HBV and HCV Pharm Flashcards
***Treatment goal for chronic HBV infection vs HCV infection
HBV cannot be eradicated. Goals of tx are
- Suppression of HBV DNA to undetectable levels
- Reduction in serum aminotransferases
HCV goal is eradication
Entecavir indication and MOA
Chronic HBV treatment
NucleoSIDE analog that inhibits reverse transcriptase
Adults or Pediatric patients
Entecavir contraindications
None
Tenofovir Disproxil indication and MOA
Chronic HBV treatment
NucleoTIDE analog that inhibits reverse transcriptase
Adults or Pediatric patients
*nephrotoxicity
Adefovir indication and MOA
Chronic HBV treatment
NucleoTIDE analogue that inhibits reverse transcriptase
*nephrotoxicity
Lamivudine indication and MOA
Chronic HBV treatment
NucleoSIDE analog that inhibits reverse transcriptase
Telbivudine indication and MOA
Chronic HBV treatment in adults
NucleoSIDE analog that inhibits reverse transcriptase
Adult patients
*do not combine with PEG IFN-a-2a, risk of peripheral neuropathy
Telbivudine contraindications
do not combine with PEG IFN-a-2a
risk of peripheral neuropathy
PEG IFN-a-2a indication and MOA
Chronic HCV or HBV treatment
binds IFN-a receptors, activating JAK/STAT pathway which increases expression of genes involved in antiviral response
What two HBV drugs should not be given to patients with renal impairment?
Tenofovir
Adefovir
PEG IFN-a-2b indication and MOA
Chronic HCV treatment
binds IFN-a receptors, activating JAK/STAT pathway which increases expression of genes involved in antiviral response
PEG IFN-a contraindications
Hypersensitivity to drug
AIH
Decompensated liver dz
Babies
Elbasvir + Grazoprevir indication and MOA
Chronic HCV
NS5A inhibitor + NSC/4A protease inhibitor
Ledipasvir + Sofosbuvir indication and MOA
Chronic HCV
NS5A inhibitor + NS5B polymerase inhibitor
Velpatasvir + Sofosbuvir indication and MOA
Chronic HCV
NS5A inhibitor + NS5B polymerase inhibitor
Velpatasvir + Sofosbuvir contraindication
pregnancy and hemoglobinopathy (same as ribivirin)
Polyglycoprotein/CYP inducers
Ribivirin (+ PEG IFN-a-2a) indication and MOA
Chronic HCV
Adults and pediatric (over 5)
Guanosine nucleoSIDE analog that inhibits reverse transcriptase
(ribivirin)
Ribivirin contraindication
Pregnant women
Hemoglobinopathies
Boceprevir (+ Ribivirin + PEG IFN-a) indication and MOA
Chronic HCV in pt who failed Rib+IFN alone
NS3/4A protease inhibitor
Prefix for NS5A inhibitors for HCV infection
-asvir
Velpastasvir
Elbasvir
Ledipasvir
Prefix for NS3/4A protease inhibitors for HCV infection
-previr
Boceprevir
Grazoprevir
Prefix for NS5B polymerase inhibitors for HCV infection
-buvir
Sofosbuvir
***Pharmacokinetics of PEGylated IFN-a-2a/2b vs IFN-a-2b
PEGylated IFN-a-2a/2b allows the drug to stay in the body longer before being broken down and excreted, decreasing the dose required for effectiveness
***PEG IFN-a black box warning
Risk for neuropsychiatric, autoimmune, ischemic, and infectious disorders
less serious but may cause flu like symptoms as a side effect
Combination therapies for HCV
VS - Velpatasvir + Sofosbuvir
LS - Ledipasvir + Sofosbuvir
EG - Elbasvir + Grazoprevir
- asvir = NS5A inhibitor
- buvir = NS5B polymerase inhibitor
- previr = NS3/4A protease inhibitor
-asvir (Velpastasvir, Elbasvir, Ledipasvir) MOA
NS5A inhibitors
-buvir (Sofosbuvir) MOA
NS5B polymerase inhibitor
-previr (Boceprevir, Grazoprevir) MOA
NS3/4A protease inhibitor
