Liver Disease Staging Options Quiz

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Questions and Answers

Which professional works primarily with patients with viral hepatitis, HIV, those on HIV PrEP, and those with other complex infections?

Ambulatory Care Residency Graduate

Infectious Disease Specialist

Community Residency Graduate

Clinical Pharmacy Specialist (correct)

What type of residency training did the person who graduated from University of Health Sciences and Pharmacy ('18) complete?

PGY-2 Community Residency

PGY-1 Community Residency

PGY-2 Ambulatory Care Residency (correct)

PGY-1 Ambulatory Care Residency

Where can one find the Hepatitis C Treatment Guidelines resource?

<a href="https://www.hep-druginteractions.org/">https://www.hep-druginteractions.org/</a>

<a href="https://www.hcvguidelines.org/">https://www.hcvguidelines.org/</a> (correct)

<a href="https://www.infectiousdiseasepharmacyresources.com/hepatitis-c-treatment-guidelines">https://www.infectiousdiseasepharmacyresources.com/hepatitis-c-treatment-guidelines</a>

<a href="https://www.vumc.org/hepatitis-c-treatment-guidelines">https://www.vumc.org/hepatitis-c-treatment-guidelines</a>

What is the primary focus of the University of Liverpool Drug Interaction Database?

Drug Interactions with Direct-Acting Antivirals Signup and view all the answers

Which individual listed has no disclosures or acknowledgements?

Ana Muscarella, PharmD, BCACP Signup and view all the answers

What is the main focus area within the Infectious Diseases Clinic at VUMC where Dr. Muscarella works?

Viral Hepatitis and HIV Patient Care Signup and view all the answers

What is the recommended action for individuals with risk factors such as being sexually active, having tattoos, or using illicit drugs?

Get screened for HCV Signup and view all the answers

Which test is used to diagnose active HCV infection?

HCV RNA test Signup and view all the answers

What is the primary consideration in choosing the treatment for HCV?

Severity of fibrosis Signup and view all the answers

What are the common long-term complications associated with HCV?

Cirrhosis and liver cancer Signup and view all the answers

Which scores are used to assess liver dysfunction and predict prognosis in patients with HCV?

CTP score and MELD score Signup and view all the answers

What is an important consideration in the evaluation and treatment of HCV?

Fibrosis status assessment Signup and view all the answers

What is a common cause of cirrhosis?

Hepatitis C Signup and view all the answers

What does decompensated cirrhosis refer to?

Liver disease unable to carry out its functions Signup and view all the answers

What is a primary factor in hepatitis C treatment selection?

Patient's genotype Signup and view all the answers

What tests need to be completed before initiating antiviral therapy for hepatitis C?

Calculation of FIB4 and CTP scores Signup and view all the answers

How long does the treatment duration typically last for hepatitis C?

8-12 weeks Signup and view all the answers

What are the targets for hepatitis C drug therapy?

NS3/4 protease, NS5A, and NS5B Signup and view all the answers

What is one of the leading causes of hepatitis C transmission?

Injection drug use Signup and view all the answers

Which organization reported on Medicaid prescribing restrictions in their 2023 National Progress Report?

National Viral Hepatitis Roundtable Signup and view all the answers

What can treating hepatitis C help to reduce?

HCC and ESLD Signup and view all the answers

Which of the following activities or exposures is considered a risk factor for HCV infection?

Injection drug use Signup and view all the answers

Who provides helpful course modules and overviews of all hepatitis C medications?

The University of Washington Signup and view all the answers

What is the recommended testing approach for individuals at risk of HCV infection according to the AASLD/IDSA Hepatitis C Treatment Guidelines?

Periodic testing for individuals with risk factors Signup and view all the answers

What are the secondary factors in HCV treatment selection?

Side effect profile, drug-drug interactions, pharmacodynamics, and metabolism Signup and view all the answers

Which side effects are commonly associated with DAAs (Direct-acting antivirals)?

Fatigue, headache, and GI upset Signup and view all the answers

Which HCV genotypes have recommended regimens including glecaprevir/pibrentasvir (G/P)?

Genotypes 1a, 1b, and 3 Signup and view all the answers

Which regimen must be taken with food?

Glecaprevir/pibrentasvir (G/P) Signup and view all the answers

What is the recommended treatment duration for genotype 4 with cirrhosis?

8 weeks for G/P and 12 weeks for SOF/VEL Signup and view all the answers

For which patient types is resistance testing recommended?

For Zepatier™ (elbasvir/grazoprevir) and Epclusa™ (velpatasvir/sofosbuvir) Signup and view all the answers

Which formulation is available for ribavirin?

200 mg tablets or capsules Signup and view all the answers

What is the starting weight-based dosing for ribavirin?

$600$ mg Signup and view all the answers

What is a contraindication for ribavirin?

Pregnancy Signup and view all the answers

Which treatment option is suitable for ribavirin-eligible patients with genotypes 1-6?

Sofosbuvir/velpatasvir + ribavirin for 12 weeks Signup and view all the answers

In which special population is treatment not recommended at this time?

HIV co-infection Signup and view all the answers

What should be evaluated prior to starting treatment?

Potential drug-drug interactions Signup and view all the answers

Which medication class requires caution and management based on drug classes and individual circumstances when used in combination with DAAs?

Pain medications Signup and view all the answers

"Treating decompensated cirrhosis: Protease inhibitors are contraindicated." What should be done for patients with CTP Class B or C and/or MELD >10?

$1000$ mg ribavirin treatment decisions should be made in collaboration with experts at liver transplant centers. Signup and view all the answers

Study Notes

Ribavirin is not suitable for monotherapy and must be used in combination with other Direct-Acting Antivirals (DAAs).
The formulation is available as 200 mg tablets or capsules, with weight-based dosing starting at 600 mg and potentially increasing to 1200 mg. Dose reductions may be needed for renal impairment.
Ribavirin must be taken with food and is contraindicated in pregnancy, with patients required to have negative pregnancy tests prior to therapy and use contraception.
Frequent monitoring is necessary due to hemolytic anemia risk and gastrointestinal side effects.
Treatment options include ledipasvir/sofosbuvir + ribavirin for 12 weeks or sofosbuvir/velpatasvir + ribavirin for 12 weeks for ribavirin-eligible patients with genotypes 1-6.
For ribavirin-ineligible patients with genotypes 1-6, ledipasvir/sofosbuvir can be used for 24 weeks or sofosbuvir/velpatasvir for 24 weeks.
Treating decompensated cirrhosis: Protease inhibitors are contraindicated. Treatment decisions should be made in collaboration with experts at liver transplant centers for patients with CTP Class B or C and/or MELD >10.
Special populations include chronic kidney disease (no dose adjustment needed with DAAs), HIV co-infection (treatment not recommended at this time), and children (testing requirements after birth if born to HCV+ mother, medications approved for age >3 if treatment required).
Hepatitis C and incomplete adherence: Adherence is crucial. Missed doses should be addressed with the patient, and treatment may need to be re-initiated.
Prior to starting treatment, potential drug-drug interactions should be evaluated by consulting prescribing information and other resources.
Drug-drug interactions: Certain medications (antacids, H2RAs, PPIs, ART regimens containing protease inhibitors, cobicistat, ritonavir, amiodarone/dronedarone, anticonvulsants, statins, oral anticoagulants, and hormone therapies) require caution and management based on drug classes and individual circumstances.
Green flag medication classes: Certain medications (pain medications, benzodiazepines, diabetes medications, SSRIs, SNRIs, mirtazapine, MAT, antibiotics used for STIs, uncomplicated URIs, or SSTIs) are generally safe to use in combination with DAAs.
Ledipasvir/sofosbuvir, sofosbuvir/velpatasvir, and glecaprevir/pibrentasir interact with PPIs, H2RAs, and antacids, with doses equivalent to pantoprazole 40 mg daily.

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Description

Test your knowledge on accepted options for staging liver disease. Also, understand the concept of cirrhosis and its formation due to long-term liver injury.