Terms in this set (26)
asymptomatic liver injury, active replication phase
Liver injury but before jaundice, anorexia, flu-like sxs, increase LFTs
Somethings wrong but not sure whats going on
mild liver/cellular damage (no jaundice)
Now have increased presentation
Stages of Acute Hepatitis Icteric
+ for jaundice with liver injury
They have change in the color of eyes
Severe hepatic necrosis, acute liver failure and this person is sick. They go in the ICU for liver transplant.
Self limiting recovery phase from hepatic necrosis. Dont recover from HBV and HCV bc its Cx.
1. Transmission: oral/fecal route, person to person, contaminated food/water. poor hygiene is a risk factor.
2. Primary cause of world-wide epidemics
3. International travel- pharmacist warns
4. Key- vaccination of children
5. Present important source of infection - person to person is HUGE
Pharmacist role is to recommend vaccination
1. percutaneous, mucosal exposure, blood/body fluids, IV drug use sexual contact, transplacents
Horizontal transmission (person to person)
2. Mom to Baby, horizontal exposure
3. Long term exposure, ie household contact
4. HBV and HCV infection increase risk for HIV
This is the only one along with HCV that will develop into chronic condition
HCV- RNA (know its RNA)
1. infected blood or blood products
2. must watch genotype to decide pharmacological tx
3. genotype 1- most virulent
4. 20% of pts get cirrhosis and need transplants
This is the only one along with HBV that will develop into chronic condition
No vaccine developed yet due to the many subtypes.
1. Superinfection it needs Hep B to be active
2. Requires HBV infection and leads to synergism
1. contaminated water, fecal oral route
3. high mortality in 3rd trimester for PG women (Globally it lethal)
4. undistinguishable from HAV
coninfection with other hepatic viruses (HCV)
This is very beneficial to the patient.
1. SVR- sustained virologic Response
a. Undetectable at end of treatment,
b. AND undetectable for at least 6 months post treatment
2. Prevent cirrhosis and hepatic failure
- 48 weeks (1 year)
1. monotherapy with lamivudine is successful in suppressing HBV replication and preventing progression of liver disease
2. Can use pegylated interferon alfa (PegIFN-a) with Ribavirin, not required
Pharmacologic Options for HBV
1. Lamivudine (HBV)- nucleoside analog is DOC for this Viral infxn.
a. Inhibits HBV polymerase (reverse transcriptase)
b. Mainly GI SEs
Other options have the same MOA
Adefovir (HBV)- nucleoside analog
Entacavir (HBV)- nucleoside analog
1. Dual therapy with pegylated interferon + ribavirin for 24-48 weeks (depends on the genotype)
genotype 1 is 48 weeks
Other viral genotypes not a virulent Tx min 24 weeks
PEG- polyethylene Glycols
First line for HCV
a. Creates shield around pegylated drug molecule preventing and was very good to Tx of HCV.
i. Renal clearance
ii. Enzymatic degredation
iii. Recognition by immune system
iv. Leads to longer circulating half-life
a. Family of proteins which have antiviral, antiproliferative properties
i. Inhibits cell growth and alters growth of viral particles
ii. Alter cell differentiation
iii. Increases phagocytic activity of macrophages
iv. Augments cytotoxicity of lymphocytes
a. MOA: inhibits replication of RNA an dDNA viruses
AEs for interferons and RBV
Reduce the dose before you stop the Tx
a. All have flu-like sxs , anorexia etc
b. Interferons you must monitor depression, RBV monitor, but depression not as severe
c. Interferons you must monitor TSH (you will burn it out)
d. RBV has teratogenicity (so preg tests need to be done)
e. RBV has alopecia, pruritis, rash
Prenancy test is required and 2 forms of protection
Will have to stop it... others the we will reduce the dose.
Later see if the patient can go back on them
severe psychiatric effects (profound) AEs, depression, suicide etc.
They will need to be on a SSRI and other options for depression
1. International travel before they travel get vaccinated
2. HCW- needle sticks
3. Transplant recipients need to be vaccinated before
5. Blood/blood products
6. Multiple sex partners
7. IV drug use
Recommend vaccinations if they travel abroad
HIV is not as..... as HBV and HCV. All it takes is one needle stick and you will get these viral infxns.
These patients need to sign a consent form to acknowledge this Tx is not a cure.
50% of the time this is not going to work.
We will treat SE and AD rxns to keep the patients on these medications. Only a 50% success rate. We can lower the dose before we take them off the regimen.