The management of viral hepatitis has undergone a dramatic transformation, marking one of the most significant public health achievements in recent decades. The development of Direct-Acting Antivirals (DAAs) has turned Hepatitis C from a chronic, progressive illness into a curable condition. As a pharmacist, navigating the complexities of these treatment regimens is a critical skill. The PharmD curriculum, particularly in the Patient Care 4 course, provides a dedicated module on the “Management of Viral Hepatitis,” covering everything from the virology and pharmacology of these agents to their clinical application. This quiz will test your knowledge on the goals of therapy, drug selection, and key monitoring parameters for Hepatitis A, B, and C.
1. What is the primary goal of treating a patient with chronic Hepatitis C infection with Direct-Acting Antivirals (DAAs)?
- a. To achieve a lifelong suppression of the virus.
- b. To achieve a Sustained Virologic Response (SVR), which is considered a cure.
- c. To reduce liver enzymes to 50% of baseline.
- d. To prevent transmission only.
Answer: b. To achieve a Sustained Virologic Response (SVR), which is considered a cure.
2. Which of the following hepatitis viruses is transmitted via the fecal-oral route and does not cause chronic disease?
- a. Hepatitis B Virus (HBV)
- b. Hepatitis C Virus (HCV)
- c. Hepatitis D Virus (HDV)
- d. Hepatitis A Virus (HAV)
Answer: d. Hepatitis A Virus (HAV)
3. The primary goal of therapy for chronic Hepatitis B (HBV) is:
- a. Complete eradication of the virus from the body (cure).
- b. A 12-week course of treatment leading to SVR.
- c. Long-term suppression of HBV DNA to undetectable levels to prevent cirrhosis and cancer.
- d. Normalization of AST and ALT only.
Answer: c. Long-term suppression of HBV DNA to undetectable levels to prevent cirrhosis and cancer.
4. A patient is prescribed sofosbuvir/velpatasvir (Epclusa). This combination represents which two DAA classes?
- a. An NS3/4A Protease Inhibitor and an NS5A Inhibitor
- b. An NS5B Polymerase Inhibitor and an NS5A Inhibitor
- c. Two different NS5B Polymerase Inhibitors
- d. An NS3/4A Protease Inhibitor and an NS5B Polymerase Inhibitor
Answer: b. An NS5B Polymerase Inhibitor and an NS5A Inhibitor
5. Entecavir and tenofovir are first-line agents for chronic HBV. What is their mechanism of action?
- a. They are Direct-Acting Antivirals that inhibit the NS5A complex.
- b. They are Nucleos(t)ide Reverse Transcriptase Inhibitors (NRTIs) that inhibit HBV DNA polymerase.
- c. They are immunomodulators that boost the host’s response to the virus.
- d. They are protease inhibitors that prevent viral assembly.
Answer: b. They are Nucleos(t)ide Reverse Transcriptase Inhibitors (NRTIs) that inhibit HBV DNA polymerase.
6. The “Management of Viral Hepatitis” is a specific learning module in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5784C Patient Care 4
7. A patient taking ledipasvir/sofosbuvir (Harvoni) should be counseled to avoid or separate their dose from which class of medications due to a pH-dependent absorption interaction?
- a. Statins
- b. Beta-blockers
- c. Acid-suppressing agents like proton pump inhibitors (PPIs)
- d. Metformin
Answer: c. Acid-suppressing agents like proton pump inhibitors (PPIs)
8. SVR12 is defined as:
- a. The patient feeling better 12 weeks into therapy.
- b. A 12-log reduction in viral load.
- c. Undetectable HCV RNA at 12 weeks after completing therapy.
- d. The need to treat 12 patients to achieve one cure.
Answer: c. Undetectable HCV RNA at 12 weeks after completing therapy.
9. A patient with chronic Hepatitis C should be screened and vaccinated (if not immune) for which other hepatitis viruses?
- a. Hepatitis D and E
- b. Only the virus they are infected with
- c. Hepatitis A and B
- d. No other vaccinations are needed.
Answer: c. Hepatitis A and B
10. What is a key counseling point for a patient stopping tenofovir or entecavir for Hepatitis B?
- a. The medication can be stopped at any time without consequence.
- b. There is a risk of a severe, acute exacerbation of HBV upon discontinuation.
- c. The patient is considered cured after stopping.
- d. They should double the dose for one week before stopping.
Answer: b. There is a risk of a severe, acute exacerbation of HBV upon discontinuation.
11. The pharmacology of hepatitis antivirals is a specific topic within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
12. A “pan-genotypic” regimen for Hepatitis C is advantageous because:
- a. It is effective against all major HCV genotypes, often eliminating the need for pre-treatment genotyping.
- b. It has a shorter duration of therapy than other regimens.
- c. It has no drug interactions.
- d. It is significantly cheaper.
Answer: a. It is effective against all major HCV genotypes, often eliminating the need for pre-treatment genotyping.
13. A patient with decompensated cirrhosis (Child-Pugh B or C) should generally avoid which class of HCV DAAs due to risk of hepatic toxicity?
- a. NS5A Inhibitors (-asvir)
- b. NS5B Polymerase Inhibitors (-buvir)
- c. NS3/4A Protease Inhibitors (-previr)
- d. All DAAs are safe in decompensated cirrhosis.
Answer: c. NS3/4A Protease Inhibitors (-previr)
14. Before initiating DAA therapy for HCV, the FDA recommends screening for what other virus due to a risk of reactivation?
- a. Human Immunodeficiency Virus (HIV)
- b. Hepatitis B Virus (HBV)
- c. Cytomegalovirus (CMV)
- d. Epstein-Barr Virus (EBV)
Answer: b. Hepatitis B Virus (HBV)
15. Ribavirin, an older antiviral, causes what significant hematologic side effect?
- a. Thrombocytopenia
- b. Leukopenia
- c. Hemolytic anemia
- d. Aplastic anemia
Answer: c. Hemolytic anemia
16. Which of the following is an example of a pan-genotypic DAA regimen?
- a. Ledipasvir/sofosbuvir
- b. Elbasvir/grazoprevir
- c. Glecaprevir/pibrentasvir
- d. Paritaprevir/ritonavir/ombitasvir
Answer: c. Glecaprevir/pibrentasvir
17. The virology of Hepatitis A, B, and C is a topic in the Patient Care 2 curriculum.
- a. True
- b. False
Answer: a. True
18. Co-administration of amiodarone with sofosbuvir-containing regimens can cause:
- a. Severe tachycardia
- b. Severe symptomatic bradycardia
- c. Acute kidney injury
- d. A hypertensive crisis
Answer: b. Severe symptomatic bradycardia
19. Which hepatitis virus is a DNA virus?
- a. Hepatitis A
- b. Hepatitis B
- c. Hepatitis C
- d. Hepatitis E
Answer: b. Hepatitis B
20. Tenofovir alafenamide (TAF) is a prodrug of tenofovir that offers what advantage over the older tenofovir disoproxil fumarate (TDF)?
- a. It is dosed twice daily.
- b. It has a higher potency against HCV.
- c. It achieves higher intracellular concentrations with lower plasma levels, leading to less renal and bone toxicity.
- d. It does not require dose adjustments for renal impairment.
Answer: c. It achieves higher intracellular concentrations with lower plasma levels, leading to less renal and bone toxicity.
21. The most important factor for achieving SVR with DAA therapy is:
- a. The patient’s age.
- b. The patient’s adherence to the regimen.
- c. The time of day the medication is taken.
- d. The brand of the medication.
Answer: b. The patient’s adherence to the regimen.
22. Which hepatitis virus can only cause infection in patients who are already infected with Hepatitis B?
- a. Hepatitis A
- b. Hepatitis C
- c. Hepatitis D
- d. Hepatitis E
Answer: c. Hepatitis D
23. The pharmacist’s role in managing viral hepatitis includes:
- a. Screening for and managing complex drug-drug interactions.
- b. Providing adherence counseling.
- c. Assisting with the prior authorization process.
- d. All of the above.
Answer: d. All of the above.
24. The management of viral hepatitis is an active learning session in the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
25. A patient on a DAA regimen containing a protease inhibitor should be advised to avoid co-administration with which medication?
- a. Metformin
- b. Lisinopril
- c. Strong CYP3A4 inducers like rifampin.
- d. Acetaminophen
Answer: c. Strong CYP3A4 inducers like rifampin.
26. Management of an acute Hepatitis A infection primarily involves:
- a. A 12-week course of DAAs.
- b. Supportive care.
- c. A 1-year course of NRTIs.
- d. Interferon injections.
Answer: b. Supportive care.
27. What is a key counseling point for a woman of childbearing potential being treated with a ribavirin-containing regimen?
- a. The medication can be used safely during pregnancy.
- b. The medication is a potent teratogen, and strict contraception must be used by both male and female patients during and for 6 months after therapy.
- c. Ribavirin enhances fertility.
- d. The medication only affects male fertility.
Answer: b. The medication is a potent teratogen, and strict contraception must be used by both male and female patients during and for 6 months after therapy.
28. What is the main route of transmission for Hepatitis B and C?
- a. Fecal-oral
- b. Contaminated water
- c. Respiratory droplets
- d. Parenteral (blood-borne)
Answer: d. Parenteral (blood-borne)
29. The suffix “-asvir” indicates a DAA that inhibits which viral protein?
- a. NS3/4A Protease
- b. NS5A Replication Complex
- c. NS5B Polymerase
- d. Helicase
Answer: b. NS5A Replication Complex
30. A patient successfully cured of Hepatitis C is still at risk for what long-term complication if they had pre-existing cirrhosis?
- a. Reinfection with the same genotype.
- b. Hepatitis B infection.
- c. Hepatocellular carcinoma (HCC).
- d. Acute pancreatitis.
Answer: c. Hepatocellular carcinoma (HCC).
31. Which of the following is NOT a Direct-Acting Antiviral for Hepatitis C?
- a. Sofosbuvir
- b. Ledipasvir
- c. Entecavir
- d. Glecaprevir
Answer: c. Entecavir
32. The older therapy, interferon-alfa, worked by:
- a. Directly inhibiting viral replication.
- b. Modulating the host’s immune system to fight the virus.
- c. Blocking viral entry.
- d. Inhibiting the viral protease.
Answer: b. Modulating the host’s immune system to fight the virus.
33. For a treatment-naive, non-cirrhotic patient, the typical duration of therapy with a modern pan-genotypic DAA regimen is:
- a. 4 weeks
- b. 8-12 weeks
- c. 24 weeks
- d. 48 weeks
Answer: b. 8-12 weeks
34. The main reason for the high cost of DAA therapies is:
- a. The complexity of the tablet manufacturing process.
- b. The cost of the raw chemical ingredients.
- c. The high cost of research and development for a curative therapy.
- d. The cost of the plastic bottle it comes in.
Answer: c. The high cost of research and development for a curative therapy.
35. A patient taking tenofovir disoproxil fumarate (TDF) should be monitored for:
- a. Hepatotoxicity
- b. Nephrotoxicity and decreased bone mineral density
- c. Severe rash
- d. Hyperkalemia
Answer: b. Nephrotoxicity and decreased bone mineral density
36. A patient is taking Harvoni (ledipasvir/sofosbuvir) and complains of heartburn. What is the most appropriate OTC recommendation?
- a. Omeprazole 20 mg twice daily.
- b. Famotidine 20 mg twice daily, taken at the same time as Harvoni.
- c. Calcium carbonate (Tums), separated from the Harvoni dose by 4 hours.
- d. Any OTC product is safe to take at any time.
Answer: c. Calcium carbonate (Tums), separated from the Harvoni dose by 4 hours.
37. The goal of HBV therapy is to suppress HBV DNA and achieve:
- a. SVR
- b. Loss of HBsAg (Hepatitis B surface antigen)
- c. Development of HBeAg
- d. A high viral load
Answer: b. Loss of HBsAg (Hepatitis B surface antigen)
38. The suffix “-buvir” indicates a DAA that inhibits which viral protein?
- a. NS3/4A Protease
- b. NS5A Replication Complex
- c. NS5B Polymerase
- d. Integrase
Answer: c. NS5B Polymerase
39. A patient with HIV and HBV co-infection should be treated with a regimen that:
- a. Treats only the HIV.
- b. Treats only the HBV.
- c. Contains two agents that are active against both viruses, as part of a complete HIV regimen.
- d. Uses interferon as the primary agent.
Answer: c. Contains two agents that are active against both viruses, as part of a complete HIV regimen.
40. A facilitated case discussion on hepatitis is part of the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
41. Which class of DAAs has the most significant drug-drug interactions due to CYP3A4 inhibition/induction?
- a. NS5B Nucleotide inhibitors (e.g., sofosbuvir)
- b. NS5A inhibitors
- c. NS3/4A Protease inhibitors
- d. All have minimal interactions.
Answer: c. NS3/4A Protease inhibitors
42. Post-exposure prophylaxis for Hepatitis A can include:
- a. A course of DAAs
- b. The Hepatitis A vaccine and/or immune globulin (IG)
- c. A course of NRTIs
- d. Supportive care only
Answer: b. The Hepatitis A vaccine and/or immune globulin (IG)
43. A patient cured of HCV:
- a. Will always have a positive HCV antibody test.
- b. Will always have a negative HCV antibody test.
- c. Will have a positive HCV RNA test.
- d. Is immune to all other forms of hepatitis.
Answer: a. Will always have a positive HCV antibody test.
44. What is the most important role of the pharmacist in the management of DAAs?
- a. Diagnosing the specific HCV genotype.
- b. Performing a comprehensive medication review to screen for drug interactions.
- c. Administering the medication to the patient.
- d. Drawing blood for follow-up labs.
Answer: b. Performing a comprehensive medication review to screen for drug interactions.
45. What is the primary reason interferon is no longer a first-line therapy for HCV?
- a. It is not effective.
- b. Its significant side effect burden and the superior efficacy and safety of DAAs.
- c. It is too expensive.
- d. It is no longer manufactured.
Answer: b. Its significant side effect burden and the superior efficacy and safety of DAAs.
46. Which DAA must be taken with food to improve its absorption?
- a. Ledipasvir/sofosbuvir
- b. Glecaprevir/pibrentasvir
- c. Sofosbuvir/velpatasvir
- d. All DAAs should be taken on an empty stomach.
Answer: b. Glecaprevir/pibrentasvir
47. A patient on HBV therapy with lamivudine develops resistance. This is a common issue with which class of HBV agents?
- a. Tenofovir
- b. Entecavir
- c. Older NRTIs with a low barrier to resistance.
- d. DAAs
Answer: c. Older NRTIs with a low barrier to resistance.
48. Why is adherence to HBV therapy critical?
- a. To achieve a cure in 12 weeks.
- b. To prevent the development of drug resistance and viral rebound.
- c. To minimize drug interactions.
- d. Adherence is not critical for HBV therapy.
Answer: b. To prevent the development of drug resistance and viral rebound.
49. An active learning session covering hepatitis is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
50. The ultimate goal of understanding the pharmacology of hepatitis antivirals is to:
- a. Be able to list every brand and generic name.
- b. Safely and effectively utilize these medications to improve public health by curing HCV and controlling HBV.
- c. Focus only on the most expensive therapies.
- d. Avoid treating patients with viral hepatitis due to complexity.
Answer: b. Safely and effectively utilize these medications to improve public health by curing HCV and controlling HBV.