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GI > HBV Treatment > Flashcards

HBV Treatment Flashcards

1
Q

current recommendations for chronic HBV treatment

A

entecavir, TAF, TDF, pegylated interferon alfa 2a

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2
Q

pegylated interferon alfa 2a dose

A

180 mcg weekly

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3
Q

entecavir dose

A

0.5 mg daily naive, 1 mg daily

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4
Q

TDF dose

A

300 mg daily

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5
Q

TAF dose

A

25 mg daily

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6
Q

actions of interferons

A

induce resistance to viral replication in all cells, increase MHC Class I expression and antigen presentation, activate NK cells to kill virus-infected cells

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7
Q

dose of pegylated interferon alfa 2a if CrCL< 30 mL/min

A

135 mcg weekly

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8
Q

interferon adverse effects

A

influenza like illness, fatigue, wt loss, hairloss, myelosuppression, psychiatric (suicidal), etc

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9
Q

interferon contraindications

A

severe uncontrolled depressive disorder, suicidal ideation, decompensated liver disease, neutropenia, thrombocytopenia, pregnancy, babies, others

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10
Q

duration of pegasys (peginterferon alpha 2a) therapy

A

48 weeks

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11
Q

peginterferon is pregnancy category _

A

C

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12
Q

peginterferon contains ____

A

benzyl alcohol

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13
Q

renal dosing for entecavir

A

CrCL >50= 0.5 mg daily
CrCL 30-49= 0.5 mg q48h
CrCL 10-12= 0.5 mg q72h
CrCL <10 or HD= 0.5 mg weekly

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14
Q

TDF renal dosing

A

CrCL>50= 300 mg daily
CrCL 30-49= 300 mg q48h
CrCL 10-29= 300 mg q72-96h
CrCL <10 or HD= 300 mg weekly

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15
Q

adverse effects of entecavir

A

lactic acidosis

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16
Q

adverse effects of tenofovir AF

A

lactic acidosis, nephropathy, fanconi syndrome

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17
Q

adverse effects of TDF

A

nephropathy, fanconi syndrome, osteomalacia, lactic acidosis

18
Q

treatment in renal and bone disease

A

no preference btwn TDF and entecavir. if TDF associated bone/renal disease–> TAF.

19
Q

TAF metabolism?

A

p-gp substrate, inducers contraindicated

20
Q

TAF, CrCL <15?

A

not recommended

21
Q

TAF dose/food

A

25 mg daily with food

22
Q

TAF drug interaction with carbamazepine

A

carbamazepine inducer: decreases TAF exposure by half

23
Q

TAF drug interaction with cobicistat

A

inhibitor: increases TAF exposure

24
Q

what other drugs interact with TAF

A

harvoni and epclusa

25
Q

safety in HBV treatment with nucleos(t)ide analogues

A

low AE profile, safe in immunocompromised, all stages of liver disease, indefinite treatment duration, resistance

26
Q

safety in HBV treatment with interferons

A

many AE, contraindications, limited treatment duration, no resistance

27
Q

phases of chronic hepatitis b infection

A

immune tolerant, immune active, inactive CHB, immune reactivation

28
Q

during which phases of CHB is HBV DNA elevated?

A

immune tolerant, immune active, reactivation

29
Q

during which phases of CHB is ALT elevated?

A

immune active, reactivation

30
Q

during which phase of CHB is there liver injury?

A

immune active

31
Q

during which phase of CHB is there necroinflammation and fibrosis?

A

immune reactivation

32
Q

when to treat for immune active CHB

A

generally do. ALT >2x ULN, liver injury, HBeAg- 2000, HBeAg +20,000

33
Q

when to treat for immune tolerant CHB

A

generally don’t, if everything looks good. monitor.

34
Q

when to treat after HBeAg seroconversion

A

we want the HB envelope antigen (HBeAg) to be negative. emergence of anti-Hbe (envelope). but don’t stop when it emerges, generally consolidate for 12 months with persistent normal ALT, negative HBV DNA, monitor q3m post cessation.

35
Q

when to treat after HBeAg seroconversion with cirrhosis?

A

kind of a grey area: things to balance– cost, adverse effects, resistance. relapse, decompensation, HCC.. just realize it is difficult to decide

36
Q

if people don’t convert?

A

indefinite antiviral therapy

37
Q

role for duel therapy?

A

breakthrough on monotherapy.

38
Q

treatment options for cirrhosis?

A

interferon is NOT an option. tenofovir and entecavir preferred.

39
Q

HBV for pregnancy?

A

HBV DNA >200,000. start at 28-32 weeks gestation: TDF, lamivudine, telbivudine, breastfeeding not contraindicated.

40
Q

HBV treat for children?

A

we should if they have immune active: elevated ALT, HBV DNA.

41
Q

which HBV drugs for children >2 (not rlly on test)

A

lamivudine, entecavir, TDF

42
Q

which HBV drugs for children >12 (not rlly on test)

A

adefovir, TAF

GI (15 decks)

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