Drugs to treat Viral Hepatitis Flashcards
What is the treatment for Hep B infection?
No specific treatment for acute Hep B infection, most often it resolves spontaneously
What are the goals of chronic HBV therapy? (3)
- Suppress HBV DNA to undetectable levels
- Seroconversion of HbeAg (or HbsAg) from positive to negative
- Reduction in elevated serum aminotransferase levels
What are the goals of HBV therapy correlated with? (3)
- Improvement in necro-inflammatory dz
- Decreased risk of hepatocellular carcinoma and cirrhosis
- Decreased need for liver transplantation
Is HBV curable?
Yes, but it is RARE (so, no, ish)
What do current therapies for HBV do?
Suppress HBV replication only
Why is HBV so hard to cure?
B/c the covalently closed viral DNA is very stable and can exist indefinitely within the cell, serving as an HBV reservoir throughout the life of the cell so it can be reactivated
When is HBV relapse more common?
When patients are co-infected with Hep D virus
What is entecavir?
A Hep B virus nucleoSide analogue reverse transcriptase
When is entecavir indicated?
In treatment of chronic Hep B virus infection in adults and children AT LEAST 2 YEARS OF AGE w/active viral replication and either evidence of persistent elevation in serum AST or ALT or histologically active dz
Entecavir contraindications?
None
Entecavir adverse effects? (most common)
headache, fatigue, dizziness, nausea
Entecavir black box warning (4)
- Severe acute exacerbations of Hep B
- don’t use in patients co-infected w/ HIV and HBV
- It can cause lactic acidosis
- can cause hepatomegaly
What is tenofovir disoproxil?
A nucleoTide analog HIV-1 reverse transcriptase inhibitor, and an HBV reverse transcriptase inhibitor
When is tenofovir indicated?
Use in combo w/other antiretroviral agents to treat HIV-1 in adults and kids 2+
Use in treatment of chronic Hep B in adults and kids age 12 and older
What are warnings when using tenofovir?
Watch for new onset or worsening renal impairment (can include acute renal failure and Fanconi syndrome)
Tenofovir adverse effects?
in HBV infected pts with compensated liver dz: nausea
Tenofovir black box warning (2)
- Lactic acidosis/ severe hepatosplenomegaly w/steatosis
2. post treatment exacerbation of hepatitis
What is adefovir?
a nucleoTide analogue used for treatment of chronic Hep B in patients 12 and older
When is adefovir contraindicated?
In patients w/previously demonstrated hypersensitivity to any of the components of it
What are warnings for use of adefovir?
It is NEPHROTOXIC, renal function should be monitored during therapy for all patients, but esp those w/pre-existing or other risks of renal impairment
Can also severely exacerbate acute hepatitis
Adverse effects of adefovir
asthenia, increased creatinine in pre and post transplantation lamivudine-resistant liver disease patients
Adefovir drug interactions?
coadministering w/drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of adefovir or the coadministered drug
What is lamivudine?
A nucleoside analogue reverse transcriptase inhibitor
When is lamivudine contraindicated?
In pts w/previous hypersensitivity reaction to lamivudine
Warnings for lamivudine use:
In patients w/HIV-1 and HBV coinfection, emergence of lamivudine-resistant HBV variants associated w/ lamivudine-containing antiretrovirals has been reported, and you should monitor pts for treatment associated toxicities.
pancreatitis can occur, watch patients with significant risk factors for pancreatitis
Lamivudine adverse effects?
headache, nausea, malaise, fatigue, nasal signs and symptoms, diarrhea, cough
Lamivudine black box warnings? (3)
- lactic acidosis
- severe hepatomegaly
- exacerbation of Hep B
What is telbivudine?
A nucleoSide analogue reverse transcriptase inhibitor