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GI II Exam 1 > HBV and HCV Pharm > Flashcards

HBV and HCV Pharm Flashcards

1
Q

What are the goals of chronic HBV therapy?

A
  1. supression of HBV DNA to undetectable levels
  2. seroconversion of HBeAg from positive to negative
  3. Reduction in elevated serum aminotransferase levels
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2
Q

What are the results of all HBV therapies on the market today?

A

improved necro-inflammatory disease

decreased risk for hepatocellular carcinoma and cirrhosis

decreased need for liver transplant

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3
Q

What is the MOA for Entecavir?

A

HBV nucleoside analogue reverse transcriptase

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4
Q

What is the BB warning for Entecavir?

A

severe acute exacerbation of Hep B when discontinuing therapy (can be fatal)

Complications in those coinfected with HIV

lactic acidosis

hepatomegaly

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5
Q

What are the indications for Entecavir?

A

Tx chronic HBV in adults and kids ages 2+ with persistent elevated ALT/AST or histologically active disease and evidence of active viral replication

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6
Q

What are the contraindications for Entecavir?

A

None

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7
Q

What is the MOA for Tenofovir Disoproxil?

A

nuceloside analog HBV reverse transcriptase inhibitor (also for HIV-1)

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8
Q

What is the BB warning for Tenofovir Disoproxil?

A

Lactic acidosis

severe hepatomegaly with steatosis

post-treatment exacerbation of hepatitis after discontinuation

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9
Q

What are the indications for Tenofovir Disoproxil?

A

Use in combo for HIV-1 in adults and kids 2+

Use for HBV in adults and kids 12+

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10
Q

What are the warnings/precautions for Tenofovir Disoproxil?

A

New onset or worsening renal impairment (ARF or Fanconi)

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11
Q

What is the MOA and indication for Adefovir?

A

Nucleotide analogue for HBV in pt’s ages 12+

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12
Q

What are the contraindications for Adefovir?

A

Don’t use in any pt with a hx of hypersensitivity to any of the ingredients

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13
Q

What is the main warning/precaution of Adefovir?

A

nephrotoxicity

monitor renal fxn, esp in those with prexisting conditions that predispose them to renal injury

Severe actue exacerbations of hepatitis

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14
Q

What are the adverse effects of Adefovir?

A

asthenia (muscle weakness) and increased creatinine in pre- and post- transplantation lamivudine-resistant liver disease patients

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15
Q

What are the drug interactions for Adefovir?

A

other drugs that affect kidney excretion or have nephrotoxic effects

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16
Q

What is the MOA for Lamivudine?

A

nucleoside analogue RT inhibitor for HBV

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17
Q

What is the BB warning for Lamivudine?

A

Lactic Acidosis

Severe Hepatomegaly

Exaceration of Hep B (in those co-infected with HIV)

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18
Q

What are the indications of Lamivudine?

What are the contraindications for Lamivudine?

A

Used in combination with other antiretroviral agents for the treatment of HBV/HIV1

Don’t use in pt’s with previous hypersensitivity rxn to any ingredient

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19
Q

What are the warnings/precautions for Lamivudine?

A

In co-infected pt’s with HBV/HIV-1: Lamivudine resistant HBV strains

Pancreatitis

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20
Q

What is the MOA for Telbivudine?

A

nucleoside analogue RT inhibitor for HBV (NARTI)

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21
Q

What are the BB warnings for Telbivudine?

A

Lactic Acidosis

Severe Hepatomegaly with steatosis

severe acute exacerbations of Hep B with discontinuation

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22
Q

What are the indications for Telbivudine?

A

Used for chronic HBV with evidence of viral replication, and either elevated ALT/AST or histological evidence

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23
Q

What are the contraindications for Telbivudine?

A

don’t use in combo with PEGylated interferon alfa-2a (increases risk of peripheral neuropathy), Elevates CK due to muscular damage

24
Q

What is the indication for PEG Interferon Alfa-2a?

A

Treat HCV in pt’s not previously treated with this agent (compensated liver) & treatment of those with histo evidence of cirrhosis and compensated liver dz

Treat HBV in those with compensated liver dz and evidence of viral replication and liver inflammation

25
Q

What is the BB warning for PEG interferon alfa-2a?

A

risk of serious disorders (autoimmune, ischemia, other sever disorders)

Ribavirin associated effects like birth defects (bc the two can be used in combo)

(Lots of side effects so not used commonly)

26
Q

What are the contraindications for PEG interferon alfa-2A?

A

autoimmune hepatitis

hepatic decompensation in pt’s with cirrhosis

use in neonates/infants

Expensive and lots of side effects so not commonly used (success rate only 50%)

27
Q

What are the adverse reactions to PEG interferon alfa 2a?

A

fatigue, asthenia, pyrexia, HA

“flu-like sx”

Lots of side effects so not commonly used

28
Q

What drugs are used to treat chronic hepatitis B?

A

“PB Latte”

PEG-Interferon Alfa-2a

Lamivudine

Adenofir pipivoxil

Tenofovir Disoproxil

Telbivudine

Entecavir

29
Q

What are the indications for PEG interferon alfa-2b

A

Treat HCV in pt’s 18+ with hx of blood exposure and/or are HCV positive

30
Q

What is the BB warning for PEG inteferon alfa-2b

A

cause or aggrevate fatal neuropsych, autoimmune, ischemic, and infectious disorders

31
Q

What are the contraindications for PEG interferon alfa-2b?

A

HSN rxn to interferon alpha or other ingredients

autoimmune hepatitis

decompensated liver dz

32
Q

What are the adverse effects of PEG interferon alfa-2b?

A

flu-like sx, esp at high doses

33
Q

What is the main goal of HCV treatment?

A

eradication of the virus

34
Q

Sustained viral response is defined as the absence of decetable viremia ___ after completion of therapy.

A

24 weeks

35
Q

What is the MOA and indication of Elbasvir/Grazoprevir?

A

Elbasvir: HCV NS5A inhibitor

Grazoprevir: NS3/4A protease inhibitor

36
Q

What are the contraindications for Elbasvir/Grazoprevir?

A

Pt’s with moderate to severe hepatic impairment

37
Q

What are the warnings/precautions of Elbasvir/Grazoprevir?

A

ALT elevations (possibly more liver damage)

38
Q

What are the drug interactions for Elbasvir/Grazoprevir?

A

Co-administration with moderate CYP3A inducers is NOT recommended as it may decrease drug concentrations

39
Q

What is the MOA and indication for Ledipasvir/Sofosbuvir?

A

Ledipasvir: NS5A inhibitor

Sofosbuvir: NS5B polymerase inhibitor

Indicated for use of chronic HCV in adults

40
Q

What are the warnings/precautions for Ledipasvir/Sofosbuvir?

A

Shouldn’t use with other products containing Sofosbuvir

41
Q

What are the drug interactions with Ledipasvir/Sofosbuvir?

A

poly glycoprotein inducers (rifampin, St. John’s Wort) may alter concentrations of drug-not recommended

42
Q

What is the MOA for Velpatasvir/Sofosbuvir?

A

Velpastasvir: HCV NS5A inhibitor

Sofosbuvir: NS5B polymerase inhibitor

43
Q

What is the indication for Velpatasvir/Sofosbuvir?

A

adults with HCV without cirrhosis, with compensated cirrhosis, or with decompensated cirrhosis in combo with ribavirin

44
Q

What are the contraindications for Velpatasivir/Sofosbuvir?

A

do not use in pt’s in whom ribavirin is contraindicated

45
Q

What are the warnings/precautions for Velpatasvir/Sofosbuvir?

A

bradycardia with amiodarone co-administration

cardiac and liver issues with co-admin of beta blockers

46
Q

What are the drug interactions with Velpatasvir/Sofosbuvir?

A

PGP inducers and/or moderate CYP inducers may decease drug concentrations-not recommended

47
Q

What are the BB warnings for Ribivarin?

A

Serious birth defects and fetal death

Do not use in pregnancy (and don’t get pregnant within 6 months after treatment)

For males, don’t use if female partner is pregnant/trying to get pregnant

48
Q

What are the indications and MOA for Ribivarin?

A

nucleoside analogue for HCV with Interferon alfa-2a in patients ages 5+ with compensated liver disease not previously treated with interferon alpha

adults with HIV coninfection

49
Q

What are the contraindications for Ribavirin?

A

pregnant women and men whose female partners are pregnant

hemoglobinopathies

50
Q

What is the MOA and indication for Boceprevir?

A

HCV NS3/4A protease inhibitor indicated for chronic HCV in adults with compensated liver dz/cirrhosis previously untreated or failed interferon/ribavirin therapy

Use with PEG alfa and Ribavirin

51
Q

What are the contraindications for Boceprevir?

A

any contraindications for PEG alfa and ribavirin apply since Boceprevir is co-administered with them

52
Q

What are the warnings/precautions for Boceprevir?

A

same as for Ribavirin/Peg alfa

(birth defects being major Ribavirin BB warning)

53
Q

What are the unique AEs for Boceprevir?

A

anemia, dysguesia

54
Q

What do drugs ending in “previr” target?

A

NS3 (metalloproteases, serine proteases, & RNA Helicase)

NS4A (Cofactors)

55
Q

What do drugs ending in “asvir” targer?

A

NS5A

56
Q

What drugs ending in “buvir” target?

A

NS5B (RNA Polymerase)

57
Q

What drugs are used to treat chronic hepatitis C (without cirrhosis)?

A

“blevs”

Boceprevir, given with interferon 2a and ribivirin

Ledipasvir/Sofosbuvir (plus ribavirin)

Elbasvir/Grazoprevir

Velpatsvir/Sofosbuvir - if it’s decompensated cirrhosis

Sofosbuvir (plus ribavirin)

Ribivirin

Interferon alfa 2b

GI II Exam 1 (6 decks)

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