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PT3 ID 2 > HEP B and C therapeutics > Flashcards

HEP B and C therapeutics Flashcards

1
Q

risk factors for Hep B transmission

A
  • IV drug use
  • contact with blood
  • multiple sexual partners
  • mother to infant
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2
Q

Hep B anti-HBc+ indicates

A

prior exposure

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3
Q

HBsAg+ indicates

A

current hep B infection

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4
Q

Hep B anti-HBs+ indicates

A

immunity from vaccine or previous infection

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5
Q

hep B HBeAg+ indicates

A

active Hep B replication

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6
Q

hep B HBV DNA+ indicates

A

active Hep B replication

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7
Q

immediate prophylaxis for Hep B

A

hepatitis B immune globulin IM injection

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8
Q

Hep B vaccine scedule

A

at 0, 1 month, 6 months

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9
Q

which hep B tests to do first when checking for status

A

anti-HBc and HBsAg

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10
Q

if initial hep B tests come out positive what tests to follow up with

A

HBeAg
HBV DNA
ALTs

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11
Q

when to vaccinate adults for hep B

A

when all tests come up negative

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12
Q

how to test for efficacy to hep B vaccine

A

have antiHBs+ (immunity)
antiHBc-
HBsAg-
(not from past exposure or infection)

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13
Q

phases of chronic HBV

A
  • immune tolerant
  • HBeAg-positive immune active
  • inactive chronic hep B
  • HBeAg-negative immune reactivation
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14
Q

HBV immune tolerant phase lab values

A
  • ALT normal
  • HBV DNA >1 million
  • HBeAg positive
  • minimal liver fibrosis
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15
Q

Inactive chronic hep B phase lab values

A
  • ALT normal
  • HBV DNA <2,000 (low or undetectable)
  • HBeAg negative
  • variable fibrosis
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16
Q

HBeAg positive immune active phase labs

A
  • ALT elevated
  • HBV DNA >20,000
  • HBeAg positive
  • moderate to severe inflammation/fibrosis
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17
Q

HBeAg-negative immune reactivation phase labs

A
  • ALT elevated
  • HBV DNA >2,000
  • HBeAG negative
  • mod-severe inflammation/fibrosis
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18
Q

why is HBV not curable

A

gets incorporated into the nucleus of the cell

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19
Q

lab goals of treatment in HBV

A
  • HBV DNA -
  • convert HBeAg- to anti-HBe+
  • convert HBsAg- to anti-HBs+ (rarely done)
  • normalize ALT and AST
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20
Q

secondary goal of HBV treatment

A

reduce progression to cirrhosis, liver cancer

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21
Q

indications for treatment of HBV

A

-HBeAg-positive/negative immune active phase

elevated ALT, HBV DNA, liver damage

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22
Q

treatment options in HBV

A 
interferon
lamivudine
adefovir
entecavir
telbivudine
tenofovir
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23
Q

Interferon alfa regimen

A

sc weekly for 48 weeks

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24
Q

interferon alfa adverse effects

A 
flu like symptoms
depression
alopecia
thrombocytopenia
leukopenia
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25
Q

patients best suited for interferon alfa treatment

A
  • low baseline HBV DNA
  • short disease duration
  • HBeAg+
26
Q

patients least suited for interferon alfa treatment

A

HIV coinfection

27
Q

regimen for nucleotide/side analogs

A

all oral once daily

28
Q

telbivudine adverse effect

A

myopathy w/ CK elevation

29
Q

adefovir adverse effect

A

nephrotoxicity, especially in decomp cirrhosis

not used much

30
Q

TDF adverse effects

A

nephrotoxicity

reduced bone mineral density

31
Q

TAF adverse effects

A

low risk nephrotoxicity

32
Q

clearance of HBsAg by drug groups

A

interferon - good

nucleotide/sides - bad

33
Q

in HBV if nucleotide/side resistance what are pts at risk of

A

acute hepatitis

increased ALT and DNA

34
Q

HBV drugs with low drug resistance

A

entecavir

tenofovir

35
Q

treatment criteria for chronic HBV

A
  • if ALT is >2x or significant histology

- normal ALT with some fibrosis/inflammation and over 40 years old

36
Q

treatment drugs for chronic HBV

A

entecavir
tenofovir
peg-inf

37
Q

treatment drugs for chronic HBV with cirrhosis

A

compensated:
entecavir
tenofovir

decompensated:
combo therapy

38
Q

term for hep C cure

A

sustained virologic response

39
Q

sustained virologic response

A

no detectable HCV in the blood at 12 or more weeks after therapy is complete

40
Q

3 drug classes used in HCV regimens

A

NS3/5
NS5B
NS5A
+/- ribavirin

41
Q

duration of HCV regimens

A

8-24 weeks

typically 12

42
Q

HCV drugs to avoid in liver disease

aka use these in renal insufficiency

A

PrOD/PrO +/- RBV
Grazoprevier/elbasvir +/- RBV
Glecaprevir + pibrentasvir

43
Q

challenges of HCV treatment

A
  • hepatic failure/decompensation
  • many DDIs (amiodarone big one)
  • reactivation of hep B
44
Q

HCV drugs recommended for decompensated cirrhosis

A 
sofosbuvir
velpatasvir
ledipasvir
daclatasvir
\+/- RBV
45
Q

protease inhibitor regimens are not recommended when in HCV

A

decompensated cirrhosis

46
Q

most common drug interactions with HCV drugs

A 
st. john's wort
rifampin
phenobarbital
carbamazepine
phenytoin
amiodarone
47
Q

other drug classes to consider avoiding or adjusting when using HCV drugs

A

statins
PPIs
H2RAs
antacids

48
Q

main cyp and transporters to be worried about in DDIs for HCV drugs

A

pgp
BCRP
3A4

49
Q

antivirals that have pH dependent absorption

A

ledipasvir

velpatasvir

50
Q

ledipasvir and PPI use

A

take simultaneously

51
Q

velpatasvir and PPI use

A

not recommended

if necessary take 4 hours prior to omeprazole

52
Q

H2RA instructions with DAA

A

take together or 12 hours apart

53
Q

antacids instructions with DAA

A

separate by 4 hours

54
Q

if reactivation of hep B occurs in HCV treatment when does it usually occur

A

4-8 weeks

55
Q

for genotype 1a a positive RAS test treatment

A

GRZ+EBR
add RBV
16 week duration

56
Q

for genotype 1a a negative RAS test treatment

A

GRZ+EBR
no RBV
12 week duration

57
Q

for genotype 3 a positive RAS test treatment

A

VEL+SOF or DCV+SOF

add RBV

58
Q

for genotype 3 a negative RAS test treatment

A

VEL+SOF or DCV+SOF only

59
Q

RBV adverse effects

A 
nausea
insomnia
cough
rash
anemia (get tested q2wk until stable)
teratogen
60
Q

DAAs tolerability

A

mild side effects when used without RBV
headache
fatigue
nausea

61
Q

labs to consider for DAAs

A

CBC q2wk with RBV
creatinine
hepatic function
HCV genotype

62
Q

tests to assess efficacy of HCV drugs

A

HCV PCR at week 4 and week 12 after treatment

PT3 ID 2 (6 decks)

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