumption
Clinical presentation of cirrhosis Yellowed skin and whites of the eyes (jaundice), darkened urine, light-colored stools
Objective Criteria for cirrhosis Increased ALT, AST, alkaline phosphatase, total bilirubin, LDH, PT, and INR. Decreased albumin
Key Drugs with BBW for Liver Damage Acetaminophen Amiodarone Isoniazid Ketoconazole MTX Nefazodone Nevirapine Propylthiouracil Valproic Acid Zidovudine
Treatment for Alcohol-associated liver disease 1. alcohol cessation 2. BZDs can control withdrawal 3. naltrexone, acamprosate, and disulfiram can prevent relapse 4. thiamine can prevent and treat Wernicke-Korsakoff syndrome
Complications of Liver Disease & Cirrhosis Portal HTN & Variceal bleeding: Octreotide, vasopressin, band ligation for Tx. Nadolol, propranolol, carvedilol for prevention. CTX or cipro to reduce infection risk HE: Lactulose, rifaximin can lower the amount of ammonia, also limit animal protein
Ascites Fluid accumulation within the peritoneal space. Restrict sodium intake to < 2g/day Diuretic therapy is spironolactone +/- furosemide at a 100:40 mg ratio Paracentesis can remove fluid and should be supplemented with albumin if > 5L removed
Spontaneous bacterial peritonitis Acute infection of the ascitic fluid Target streptococci and enteric gram negative CTX or an equivalent for 5-7 days Survivors should receive secondary prophylaxis with oral cipro or bactrim
Created by: skelly46
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