Which of the following natural products is used for liver disease?

Milk thistle

Sometimes used by patients with liver disease. Efficacy data is limited, but it does not appear to be harmful.

Which of the following is a formulation of tenofovir?

Viread is a brand name for tenofovir disoproxil fumarate.

Which medication has a warning for serious symptomatic bradycardia if used in combination with amiodarone?

Epclusa

Which of the following drugs is correctly matched with the hepatitis virus that it treats?

Epclusa-HCV

A patient complains of abdominal pain, nausea, itching, dark urine and yellow eyes/skin. Which of the following tests can help evaluate the underlying cause?

Patients with liver disease can present jaundiced due to elevated total bilirubin.

Which of the following is used to assess the severity of liver disease?

The Child-Pugh Classification

SH is beginning therapy with Pegasys (pegylated interferon-alfa-2a). The pharmacist will counsel him on possible side effects from Pegasys therapy. He should receive counseling on which of the following side effects? (Select ALL that apply.)

Depression

Flu-like syndrome

Fatigue

Liver damage

The pharmacist is counseling a patient who is starting HCV treatment with Mavyret. Which of the following would be an appropriate counseling point?

Take this medication with food

JH has cirrhosis and comes to the pharmacy to ask about pain medication for his headache. Which of the following should be avoided due to the risk of decompensation?

Motrin

Which of the following is the first-line treatment for spontaneous bacterial peritonitis?

Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid. Primary treatment is with ceftriaxone.

Which patients are at risk of contracting hepatitis B? (Select ALL that apply.)

An unvaccinated healthcare professional

A hemodialysis patient

A person getting a tattoo or body piercing

SC, a 33-year-old female, hands the pharmacist a prescription for ribavirin. She states this is a new prescription for her hepatitis C infection. She is not currently taking any other medications for hepatitis C. The following information is available from the clinic records:

Weight: 145 poundsAlbumin (g/dL) = 4.2 (3.5–5)Potassium (mEq/L) = 5.1 (3.5–5)BUN (mg/dL) = 23 (7–20)SCr (mg/dL) = 1.3 (0.7–1.3)AST (IU/L) = 83 (10–40)ALT (IU/L) = 75 (10–40)Bilirubin (mg/dL) = 0.7 (0.1–1.2)INR = 1.1
Question:The pharmacist should not fill the prescription. What should the pharmacist discuss with the prescriber?

Ribavirin monotherapy is not effective

Which of the following drug classes is used to treat ascites due to portal hypertension?

Aldosterone antagonist

Which of the following antiviral medications would be expected to have a drug-drug interaction with pantoprazole? (Select ALL that apply.)

Epclusa

Sofosbuvir/velpatasvir/voxilaprevir

In a patient unable to tolerate lactulose for the prevention of hepatic encephalopathy, which of the following would be the best recommendation?

Start rifaximin

History of Present Illness:HF is a 31-year-old Caucasian male transferred to the hospital from a nearby jail with poorly healing cellulitis on his left lower extremity that has not responded to treatment.
Labs:
WBC (cells/mm³) = 13.6 (4 – 11 x 10³)
Hgb (g/dL) = 15 (male: 13.5 – 18, female: 12 – 16)
Hct (%) = 44.2 (male: 38 – 50, female: 36 – 46)
Plt (cells/mm³) = 182 (150 – 450 x 10³)
AST (IU/L) = 37 (10 – 40)
ALT (IU/L) = 32 (10 – 40)
Albumin (g/dL) = 4.1 (3.5 – 5)
Anti-HCV = positive
HCV RNA PCR = positive
Wound Culture:
Many WBC, moderate RBC, many Gram-positive cocci resembling S. aureus.

Liver Biopsy:
Changes consistent with chronic HCV infection. No cirrhosis.

Plan:
Discontinue Keflex and consult infectious disease pharmacist for an oral antibiotic to cover community-acquired MRSA.

Sofosbuvir + velpatasvir

**case above**

Which of the following tests must be performed prior to starting treatment for hepatitis C?

Hepatitis B surface antigen (HBsAG) and core antibody (anti-HBc)

Which of the following should be recommended for SB's abdominal distention?

Add spironolactone 100 mg daily

Which of SB's medications is correctly matched with its indication?

Nadol- secondary prevention of variceal bleeding

What is the most likely explanation for SB's INR result?

Production of clotting factors is impaired

Which medication is most likely contributing to SB's complaint of diarrhea?

Lactulose

What is the primary reason SB takes nadolol?

prevention of variceal bleeding

Which of the following medications have a boxed warning for liver damage? (Select ALL that apply.)

Tylenol

Isoniazid

Depakote

Nefazodone

A pharmacist receives an Epivir prescription for a 32-year-old female whose past medical history includes iron deficiency anemia, hypothyroidism and hepatitis B. The pharmacist should contact the prescriber to discuss which of the following?

The appropriate Epivir formulation for the patient

The prescription requires clarification with the prescriber as lamivudine has two brand names (i.e., Epivir and Epivir HBV) that have different doses. These brands are not interchangeable. Epivir is the formulation that is approved for the treatment of HIV. This patient needs to be prescribed Epivir HBV to treat her hepatitis B.

Which of YB's lab abnormalities indicate chronic liver disease and reduced synthetic function of the liver?

Hypoalbuminemia and increased INR

Albumin and clotting factors are produced by the liver, thus low albumin and increased PT/INR are indicators of the reduced synthetic ability of the liver. This is often seen in chronic liver disease that has progressed to cirrhosis.

Several days later, YB's variceal bleed has been controlled. Her renal function is much improved, and her other labs are stable. She is noted to have ascites. In addition to sodium restriction, which of the following is an appropriate recommendation for treating her ascites?

Furosemide 40 mg + spironolactone 100 mg daily

Spironolactone + furosemide in a 100:40 ratio is recommended when diuretics are needed to manage ascites. The doses can be titrated, but this ratio should be maintained.

The pharmacist received a new order for "Lactulose 30 mL PO Q6H. Titrate to 2-4 soft bowel movements per day." Which of the following best describes the expected effect on YB's labs?

Ammonia should decrease

Elevated serum ammonia (and other waste) is thought to be the cause of hepatic encephalopathy symptoms. Lactulose is expected to lower the serum ammonia level and improve symptoms.

Several days later, YB's acute variceal bleed has been controlled. Her renal function is much improved, and her other labs are stable. Her BP is 145/83, and HR is 83. Which of the following recommendations would reduce her risk of having another variceal bleed?

Start propranolol and titrate to a HR 55- 60 BPM

Which of the following is used to prevent and treat Wernicke-Korsakoff syndrome?

Vitamin B1

Which of the following is correct regarding the treatment of HCV?

Preferred regimens include at least 2 drugs with different mechanisms of action

DW has a history of alcohol abuse and cirrhosis secondary to alcohol. Which of the following could be considered to prevent alcohol relapse? (Select ALL that apply.)

Acamprosate, disulfiram, naltrexone

What is the mechanism of action for lactulose in treating hepatic encephalopathy?

Converts ammonia to ammonium which cannot diffuse back into the blood

Which of the following is correct regarding the need to test for HIV before starting HBV therapy? (Select ALL that apply.)

Antivirals used for HBV can have activity againist HIV

HIV resistance can occur if HIV is unrecognized

HIV and HBV share similar routes of transmission

Interferons are known to cause or aggravate which of the following? (Select ALL that apply.)

Parkinson disease

Autoimmune disorders

Psychiatric symptoms

Ischemic disease

Infections

DL's physician plans to begin treatment for hepatitis. Which medication/s should be avoided in combination with DL's acid-suppressive therapy? (Select ALL that apply.)

Epclusa

Harvoni