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Cology 2 Exam 3 > Antiviral 1 - Hepatitis > Flashcards

Antiviral 1 - Hepatitis Flashcards

1
Q

Differences between HBV and HCV?

A

Hep B: DNA virus, does integrate into host genome, vaccination is available

Hep C: RNA virus, cannot integrate into host genome, leading indication for liver transplantation/kills more than Hep B, and no vaccine available (heterogeneity hinders the development of vaccines)

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2
Q

Pegylated Interferon 2-alpha, Recombinant Interferon Alpha: Indications?

A

Hepatitis B, papillomavirus

Hep C no longer a recommended treatment

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3
Q

Pegylated Interferon 2-alpha, Recombinant Interferon Alpha: How do they work?

A

They are antiproliferative and have immune modulating actions, increase phagocytes

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4
Q

Pegylated Interferon 2-alpha, Recombinant Interferon Alpha: Dosing?

A

Given SubQ 3 times a week for 48 weeks

Cray

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5
Q

Pegylated Interferon 2-alpha, Recombinant Interferon Alpha: Adverse effects?

A

Fever, chills, flu-like syndrome
Hypotension, chest pain, arrhythmias
GI disturbances
Leukopenia, thrombocytopenia

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6
Q

Pegylated Interferon 2-alpha, Recombinant Interferon Alpha: Cautions?

A

Caution in pulmonary disease, diabetes, coagulation disorders
Causes mood disorders - do not use in untreated or severe depression
Contraindicated in pregnancy

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7
Q

Which Hep B treatment is contraindicated in pregnancy?

A

Interferon 2 Alphas

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8
Q

Lamivudine: What is it?

A

Cytosine nucleoside

Inhibits DNA polymerase/reverse transcriptase in HBV

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9
Q

Lamivudine: Indications

A

Used in HBV in adults and children, usually treat for 1 year (doesn’t cure HBV!!)

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10
Q

Lamivudine: Clinical effects

A

Normalizes liver enzymes ~40%
Reduces hepatic inflammation ~50%
Renal elimination
Risk of lactic acidosis

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11
Q

Telbivudine: What is it?

A

Thymidine analog

Inhibits DNA polymerase/reverse transcriptase in HBV

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12
Q

Telbivudine: Cautions

A

Renal elimination

Increased risk of lactic acidosis

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13
Q

Telbivudine: Adverse effects

A

Myopathy

Peripheral neuropathy

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14
Q

Tenofovir, Adefovir: What are they

A

Adenosine analogs

Inhibit viral DNA polymerase and reverse transcriptase

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15
Q

Tenofovir, Adefovir: Indications

A

Hep B and Lamivudine resistant HBV

Also effective in HIV

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16
Q

Tenofovir, Adefovir: Duration

A

Long term treatment, doesn’t cure infection

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17
Q

Tenofovir, Adefovir: Adverse effects

A

Both cause nephrotoxicity

Tenofovir can also cause decreases in bone density

Headache, abdominal discomfort, and diarrhea at low doses

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18
Q

Entecavir: What is it

A

Guanosine nucleoside analog inhibits viral DNA polymerase and reverse transcriptase

REQUIRES INTRACELLULAR PHOSPHORYLATION

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19
Q

Entecavir: Counseling points

A

Take on empty stomach

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20
Q

Entecavir: Cautions

A

Renal elimination

21
Q

Entecavir: Compared to other drugs

A

It is superior to lamivudine in reducing viral load

Also has limited resistance development

22
Q

Describe the Hep C virus

A

Small, enveloped, single-stranded, positive sense RNA virus

Blood to blood contact (sharing needles, etc)

Seven major genotypes known as 1-7, divided into several subtypes with the number of subtypes depending on the genotype

23
Q

Hep C virus genotypes

A

70% in US caused by Genotype 1
20% type 2
1% by each of the other ones

Genotype 1 is also the most common in South America and Europe

24
Q

How many Hep C viruses are produced each day in an infected person?

A

1x10^12

25
Q

Recommended therapies for Hep C 1a?

A

Lepidasivir and Sofosbuvir:
Paritavir/Ritonavir/Ombitasivir PLUS Dasabuvir and Ribaviron
Sofosbuvir and Simeprevir

26
Q

Recommended therapies for Hep C 1b?

A

Lepipasivir and Sofosbuvir:
Paritavir/Ritonavir/Ombitasvir plus Dasabuvir and Ribaviron
Sofosbuvir and Simeprevir

27
Q

Recommended therapies for Hep C 2?

A

Sofosbuvir and Ribaviron

28
Q

Recommended therapies for Hep C 3?

A

Sofosbuvir and Ribaviron

29
Q

Recommended therapies for Hep C 4?

A

Ledipasivir and Sofosbuvir:
Paritavir/Ritonavir/Ombitasvir plus Dasabuvir and Ribaviron
Sofosbuvir and Simeprevir

30
Q

Recommended therapies for Hep C 5?

A

Sofosbuvir and Ribaviron

31
Q

Recommended therapies for Hep C 6?

A

Ledipasivir and Sofosbuvir

32
Q

Ledipasvir: What is it

A

NS5A inhibitor, alters posttranslational processing of HVC proteins

33
Q

Sofosbuvir: What is it

A

NS5B polymerase inhibitor, mimics uridine, blocks RNA elongation

34
Q

Ledipasvir, Sofosbuvir: How supplied

A

Fixed dose combination Harvoni

35
Q

Ledipasvir, Sofosbuvir: Adverse effects

A

Fatigue, headache

36
Q

Ledipasvir, Sofosbuvir: Drug interactions

A

Drug interactions with P-glycoprotein inducers (St johns wart, rifampin)
Avoid concomitant use

37
Q

Ledipasvir, Sofosbuvir: Cost

A

12 week treatment is 95,000

24 week treatment is 189,000 (with cirrhosis)

38
Q

Which drug should not be taken with Amiodarone?

A

Sofosbuvir - March 2015 FDA warning about severe bradycardia caused when given these drugs to patients taking amiodarone

(also worry about beta blockers)

39
Q

Ledipasvir, Sofosbuvir: Monitoring

A

Monitor pt in hospital first 48 hours CV function, monitor at home daily for 2 weeks

40
Q

Paritaprevir: What is it?

A

HCV NS3/4a protease inhibitor necessary for mature virus

41
Q

Ombitasvir: What is it?

A

HCV NS5A inhibitor, used for viral replication and virus assembly

42
Q

Dasabuvir: What is it?

A

Non-nucleoside inhibitor of RNA NS5B polymerase

43
Q

Ritonavir: What is it?

A

Potent CYP3A4 inhibitor, prevents metabolism of Paritaprevir

44
Q

Adverse effects of Paritaprevir, Ombitasvir, Dasabuvir, Ritonavir combo?

A

Fatigue, insomnia, pruritus

Avoid in pregnancy and breast feeding!

45
Q

Simepravir: What is it?

A

2nd generation NS4/4A protease inhibitor, used in genotype 1, 2, 4 Hep C

Inhibits posttranslational processing of HVC proteins

46
Q

Simepravir: How administered?

A

As combo with Ribavirin and Sofosbuvir

47
Q

Simepravir: Cautions?

A

CYP3A4 interactions, less drug interactions and none with birth control yay

Avoid in pregnancy
Increased liver enzymes

48
Q

Simepravir: Adverse effects?

A

Rash, photosensitivity, elevated bilirubin, myalgia, dyspnea, increased liver enzymes

Cology 2 Exam 3 (11 decks)

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