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IOS 11 Exam 2
HAV, HBV, HCV
| Question | Answer |
|---|---|
| HAV is transmited, ?envelope, ? neucleic material | Oral-fecal route, does not have an envelope, and is ssRNA |
| HBV is transmited, ?envelope, ? neucleic material | Percutaneous or permucosal transfer, contains envelope, is partial dsDNA |
| HCV is transmited, ?envelope, ? neucleic material | Percutaneous or permucosal transfer, does have an envelope, and is ssRNA |
| HAV infection cycle is | Incubation 2weeks, acute phase 5weeks, Convalescence 5 weeks |
| HAV family | Picornaviridae 1 serotype and many subtypes |
| HAV infection and replication | Acid resistant , replicates in lower GI, transplorted to the liver and it replicates in the hepatocytes and shed into bilary tree and excreted in feces |
| Symptoms of HAV | Fever, maliase, anorexia, nausea, dark urine, pale stools and jaundise > 6 years old |
| Labs to monitor in HAV | Serium IgM and antiHAV which peaks during convalescence (7week) |
| HAV patients are infectious for the first | 5 weeks |
| Treatment of HAV | Supportive care, IMIG |
| Prevention of HAV | Hygine, sanitation (clean water source), HAV vaccine- Mono-(Havrix, Vaqta) and duel A&B (Twinrix) |
| Side effects of the HAV vaccine | Soreness,HA, maliase |
| Indications for HAV vaccination | Traveling to a high or intermediated risk area, MSM, IVDA, HAV lab workers, Clotting factor disorders, chronic liver disease, Children |
| IVIG and IMIG are | 85% effective when used within 2 weeks of exposure, use thimerosal free product fro pregnant and children- ONLY IMIG can be used as PREVENTION |
| PRe-exposure or prevention used of IMIG | International travel>3 months 0.02ml/kg IM |
| Post exposure IMIG or IVIG indications | Close personal contact with (+) person, documentateed daycare outbreak, foodhandler has HAV, schoold, hospitals |
| Post exposure dose of IMIG | 0.02ml/kg can give vaccination together but wait 3-5 months to give live vaccines- varicella or MMR |
| HBV family is | Hepadnaviridaw it is a partial dsDNA, that has multiple serotypes and genotypes A-G |
| HBV is the leading cause of | Hepatocellular carcinoma and it is 50-100 times more infectious that HIV |
| HBV is transmitted via | percutaneous or permucosal- Perinatal (sexual, IVDA, horzontal) |
| HBV lifecycle | Incubation 60-90days, Acute phase <6 months, Chronic phase considered years |
| HBV clinical features | Jaundice if >5, chronic infection worse prognosis if young |
| Risk factors for HBV | IVDA, transfusion, occupational exposure,perinatal (mucosal), sexual |
| Routes of transmission of HBV | High perinetal (china), |
| Serological course of infection | HBsAg (surface antigen), HbeAg(acute and chronic)- surface antigen, anti-Hbc-antibody to surface antigen (vaccine responder), AntiHBe- Antibody to surface antigen indicated cured infection, ANtiHBC IgG- Acute and chronic, AntiHbcIgM-acute infection, HBV D |
| Diagnosis of HBV | Screen for HBsAg, anti-HBc IgG and IgM, and anti-HBs if positive do PCR |
| If have HBsAg for >6 months patient is | Chronic |
| Goals of HBV treatment | Seroconversion from antigen to antibody, suppression of viral replication, histological/biological improvement |
| Treat patient if | HBeg (+), HBV DNA (+) and >10x6 or HBE( - ) but (+) HBV DNA 10x4 |
| Anti-HBV medication | Peg-interferon or Nucleoside analogues (purines- Adefovir or Entecavir or Pyrimidines-Lamivudine or Telbivudine |
| HBV treatment with PEG-INF | Activates cellular ribonucleases (degrade viral mRNA) Increase HLA class 1 expression to increase cytotoxic T-cells, macrophages, and NK cells |
| Side effects of PEG-INF | Flu-like symptoms, incomnia, depression, rash, pruitis, anorexia, neutropenia, thrombocytopenia, hair thinning, thyroid dysfunction |
| PEG-INF dosing for HBV | Pegsys-180mcg /week SQx 48 weeks (renal & hepatic excretion) and PEG-Intron 1.5mcg/kg SQ x 48 weeks (renal & reconstitution required) |
| HBV oral Purines MOA | Intracelluar phosphorylation by hose enzymes, and further phosphorylation to compete with endogenous bases and take up by viral reverse transcriptase and incorporated into DNA- chain termination due to lack of 3'hydroxyl- stop syn of viral reverse transcr |
| HBV treatment with Adefovir | It is a NUCLEOTIDE (Monophosphorylation)that competes with adenosine (renal excretion-low resistance) |
| HBV treatment with Entecavir | It is a Guanosine nucloside inhibitor- Used in resistance lamivudine patients-Metabolism is via glucoronidation & sulfation, Renal excretion |
| HBV treatment with Lamivudine (3TC) | It is a Cytodine nucleoside analogue that have HIV activity- Renal elimination, but High resistance that occurs in annual steps |
| HBV treatment with Telbivudine | This is a nucleoside anolgue that is renally excreted,pregnancy B (new drug) |
| Treatment of HBV patients with Nucelosides | Should go on until 6-12 months after patient is AntiHBe (-) or patient has cirrhosis -HBV (-) and loss of HBe Ag |
| Hepatocellular carcinoma treatment | Hepatic resection, radio frequency ablation, chemoembolizatio, liver transplant (>90% 2 year survival) |
Created by:
liza001
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