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GEM > 4.13 GI Pharm > Flashcards

4.13 GI Pharm Flashcards

1
Q

What viral forms of hepatitis have no pharm treatment?

A

HAV, HDV, HEV

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2
Q

What viral form of viral hepatitis can be cured?

A

HCV

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3
Q

What makes it more likely that a patient will develop chronic HBV (Antigen marker detected for over 6 months) ?

A

The younger the patient is (children)

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4
Q

Because some HBV drugs target the DNA reverse transcriptase, they can also be used to treat what?

A

HIV

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5
Q

What is the goal for treating HBV?

A

Suppress HBV within patients (prevent reactivation) and prevent associated damage of chronic HBV (cirrhosis, HCC, etc.)

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6
Q

What kind of liver cirrhosis if there is some damage but liver is still able to functional adequately with minimal complication?

A

Compensated cirrhosis

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7
Q

Why is it important to screen and treat for HBV in pregnant women?

A

High likelihood of passing it onto child and newborns have highest risk 90% of developing chronic HBV

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8
Q

Can be used to treat HBV and HCV?

A

Interferon a 2A

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9
Q

Immunomodulatory and inhibition of viral processes, type 1 interferons lead to activation of Jak/Stat pathways and transcription of specific mRNAs that help cells respond to viruses

A

Interferon a 2A

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10
Q

What is done to interferon a 2A to increase its half-life?

A

Pegylated

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11
Q

BBW for interferon Alfa 2A?

A

Fatal neuropsychiatric, autoimmune, ischemic and infectious disorders (esp elderly)

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12
Q

ADME and ADSE interferon Alfa 2A?

A

Once a week subcutaneous
Flue like symptoms in 90%
Long term risk of neuropsych, myelosuppresison, etc.

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13
Q

Who should use PEG interferon alpha 2A?

A

Younger, well compensated cirrhosis, patients who don’t want long term treatment

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14
Q

An absolute contra for PEG interferon alpha 2A?

A

Pregnant women with HCV

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15
Q

What are drugs that can be used for treating both HBV and HIV?

A

Tenofovir & Lamivudine

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16
Q

What is a first line HBV for naive patients?

A

Entecavir

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17
Q

Guanine nucleoside analog that inhibits HBV DNA polymerase

A

Entecavir

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18
Q

Why is Entecavir first line for HBV naive?

A

High potency and low resistance (unless resistant to Lamivudine)

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19
Q

BBW for lactic acidosis and severe hepatomegaliy with steatosis and exacerbation of HBV when discontinued?

A

Entecavir

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20
Q

ADME and ADSE for enetcavir?

A

Oral, 15hr half life, renal excretion
Well tolerated but some headaches, fatigue, dizziness, nausea

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21
Q

Adenosine nucleotide analog?

A

Tenofovir

22
Q

Which version of Tenofovir is preferred due to reduced serious side affects?

A

TAF > TDF (bone problems)

23
Q

What are Tenofovir ADSE?

A

GI effects, renal tubulopathy

24
Q

What does Tenofovir interfere with when HBV is resistant against entecavir or Lamivudine?

A

Viral RNA dependent DNA polymerase

25
Q

Incorporated into the viral DNA by HBV polymerase resulting in DNA chain termination (cytidine analog)

A

Lamivudine

26
Q

What are the HBV specific ADSE for Lamivudine?

A

Longer half life in liver cells so given at lower concentrations than for ART (HIV therapy)

27
Q

BBW for Lamivudine?

A

Lactic acidosis, severe hepatomegaly, exacerbations of Hep B when discontinued

28
Q

Has some relatively normal respiratory ADSE (cough, sore throat, nasal effects)?

A

Lamivudine

29
Q

What drugs can be used to treat HCV?

A

PEG interferon 2A
Ribavirin
Sofosbuvir - NS5B
Velpatasvir - NS5A
Glecaprevir - NS3/4A protease inhib

30
Q

What are the treatment options for HCV?

A

Interferon + ribavirin

Duo: NS5A inh.ib + NS5B inhib OR protease inhib.

Triple/Quad
N5A inhibitor + NS5B inhib + protease inhib+ CYP3A4 inhib

31
Q

Guanosine analog that interferes with viral mRNA capping, inhibits synthesis of guanosine synthesis, inhibits viral RNA dependent polymerase

A

Ribavirin

32
Q

What drugs needs to be phosphorylated to become active and can be admin orally or by inhaler?

A

Ribavirin

33
Q

Ribavirin inhalation is used to treat what?

A

RSV

34
Q

BBW: NOT monotherapy, hemolytic anemia PO), teratogenic

A

Ribavirin

35
Q

Uracil analog that inhibits the RNA dependent RNA polymerase found in genotypes 1-6 (NS5B) of HCV?

A

Sofosbuvir

36
Q

ADSE for Sofosbuvir?

A

LOTS but especially patients on amiodarone can cause severe bradycardia

37
Q

Inhibits NS5A that may be involved in induction of viral RNA dependent RNA polymerase?

A

Velpatasvir

38
Q

What is approved to be used in conjunction with Sofosbuvir?

A

Velpatasvir

39
Q

This combination is considered pangenotypic and curative for HCV?

A

Velpatasvir + Sofosbuvir

40
Q

What do you need to be cautious for in patients taking Velpatasvir?

A

HBV reactivation bc of Sofosbuvir AND hypoglycemia in medicated diabetics

41
Q

Potent pan genotypes inhibitor of HCV NS3/4A protease that cleaves the encoded polyprotein essential for viral replication

A

Glecaprevir

42
Q

What is the Glecaprevir BBW?

A

HBV reactivation on discontinuation

43
Q

What do you monitor with patients on Glecaprevir?

A

LFTs, liver dysfunction signs, and diabetes improvement

44
Q

What is the liver extraction rate?

A

ER = ([before]-[after]) / [before]

45
Q

What does a low ER indicate?

A

Very little drug is extracted

46
Q

What is teh hepatic clearance?

A

HC = ER X Q

Q= how much blood goes to liver

Volume of blood that passes through and is cleared by the liver

47
Q

Low ER drug characteristics?

A

Minimal metabolism by liver, low first pass effects, high serum binding, changes in liver perfusion rates don’t affect extraction that much

48
Q

What are conditions that can alter hepatic blood flow (and thus High ER drugs)?

A

CHF, hypotension

49
Q

What are some high ER drugs?

A

Morphine
Nitro
Propranolol
Isoniazid

50
Q

Low ER ratio drug examples?

A

Phenytoin
Diazepam
Digitoxin
Warfarin
Theophylline

TRENDS: zero order drugs

GEM (31 decks)

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