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Hep B & C Flashcards

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1
Q

What are the 5 at risk populations for Hep C?

A

IV drug users, received blood before 7/1992, chronic HD, HIV+ individuals, persons with known exposure (healthcare workers)

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2
Q

What is the pathophysiology of Hep C?

A

Hep C redirects your immune system. Hidden in hepatocytes. Slow transition to cirrhosis/liver cancer. What kills you is susceptibility to another disease.

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3
Q

Name the 4 HCV drug targets.

A

NS3/NS4A, NS5A, NS5B (polymerase)

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4
Q

Which HCV genotype is the worst one and has a faster rate of fibrosis?

A

Genotype 3

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5
Q

Which HCV genotype has a higher likelihood for resistance mutations and a lower cure rate?

A

Genotype 1a

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6
Q

A positive HCV infection requires which testing results…

A

+ HCV antibody and + HCV RNA

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7
Q

What is the biggest interacting drug with HCV options?

A

PPIs

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8
Q

What FIB-4 score indicates that cirrhosis is likely present?

A

FIB-4 >3.25

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9
Q

Child-Pugh A indicates

A

compensated cirrhosis

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10
Q

Child-Pugh B or C indicates

A

decompensated cirrhosis

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11
Q

Increased bilirubin, decreased albumin, increased INR indicate

A

more points for a higher Child-Pugh score

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12
Q

Decreased bilirubin, increased albumin, decreased INR indicate

A

lesser points for a lower Child-Pugh score

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13
Q

When is HCV urgent to treat?

A

3 factors: HIV coinfection, genotype 3, chronic Hep B coinfection

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14
Q

-previr medications target which HCV drug targets

A

NS3/NS4A

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15
Q

-asvir medications target which HCV drug targets

A

NS5A

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16
Q

-buvir medications target which HCV drug targets

A

NS5B

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17
Q

Which HCV medication is notorious for its considerable toxicity?

A

Ribavirin

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18
Q

Which HCV medication should be used in all decompensated cirrhotic patients unless ineligible?

A

Ribavirin

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19
Q

Ribavirin should be discontinued permanently if…

A

WBC <1,000 cells/mm3, ANC <500 cells/mm3, Hgb <8.5 g/dL, Plts <25 x 10*9 cells/L

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20
Q

Which HCV medication should you AVOID if heart disease is unstable of significant?

A

Ribavirin

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21
Q

What are common ADE for HCV meds?

A

HA, fatigue, dizziness, insomnia, memory impairment

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22
Q

Which medication requires men and women to avoid becoming pregnant for 6 months after treatment cessation?

A

Ribavirin

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23
Q

Harvoni is approved for which genotypes?

A

1, 4, 5, 6

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24
Q

Which HCV medications are efficacious in patients with and without cirrhosis?

A

Harvoni (add ribavirin for decompensated)

Epclusa (add ribavirin for decompensated)

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25
When should you complete NS5A resistance testing for Harvoni?
If patient is treatment experienced and has genotype 1a
26
What is the standard duration for Harvoni?
12 weeks (however, may be eligible for 8 weeks)1
27
If Harvoni patients have decompensated cirrhosis and are ineligible for ribavirin, what is the duration of treatment?
24 weeks [need extended therapy]
28
Does Harvoni require renal adjustments?
No!
29
When can you initiate 8 week treatments for Harvoni?
Viral load <6 million Non-cirrhotic [if pt is HIV coinfected, ineligible for 8 week treatment]
30
Which HCV medication hits every genotype?
Epclusa
31
When should you complete resistance testing for Epclusa?
Genotype 3, experienced or cirrhotic patients
32
What is the standard duration for Epclusa?
12 weeks (NO 8-WK OPTION)
33
Epclusa patients with decompensated cirrhosis should have a treatment duration of...
24 weeks
34
Does Epclusa require renal adjustments?
No!
35
What is the max dose of omeprazole a patient can take while on Epclusa or Harvoni?
omeprazole 20 mg once per day
36
Which HCV med requires you to take your PPI 4 hours afterwards? Epclusa or Harvoni?
Epclusa
37
Which HCV med requires you to take your PPI together in the AM after fasting overnight? Epclusa or Harvoni?
Harvoni
38
Which HCV medication is the biggest gun and has all three drug classes in one tablet?
Vosevi
39
Which HCV meds should you AVOID in decompensated cirrhosis?
Vosevi, Mavyret, Zepatier
40
Which side effect is slightly worse in Vosevi than Epclusa?
Diarrhea
41
What kind of DDI does atazanavir have with voxilaprevir in Vosevi?
Quadruples the AUC, should be avoided
42
Does Vosevi require renal adjustments?
No!
43
Which HCV med is the most popular because of its low cost option and shortest duration?
Mavyret
44
What is the duration of treatment for Mavyret in all naive, non-cirrhotic, or compensated patients?
8 weeks (HIV+ with compensated cirrhosis should receive 12 weeks)
45
Which HCV med is not recommended for Child-Pugh class B or C?
Mavyret
46
Does Mavyret need any ESRD or HD adjustment?
No!
47
Why is Zepatier not as good of a HCV med as the rest?
Hits the liver a little harder
48
Which genotypes are Zepatier indicated for?
1 & 4
49
Zepatier is recommended for patients with compensated cirrhosis unless they have genotype...
1a
50
What is the standard duration of treatment for Zepatier?
12 weeks (just do not use)
51
If doses are missed in HCV therapy, what should you do?
Add them to the end of therapy - do not stop exactly at 12 weeks if tablets are remaining
52
What can happen if patients are admitted for GIB and given high-dose PPIs...
High-dose PPIs can overcome Harvoni/Epclusa/Vosevi
53
If PPIs are absolutely necessary, you should
negotiate lower PPI doses
54
If no compromise can be reached regarding PPIs, you should
Stop HCV therapy (may be able to restart in 2-3 days if situation improves)
55
Which HCV med requires a repeated hepatic functional panel every 4 weeks?
Zepatier
56
Which HCV med requires constant CBC monitoring?
Ribavirin
57
What are the two instances you should stop HCV treatment for ADRs?
1. ALT increases 10-fold from baseline | 2. ALT increases <10x but patient is symptomatic (nausea, weakness, jaundice, vomiting)
58
What happens if HCV treatment fails?
1. CBC, hepatic function panel, INR check every 6-12 months | 2. Hepatocellular carcinoma screening every 6 months
59
Which Hepatitis is easier to transmit sexually?
Hep B
60
When is HBV considered a chronic infection?
HBsAg (Hep B antigen) persists for ≥6 months
61
HbsAg+ (positive surface antigen) means
you actively have Hep B
62
anti-HBs+ (positive surface antibodies) means
you have the antibody and you are IMMUNE
63
anti-HBc+ (positive core antibody) means
you were exposed to Hep B at one point, you may still have it
64
Which two HBV medications are NOT PREFERRED? 1. Entecavir 2. Lamivudine 3. Tenofovir disoproxil 4. Adefovir
Lamivudine & Adefovir
65
Which HBV med works well but only if the patient is willing to suffer every day?
Peginterferon alfa-2a
66
Match which tenofovir works where (blood, tissues). 1. tenofovir disoproxil fumarate (TDF) 2. tenofovir alafenamide (TAF)
``` tenofovir disoproxil fumarate (TDF) -> blood tenofovir alafenamide (TAF) -> tissues ```
67
Which HBV med can improve fibrosis/cirrhosis, reduce risk of hepatocellular carcinoma, and can work despite HBV resistance?
Tenofovir
68
Which tenofovir is easier to tolerate and has a high likelihood of success?
TDF
69
TDF should be avoided if CrCl is... a. <40 mL/min b. <50 mL/min c. <60 mL/min d. <70 mL/min
<60 mL/min
70
TAF is safe for patient with CrCl down to at least...
15 mL/min and also HD patients
71
When should you avoid TAF?
Pregnancy | Anti-epileptic therapy
72
Does entecavir require renal adjustments?
Yes, if CrCl <50 mL/min
73
The oddball but good HBV medication (has same benefits as tenofovir)
Entecavir
74
When would you dose 0.5 mg of entecavir vs. 1 mg?
0.5 mg for treatment naive patients | 1 mg for lamivudine-experienced or decompensated cirrhosis
75
Entecavir has what cross-resistance
Lamivudine (but tenofovir is advantageous)
76
Which HBV med has very high rates of resistance and a very high likelihood of generating resistance within 5 years?
Lamivudine
77
Which HBV med is less active and slower-acting than TFV?
Adefovir
78
Which HBV med is more likely to be part of a dual drug regimen for HIV/HBV?
Lamivudine
79
When is emtricitabine recommended?
Treating HBV when HIV/HBV coinfection
80
HIV/HBV requires two HBV agents which are
emtricitabine and TFV
81
This HBV med has shortened therapy but is contraindicated in decompensated cirrhosis
PegIFN
82
What are the goals of therapy for Hep B?
1. Achieve HBeAg seroconversion 2. Loss of HBsAg (lose the surface antigen) 3. Minimize or halt progression of liver damage 4. Reduce risk of developing HCC
83
For Immune-active CHB (liver is getting irritated), which HBV medications are recommended?
PegIFN, TFV, or entecavir (PegIFN has high rates of success)
84
Immune-active HBeAg+ that seroconverts to HBeAg- should continue treatment for at least ____ after seroconversion
1 year
85
Immune-active HBeAg- likely requires ____ treatment
indefinite
86
This hepatitis needs Hep B to survive
Hep D
87
The only approved agent for Hep D is
IFN

Therapeutics (10 decks)

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