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Gastrointestinal II Exam 2 > 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 endpoints of HBV supression?

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

Coinfection with HIV and HBV

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 are the AE of Entecavir?

A

Adults and kids-HA, dizziness, nausea

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8
Q

What is the MOA for Tenofovir Disoproxil?

A

HBV reverse transcriptase inhibitor (also for HIV-1)

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9
Q

What is the BB warning for Tenofovir Disoproxil?

A

Lactic acidosis

severe hepatomegaly with steatosis

post-treatment exacerbation of hepatitis

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10
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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11
Q

What are the contraindications for Tenofovir Disoproxil?

A

New onset or worsening renal impairment (ARF or Fanconi)

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12
Q

What are the AE for Tenofovir Disoproxil?

A

Pt’s with compensated liver disease most commonly experience is Nausea

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13
Q

What is the MOA and indication for Adefovir?

A

Nucleotide analogue for HBV in pt’s ages 12+

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14
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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15
Q

What is the main warning/precaution of Adefovir?

A

nephrotoxicity

monitor renal fxn!!

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16
Q

What are the adverse effects of Adefovir?

A

asthenia and increased creatinine

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17
Q

What are the drug interactions for Adefovir?

A

coadministration with drugs that reduce renal function may increase concentrations of adefovir or the coadministered drug

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18
Q

What is the MOA for Lamivudine?

A

nucleoside analogue RT inhibitor for HBV

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19
Q

What is the BB warning for Lamivudine?

A

Lactic Acidosis

Severe Hepatomegaly

Exaceration of Hep B

Different formulations

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20
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 HIV1

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

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21
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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22
Q

What are the AE for Lamivudine?

A

HA, nausea, malaise, fatigue

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23
Q

What is the MOA for Telbivudine?

A

nucleoside analogue RT inhibitor for HBV

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24
Q

What are the BB warnings for Telbivudine?

A

Lactic Acidosis

Severe Hepatomegaly with steatosis

severe acute exacerbations of Hep B

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25
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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26
Q

What are the contraindications for Telbivudine?

A

combination of telbivudine with PEGylated interferon alfa-2a increases risk of peripheral neuropathy

27
Q

What are the AE of Telbivudine?

A

fatigue, increased CK, HA

28
Q

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

A

Treat HCV in pt’s not previously treated with this agent

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

29
Q

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

A

risk of serious disorders

Ribavirin associated effects

30
Q

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

A

autoimmune hepatitis

hepatic decompensation in pt’s with cirrhosis

use in neonates/infants

31
Q

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

A

fatigue, asthenia, pyrexia, HA

“flu-like sx”

32
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

33
Q

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

A

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

34
Q

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

A

HSN rxn to interferon alpha or other ingredients

autoimmune hepatitis

decompensated liver dz

35
Q

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

A

flu-like sx

36
Q

What is the main goal of HCV treatment?

A

eradication of the virus

37
Q

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

38
Q

What is the MOA and indication of Elbasvir/Grazoprevir?

A

Elbasvir: HCV NS5A inhibitor

Grazoprevir: NS3/4A protease inhibitor

39
Q

What are the contraindications for Elbasvir/Grazoprevir?

A

Pt’s with moderate to severe hepatic impairment

40
Q

What are the warnings/precautions of Elbasvir/Grazoprevir?

A

ALT elevations

41
Q

What are the AE of Elbasvir/Grazoprevir?

A

fatigue, HA, nausea

42
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

43
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

44
Q

What are the warnings/precautions for Ledipasvir/Sofosbuvir?

A

Do not combine with other Sofosbuvir containing products

45
Q

What are the AE of Ledipasvir/sofosbuvir?

A

Fatigue and HA

46
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

47
Q

What is the MOA for Velpatasvir/Sofosbuvir?

A

Velpastasvir: HCV NS5A inhibitor

Sofosbuvir: NS5B polymerase inhibitor

48
Q

What is the indication for Velpatasvir/Sofosbuvir?

A

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

49
Q

What are the contraindications for Velpatasivir/Sofosbuvir?

A

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

50
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

51
Q

What are the adverse reactions for Velpatasvir/Sofosbuvir?

A

HA and fatigue

52
Q

What are the drug interactions with Velpatasvir/Sofosbuvir?

A

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

53
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)

54
Q

What are the indications and MOA for Ribivarin?

A

nucleoside analogue for HCV with Interferon alfa-2a in patients ages 5+

adults with HIV coninfection

55
Q

What are the contraindications for Ribavirin?

A

pregnant women and men whose female partners are pregnant

hemoglobinopathies

56
Q

What are the AE of Ribivarin?

A

fatigue, asthenia, HA

57
Q

What is the MOA and indication for Boceprevir?

A

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

58
Q

What are the contraindications for Boceprevir?

A

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

59
Q

What are the warnings/precautions for Boceprevir?

A

same as for Ribavirin/Peg alfa

(birth defects being major)

60
Q

What are the AE for Boceprevir?

A

fatigue, anemia, HA, dysguesia

61
Q

What drugs are the NS3/4A protease inhibitors?

A

“Previr”

Telaprevir

Boceprevir

Simeprevir

Paritaprevir

Grazoprevir

62
Q

What drugs are the NS5A inhibitors?

A

“Asvir”

Daclastasvir

Ledipasvir

Velpatasvir

Ombitasvir

Elbasvir

63
Q

What drugs are the NS5B RNA polymerase inhibitors?

A

“Buvir”

Nucleosides: Sofosbuvir

Nonnucleosides: Dasabuvir

Gastrointestinal II Exam 2 (10 decks)

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