Testing
Treatment
Randos
Randos
Drug/Drug Interactions
100
What immunizations are recommended before treatment of hepatitis C?
Hepatitis B (3-shot series), Hepatitis A (2-shot series), PPSV23
(There is a combined Hep A and Hep B vaccine called Twinrix.)
100
Describe the typical course of Mavyret for treatment of Hepatitis C.
3 tablets, once daily, for 8 weeks.
100
Common exclusion criteria for Hepatitis C treatment:
- pregnancy
- decompensated liver disease
- co-morbid medical conditions that would interfere with completion of treatment
- severe end-organ disease not eligible for transplant
- indeterminate Hepatitis C genotype
- therapy durations outside of the FDA-approved regiment
- co-morbid life-limiting diagnoses such as malignancy not amenable to cure, HCC, severe cardiopulmonary disease
100
This DFMC resident was the first to negotiate a release from his Essentia non-compete clause so he could sign on as a merchant marine aboard the Paul R. Tregurtha during off weeks
After a long career as a hospitalist Dr. Palmquist entered his second career as the Duluth Lift Bridge Operator where he resides on Park Point with Angela and many many cats!
100
With glecaprevir/pibrentasvir (Mavyret) what medication related side effects (SE) can occur with concurrent statin therapy?
Co-administration of Mavyret and a statin should be monitored carefully with reduction or discontinuation of the statin based on the specific agent:
-DC recommended for atorvastatin, lovastatin and simvastatin
-Rosuvastatin at a max dose of 10 mg
-Pravastatin: reduce dose by 50%
200
What are common methods to evaluate for liver fibrosis?
Noninvasive methods frequently used to estimate liver disease severity include:
- Liver-directed physical exam (normal in most patients)
- Routine blood tests (eg, ALT, AST, albumin, bilirubin, international normalized ratio [INR], and CBC with platelet count)
- Serum fibrosis marker panels
- Transient elastography
- Liver imaging (eg, ultrasound or CT scan)
200
Can you treat genotype 3?
Yes; Mavyret is a pan-genotypic medication effective for genotypes 1 through 6.
200
List initial Hep C lab tests.
- Hep C RNA level within 1 of treatment initiation
- CBC
- Serum Creatinine
- TSH level
200
How much wood could John Wood chuck if John Wood could chuck wood?
Likely quite a bit.... as he was the only DFMC faculty to complete a 100 MILE race this calendar year!
200
What effect does Mavyret have on digoxin dosing and serum levels?
Measure a baseline digoxin level and reduce dose by 50% or adjust dosing schedule to approximate a 50% reduction
300
These two laboratory tests are generally required from an insurance standpoint.
Genotype; urine pregnancy test
300
Renowned author of 123 Homebirthing!
Who is Dr. Elaina
300
What medication is preferred for treatment-naive patients in Minnesota?
Bonus: in what room would you be most likely to find a faculty member enjoying their PB+J sandwich packed in an old bread bag?
Mavyret
(Treatment-experienced patients: Mavyret or Vosevi)
300
During orientation this agile resident leaped into wet concrete to avoid a motor vehicle vs. pedestrian trauma?
OT
300
This antibiotic, used in the treatment of TB, is contraindicated with Mavyret.
This second year resident shares a name with the Norse God of Thunder?
Rifampin
Lucas Thor Henningsen
400
What is the SVR 12 and why is it important?
Sustained Virologic Response at 12 weeks
(Defined as an undetectable HCV RNA level 12 weeks after completion of treatment, indicative of a cure.)
400
Referral or consultation with a specialist is recommended with which conditions or findings?
- Patient is treatment-experienced
- Patient has a liver transplant
- Patient has liver cancer
- Hepatitis B and/or HIV co-infection
- Severe liver disease
400
What does the FIB-4 index estimate?
FIB-4 estimates the amount of scarring in the liver.
400
This second year resident demonstrated the most robust Christmas spirit by hosting a Christmas tree in his residence for this many months?
400
This common herbal product can reduce the efficacy of Mavyret.
St. John’s Wort (Co-administration leads to reduced therapeutic effect of Mavyret.)
500
What is a fibroscan and where can you get one in Duluth?
A non-invasive ultrasound-based test that measures liver elastography. Fibroscan is available at the Essentia GI department. (Fibroscan is a proprietary technology.)
500
Name common tests used to define liver disease.
Fibroscan
Fib-4
APRI
MR elastography
Liver Biopsy
500
What does the APRI predict?
The likelihood of liver fibrosis
500
Name this park?
Chester Park or Golden Gate Park?
500
Co-administration of Mavyret and HIV antiviral agents is recommended: true or false?
false: co-administration can lead to varied serum levels of Mavyret.