3

A patient >40 years old is exposed to Hepatitis A and has never been vaccinated. What post-exposure prophylaxis is recommended?

Immune globulin 0.1 mL/kg

A patient with chronic liver disease is exposed to Hepatitis A. What prophylaxis is preferred?

Immune globulin

An HBV-positive mother delivers a baby weighing 1.9 kg. What should the infant receive?

HBV vaccine + HBIG

A premature infant weighing <2 kg is born to an HBV-negative mother. When should HBV vaccination occur?

At hospital discharge or age 1 month

A cirrhotic patient has undetectable HBV DNA after prolonged tenofovir therapy. Should treatment be discontinued?

No, continue indefinitely

Which HBV medication should be taken on an empty stomach?

Entecavir

Which HBV medication should be taken with food?

Tenofovir alafenamide

What is the goal of HCV treatment?

Sustained virologic response (SVR)

How is SVR defined?

Undetectable HCV RNA 12 weeks after completion of therapy

What type of virus causes HCV?

Positive-sense single-stranded RNA virus

What percentage of HCV infections progress to chronic infection?

Approximately 80%

How many HCV genotypes exist?

7 genotypes

What is the most common HCV genotype in the United States?

Genotype 1a

True or False: HCV has a proofreading polymerase.

False

True or False: Most patients with HCV are asymptomatic.

True

What is the initial screening test for HCV?

HCV antibody

If HCV antibody is positive, what confirmatory test should be performed?

HCV RNA

A patient has detectable HCV RNA but negative HCV antibodies. What does this suggest?

Acute HCV infection

A patient has positive HCV antibody and detectable HCV RNA. What does this indicate?

Current HCV infection

Which HCV medication is teratogenic?

Ribavirin

How long must contraception be used after ribavirin discontinuation?

6 months

True or False: Ribavirin is effective as monotherapy.

False

Which HCV regimens are safe in decompensated cirrhosis?

Sofosbuvir/Velpatasvir and Ledipasvir/Sofosbuvir

Why are many HCV regimens contraindicated in Child-Pugh B/C cirrhosis?

They contain protease inhibitors

Which HCV drug suffix indicates a protease inhibitor?

-previr

Which HCV regimen requires NS5A resistance testing before use?

Elbasvir/Grazoprevir

Which HCV regimen is NOT pan-genotypic?

Elbasvir/Grazoprevir

Which HCV regimen is NOT pan-genotypic?

Ledipasvir/Sofosbuvir

Which HCV regimens should be taken with food?

Glecaprevir/Pibrentasvir and Sofosbuvir/Velpatasvir/Voxilaprevir

Which HCV regimens require an acidic environment for absorption?

Ledipasvir/Sofosbuvir, Sofosbuvir/Velpatasvir, Sofosbuvir/Velpatasvir/Voxilaprevir

A patient has Child-Pugh Class C cirrhosis and HCV genotype 2. Preferred regimen?

Sofosbuvir/Velpatasvir + Ribavirin

A patient has metastatic liver cancer with less than 3 months to live and HCV. Should treatment be initiated?

No

Which population is especially susceptible to GERD?

Pregnant women

Name common GERD trigger foods.

Alcohol, chocolate, caffeine, citrus, tomatoes, spicy foods, fatty foods

What lifestyle modification has the greatest impact on GERD symptoms?

Weight loss

What GERD alarm symptom requires referral?

Dysphagia

What GERD alarm symptom requires referral?

GI bleeding

What is the mechanism of antacids?

Neutralize gastric acid

How quickly do antacids work?

Approximately 5 minutes

Can antacids heal GERD?

No

Which antacid ingredient commonly causes diarrhea?

Magnesium

Which antacid ingredient commonly causes constipation?

Calcium or aluminum

What is the mechanism of H2 receptor antagonists?

Competitive inhibition of H2 receptors on parietal cells

Which H2 blocker has the most drug interactions?

Cimetidine

What major limitation develops with H2 blockers during chronic use?

Tolerance (tachyphylaxis)

Do H2 blockers require renal adjustment?

Yes

What is the mechanism of PPIs?

Irreversible inhibition of H+/K+-ATPase

When should PPIs be administered?

30-60 minutes before breakfast

How long should initial OTC PPI therapy last?

14 days

Which PPI has the fewest drug interactions?

Lansoprazole

What are common PPI adverse effects?

Headache, diarrhea, constipation

What are the two most common causes of PUD?

H. pylori and NSAIDs

How does H. pylori survive in acidic environments?

Urease production

What are alarm symptoms of PUD?

Melena, hematemesis, anemia, weight loss

When does gastric ulcer pain typically occur?

Soon after meals

When does duodenal ulcer pain typically occur?

2-5 hours after meals or at night

Which H. pylori regimen is preferred in patients with penicillin allergy?

Bismuth quadruple therapy

Which H. pylori regimen contains bismuth, metronidazole, tetracycline, and a PPI?

Bismuth quadruple therapy

What test confirms H. pylori eradication?

Urea breath test

What is the mechanism of misoprostol?

EP3 receptor agonist

What are the two major adverse effects of misoprostol?

Diarrhea and uterine contractions

Why is misoprostol contraindicated in pregnancy?

Can induce abortion

What medication is a somatostatin analog used in GI disorders?

Octreotide

What is octreotide's mechanism?

Inhibits gastrin and histamine secretion

What are Rome IV criteria based on?

Recurrent abdominal pain associated with defecation or stool changes

Which diet is recommended for IBS?

Low-FODMAP diet

Which fruits are considered low-FODMAP?

Cantaloupe

Which medication is commonly used for IBS-related pain?

Amitriptyline

A patient with IBS-D drinks four alcoholic beverages daily. Which therapy is preferred?

Rifaximin

Why should eluxadoline be avoided in heavy alcohol users?

Increased risk of pancreatitis

What serious adverse effect is associated with alosetron?

Ischemic colitis/toxic megacolon

Linaclotide mechanism?

Guanylate cyclase-C agonist

Lubiprostone mechanism?

Chloride channel activator

Tegaserod mechanism?

5-HT4 partial agonist

Which IBS-C medication has the most contraindications and safety concerns?

Tegaserod

Histamine is synthesized from which amino acid?

Histidine

Which receptor subtype is responsible for gastric acid secretion?

H2 receptor

Which receptor subtype is targeted in allergy treatment?

H1 receptor

What activates proton pump inhibitors?

Acidic environment

Why are PPIs enteric coated?

Prevent degradation in stomach acid

How do PPIs inhibit the proton pump?

Irreversible covalent sulfide bond formation

Esomeprazole is which isomer of omeprazole?

S-isomer

Dexlansoprazole is which isomer of lansoprazole?

R-isomer

What GI drug is a prostaglandin analog?

Misoprostol

What receptor does misoprostol activate?

EP3 receptor

Lubiprostone is a synthetic analog of which endogenous mediator?

Prostaglandin

Linaclotide increases intracellular levels of what second messenger?

cGMP

Linaclotide activation ultimately increases secretion of which ion?

Chloride

HAV

MOA

is vacine ___

it ___ a treatment

it ___ be chronic

__transmitted

infection cause by hep A virus

preventable

no specfic

cannot

Fecal - Oral transmitted

HBV

MOA

it__ vacine

it ___ a treatment and ___ be emiated completly

it ___ be chronic

__transmitted

small envelped DNA virus ( 42nm Double dtear DNA viruse woth nuc;epcapscit cor)

Has a

has, cannot (treat in INK, PEG_INF)

can

blood and infected fluids

Antivirals HBV

HCV

MOA

it__ vacine

it ___ a treatment ___

it ___ be chronic

__transmitted

Positive-sense single starded RNAvisors

has no

has , goalSVR

can

blood

HCV intreatment

Cirrhosis

Signs/Symptoms

ESLD : CHild pugh Score

pathopysicolgly

well compensated = NOne , ELSD / decompensated = jaundic, asites , encephalopathy, variceal bleeding'.

Cirrhosiss leadns the HTN> relases vsoliraits >decrease bllod vol> activates RASS> NA and water rentention > asties

Variceal Hermorrhage

HVPG

prevention

signs

Treament

2nd prevention form rebleed

>12 mmhg

non seslectivve B blockers eg , propanol, nadolol, carvediol.

blood in vomit . weekness black stool (melena)

band ligation + ocetroide (lower portal pressue , stat immedialt 50mg IV LD and contnue for 72hrs) + antibiotic (reduce mortality , ceftriaxone 1gb IV for 5-7 dys)

NSSBB + blan

MOA: HTN = alt routs to systemic circulation = arge vairies = risk of bleed

AScites

signs

diagnosis

treatments

AE

increased abdominal girth, SOB, wgt gail

30-50 ml of fulid removed and checked

NOn pharm: retrict NA < 2g and fult to 1-1.5 L &tips

therapuetic : ablumin infusin (6-8 g L removed)

Pharm : diretics ex Sprionlactone 100mg max 400 (AE high K) , can take with Loop ex bumes . 40mg to 200 mg of sprionlactone to remove K

AE . volume depletion, hypotendion ,renal impairemnt

SPS

CAuse

Siginds

Diagnosis

treatment

prevention

bacterial overgrown

fever, abdominal pain. mental status change

PMN > 250

treat immediatly with Ceftriaxone @g IV Q24 × 5 days

Long term cipro or bactrim

HE

cuase

neurtoxin

treatment

prevention

reversal of slep shedule

Ammonia

Lactulose !st line: triate to effect of 2-3 stools /day (15-30ml) AE= dierraha

2nd line rifaimin

avoide benzodiazepines, zolpoidem, narcotics

Hepatorenal syndromore

cause

types

avoid

altered hemodynamics > splanchic and systemic vasodilation > aterial underfilling> poor renal absorbtion >acitivation of angiotension > vasoconstriction > decreased GFR

Hrs-CKD - SCr rise graduatlly, mange with na restriction , no diurectics, may need kidny trasplant

HRS AKi; SCr reises quickley , ocetrotide subQ q8H + midorinepo q8h or terliprssin

aviods NSAIDS snd bezos

Hep A

risk factos

Dignoisis markers

prevention