C.7. Agents against hepatitis viruses

Question 1

name the Non-Specific (traditional) agents for viral hepatitis

Answer 1

'RITE'
Ribavirin
IFN-𝝰
Tenofovir
 Entecavir

Question 2

how is IFN-𝝰 given?

Answer 2

intramuscular/subcutaneous injection

Question 3

how is Entecavir & Tenofovir given?

Answer 3

orally

Question 4

how is Ribavirin given?

Answer 4

oral, IV, aerosol

Question 5

what type of elimination do traditional agents have?

Answer 5

renal

Question 6

which traditional agent is teratogenic?

Answer 6

Ribavirin

Question 7

what is Tenofovir and what does it do?

Answer 7

Nucleotide analog

anti-retroviral agent (NRTI)

Question 8

what is Tenofovir and Entecavir used for?

Answer 8

Hepatitis B

Question 9

what are the side effects of Tenofovir?

Answer 9

Nephrotoxicity

Gi distress

Question 10

what does IFN-𝝰 do against hepatitis virus?

Answer 10

1. activation of cytokine receptors–> ↑ activity of JAK-STAT pathway
2. selective antiviral activity –> activation of host-cell defense mechanisms

Question 11

what are the hepatitis indications for IFN-𝝰?

Answer 11

1. Hepatitic B-chronic infection (monotherapy/combination)

2. Hepatitic C- acute and chronic infections (in combination with ribavirin)

Question 12

what are the other clinical indications for IFN-𝝰? (6)

Answer 12

1. Kaposi sarcoma (HHV-8)
2. hairy cell leukemia
3. malignant melanoma
4. Papillomatosis
5. renal cell carcinoma
6. genital warts (HPV)

Question 13

what type of IFN-𝝰 form can be administered weekly instead of once daily?

Answer 13

Pegylated form IFN

Question 14

what are the side effects of IFN-𝝰

Answer 14

1. Flu-like symptoms
2. GI symptoms
3. Alopecia
4. Bone marrow suppression
5. ototoxicity (reversible)
6. thyroid dysfunction
7. CNS effects (mood disorders, depression)

Question 15

what are Entecavir and Ribavirin?

Answer 15

Guanosine analogue

Question 16

side effects of Entecavir

Answer 16

Headache, dizziness
fatigue
Nausea

Question 17

what does Entecavir do?

Answer 17

inhibits HBV DNA polymerase

Question 18

what does Ribavirin do?

Answer 18

monophosphate form–> inhibits IMP dehydrogenase–>prevent GMP synthesis
Triphosphate form–> inhibits viral RNA polymerase

Question 19

what are the indications for Ribavirin?

Answer 19

1. hepatitis C infection -acute and chronic (in combination with IFN-𝝰)
2. respiratory syncytial virus (aerosol preparation)
3. influenza A & B, paramyxovirus, HIV, parainfluenza virus
4. viral hemorrhagic fever from Dengue, yellow, Lassa fever, Ebola, Bunyavirus (IV administration)

Question 20

SE of Ribavirin

Answer 20

1. Drug-induced hemolytic anemia (IV)

2. conjunctival, bronchial irritation (aerosol)

Question 21

what are DAA’S?

Answer 21

direct-acting antivirals
medications targeted at specific steps within the HCV life cycle
*provides eradication rate of >90% in HCV infections

Question 22

how many DAA’s do we have and how are they classified?

Answer 22

4

defined by their mechanism of actions and therapeutic agent

Question 23

what are the common side effects of DAA’s?

Answer 23

fatigue
GI distress
headaches
anemia

Question 24

what DAA’S class are Paritaprevir and Grazoprevir?

Answer 24

NS3/4A protease inhibitors (PI’s)

Question 25

drug regimens consist of..

Answer 25

2-3 agents

Question 26

how much time do DAA’s regimens require?

Answer 26

12-16 weeks of treatment

Question 27

what is the mechanism of DAA’s?

Answer 27

they target non-structural proteins of the virus, resulting in disruption of the viral replication and infection

Question 28

what DAA’S class does Sofobuvir belong to?

Answer 28

NS5B nucleoside polymerase inhibitors (NPI’S)

Question 29

what DAA’S class does Dasabuvir belong to?

Answer 29

NS5B non-nucleoside polymerase inhibitors (NNPI’S)

Question 30

what DAA’S class do Velpatasvir and Elbasvir Belong to?

Answer 30

NS5A inhibitors