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Hep C Flashcards

1
Q

How is Hep A transmitted?

A

Fecal-oral route -person to person and contamination of water

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2
Q

What can you admister as post exposure prophylaxis for a patient infected with Hep A?

A

Immune globulin (IG) within 2 weeks- stimulates the immune system to recognize the virus

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3
Q

Havrix

A

MOA- Inactivation Hep A vaccine, inducing the production of specific anti-HAV antibodies

IM Injection

WARNINGS- Latex allergy, bleeding disorder

Monior- LFT, serum neutralizing antibody to Hep A virus (HAVAB and HAVAB-M RIA)

Dosage- adults- 1ml followed by 1ml booster (6-12 months later)

Children- 0.5ml followed by 0.5 ml booster (6-12 months later)

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4
Q

Vaqta

A

MOA- Inactivation Hep A vaccine, inducing the production of specific anti-HAV antibodies

IM Injection

WARNINGS- Latex allergy, bleeding disorder

Monior- LFT, serum neutralizing antibody to Hep A virus (HAVAB and HAVAB-M RIA)

Dosage- adults- 1ml followed by 1ml booster (6-18 months later)

Children- 0.5ml followed by 0.5 ml booster (6-18 months later)

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5
Q

How old do you need to be to get the Hep A vaccine

A

at least 12 months for either havrix or Vaqta

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6
Q

How is Hep B tramsmitted?

A

Blood, Brith and Boinking

unportected sex

mutiple partners

Hep C medication can reactivate Hep B

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7
Q

Which antiviral meications can treat HBV?

A

Entacavir

Tenofovir

Lamivudine

Adefovir

Telbivudine

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8
Q

Engerix B

A

3 dose series vaciines for Hep B

MOA- recombinant DNA hepatitis B vaccine whihc contains purified surface antigen for the hepatitis B virus

IM injection

WARNING- syncope, apnea in premature infants, dimished immune response in immunoconpromised patients, latex allergy

Monitor- Hep B surface antibody levels

Adminstration schedule- adults 20 years and older (1ml 0,1,6 months) adults on hemodialysis 2ml (0,1,2,6 months)

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9
Q

Heplisav-B

A

2 dose series for Hep B

MOA- purified HBV surface antigen (hBsAg) with an adjuvant and is used to increase antibody concentrations against HBsAg inorder to confer protection against all known subtypes of hep b virus infections for patients 18 years and older

IM injection

2 dosees 1 month apart

ADR- cell-mediated immune reaction

Monitor- Hep B surface antibody levels

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10
Q

Recomivax

A

3 dose series vaciines for Hep B

MOA- recombinant DNA hepatitis B vaccine whihc contains purified surface antigen for the hepatitis B virus

IM injection

WARNING- latex allergy, apnea in premature infants, concomitant administration with immune globulin

Monitor- Hep B surface antibody levels

Adults- 3 dose (0, 1, 6 months)

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11
Q

Twinrix

A

Hep A and Hep B vaccination

MOA- contians inactivated Hep A virus and purified HBsAg that confers active immunity against infectins caused by Hep A virus and all known Hep B virus suntypes

Adminsitration

  • Standard- 3 doses (1ml) IM injection at 0, 1, 6 months
  • Accelerated- 4 doeses (1ml) IM injection (days 0, 7, 21-30, follwed by a booster dose at 12 months)

Monitoring- rise in anti- HAV at least 20 mIU/mL and anti-HBa levels at 1 mlIU. ML

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12
Q

How is Hep C transmitted?

A

Blood- blood transfusions, organ trasnplant, sharing needles

Vertical transmission- mother to baby

Sexual contact

NO VACCINE AVAILABLE

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13
Q

What is the goal of Hep C therapy and who should get it?

A

Reduce mortality rates and preven progression of any other liver-related health conditions by achieving sustained virologic respsone (SVR)

Recommeded for all patients- initiate treatment in all patients with HCV infections

​EXCEPT- patients with a short life expectancy, cannot tolerate HCV therapy, longer 15-20 year survival rate when unntreated

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14
Q

Sofobuvir

A

NS5B Polymerase Inhibitor

MOA- binds to active site to prevent RNA chain so no replication. Enzyme that incorporated neucloside/ nucleotide analog into RNA chain

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15
Q

Grazoprevir

A

NS3/4A Protease Inhibitor

MOA- C encodes for capsid and E1/E2 encode for envelop. Protease inhibited so virus cannot cleave proteins (non functional) cleaves non structural polyproteins that are utilized in HCV RNA replication

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16
Q

Glecaprevir

A

NS3/4A Protease Inhibitor

MOA- C encodes for capsid and E1/E2 encode for envelop. Protease inhibited so virus cannot cleave proteins (non functional) cleaves non structural polyproteins that are utilized in HCV RNA replication

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17
Q

Paritaprevir

A

NS3/4A Protease Inhibitor

MOA- C encodes for capsid and E1/E2 encode for envelop. Protease inhibited so virus cannot cleave proteins (non functional) cleaves non structural polyproteins that are utilized in HCV RNA replication

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18
Q

Simeprevir

A

NS3/4A Protease Inhibitor

MOA- C encodes for capsid and E1/E2 encode for envelop. Protease inhibited so virus cannot cleave proteins (non functional) cleaves non structural polyproteins that are utilized in HCV RNA replication

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19
Q

Voxilaprevir

A

NS3/4A Protease Inhibitor

MOA- C encodes for capsid and E1/E2 encode for envelop. Protease inhibited so virus cannot cleave proteins (non functional) cleaves non structural polyproteins that are utilized in HCV RNA replication

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20
Q

Daclatasvir

A

NS5A Inhibitor

MOA- stops phosphorylation (decrease energy= decrease cell function) Hep C RNA cannot be replicated. Phosphorylates protein required for replication

21
Q

Elbasvir

A

NS5A Inhibitor

MOA- stops phosphorylation (decrease energy= decrease cell function) Hep C RNA cannot be replicated. Phosphorylates protein required for replication

22
Q

Ledipasvir

A

NS5A Inhibitor

MOA- stops phosphorylation (decrease energy= decrease cell function) Hep C RNA cannot be replicated. Phosphorylates protein required for replication

23
Q

Ombitasvir

A

NS5A Inhibitor

MOA- stops phosphorylation (decrease energy= decrease cell function) Hep C RNA cannot be replicated. Phosphorylates protein required for replication

24
Q

Pibrentasvir

A

NS5A Inhibitor

MOA- stops phosphorylation (decrease energy= decrease cell function) Hep C RNA cannot be replicated. Phosphorylates protein required for replication

25
Q

Velpatasvir

A

NS5A Inhibitor

MOA- stops phosphorylation (decrease energy= decrease cell function) Hep C RNA cannot be replicated. Phosphorylates protein required for replication

26
Q

Dasabuvir

A

Non- Nucleoside NS5B Palm Polymerase Inhibitor

MOA- binds to allosteric site which causes a confirmational change and RNA cannot bind and replicate. Enzyme that incorporates nucleoside/nucleotide aanalog into RNA chain

27
Q

Ritonavir

A

3A4 PK Booster

MOA- Increase concentration of other meds. Used in combination with other anti-virals.

28
Q

Which antivirals work with genotype 1a/1b?

A
  • Zepatier (Elbasvir/ Grazoprevir)
    • without cirrhosis (daily 12 weeks)
    • with cirrhosis (daily 12 week)
  • Mavyret (Glecaprevir/ Pibrentasvir)
    • without cirrhosis (daily 8 weeks)
    • with cirrhosis (daily 12 week)
  • Harvoni (Ledipasvir/ Sofosbuvir)
    • without cirrhosis (daily 8 weeks)
      • HCV levels <6 million IU/mL
      • if greater then daily 12 weeks
    • with cirrhosis (daily 12 week)
  • Epclusa (Velpatasvir/ Sofosbuvir)
    • without cirrhosis (daily 12 weeks)
    • with cirrhosis (daily 12 week)
29
Q

Which antiviral work with genotype 2?

A
  • Mavyret (Glecaprevir/ Pibrentasvir)
    • without cirrhosis (daily 8 weeks)
    • with cirrhosis (daily 8 week)
  • Epclusa (Velpatasvir/ Sofosbuvir)
    • without cirrhosis (daily 12 weeks)
    • with cirrhosis (daily 12 week)
30
Q

Which antiviral work with genotype 3?

A
  • Mavyret(Glecaprevir/ Pibrentasvir)
    • without cirrhosis (daily 8 weeks)
    • with cirrhosis (daily 12 week)
  • Epclusa (Velpatasvir/ Sofosbuvir)
    • without cirrhosis (daily 12 weeks)
    • with cirrhosis (daily 12 week)
31
Q

Which antiviral work with genotype 4?

A
  • Zepatier(Elbasvir/ Grazoprevir)
    • without cirrhosis (daily 12 weeks)
    • with cirrhosis (daily 12 week)
  • Mavyret(Glecaprevir/ Pibrentasvir)
    • without cirrhosis (daily 8 weeks)
    • with cirrhosis (daily 12 week)
  • Harvoni (Ledipasvir/ Sofosbuvir)without cirrhosis (daily 8 weeks)
    • without cirrhosis (daily 12 weeks)
    • with cirrhosis (daily 12 week)
  • Epclusa (Velpatasvir/ Sofosbuvir)
    • without cirrhosis (daily 12 weeks)
    • with cirrhosis (daily 12 week)
32
Q

Which antivirlas work with genotype 5/6?

A
  • Mavyret (Glecaprevir/ Pibrentasvir)
    • without cirrhosis (daily 8 weeks)
    • with cirrhosis (daily 12 week)
  • Harvoni (Ledipasvir/ Sofosbuvir)without cirrhosis (daily 8 weeks)
    • without cirrhosis (daily 12 weeks)
    • with cirrhosis (daily 12 week)
  • Epclusa (Velpatasvir/ Sofosbuvir)
    • without cirrhosis (daily 12 weeks)
    • with cirrhosis (daily 12 week)
33
Q

Sovaldi (Sofosbuvir)- side effects and monitoring

A

side effects- fatigue/ headache, GI effects, pruritus, decrease appetite

Monitoring- Pregnancy caution (sofosbuvir alone- category B), Serious DDI, no dosage recommendation for eGFR <30ml

34
Q

Harvoni (Ledipasvir/ Sofosbuvir) - side effects and monitoring

A

side effects- Asthenia, Hyperbilirubinemia, fatigue/ headache, GI effects

Monitoring- No hepatic dose adjustment, no renal dose adjustments (caution CrCl <30mL)

35
Q

Viekira Pak (Paritaprevir/ Ritonavir/ Ombitasvir/ Dasabuvir)- side effects and monitoring

A

side effects- GI effects, Rash, Elevated LFT

Monitoring- No renal/ hepatic dose adjustment, major DDI, C/I in patients with moderate or severe hepatic impairment, drugs that are CYP3A4 inhibitors/ inducers

36
Q

Daklinza (Daclatasvir/ Sofosbuvir)- side effects and monitoring

A

side effects- Anemia, fatigue/ headache, GI effects

Monitoring- C/I with CYP Inducers, dose adjustments based on CYP3A4 sunstrates

37
Q

Technivie (Ombitasvir/ Paritaprevir/ Ritonavir)- side effects and monitoring

A

side effects- Asthenia, Fatigue/ Headache, GI effects, Pruritis/ skin reactions

Monitoring- No renal dose adjustment, C/I patient with hepatic moderate to severe impairment,

38
Q

Zepatier (Elbasvir/ Grazoprevir)- side effects and monitoring

A

side effects- Anemia, Elevated LFT, Fatigue/ Headache, GI effects

Monitoring- No hepatic/ renal dose adjustment, C/I patient with moderate or severe hepatic impairment

39
Q

Epclusa (Sofosbuvir/ Velpatasvir) - side effects and monitoring

A

side effects- Anemia, GI effects, fatigue/ headache

Monitoring- No hepatic/ renal dose adjustment, Major DDI

40
Q

Vosevi (Sofosbuvir/ Velpatasvir/ Voxilaprevir)- side effects and monitoring

A

side effects- Fatigue/ headache, GI effects, Rash, Depression, Elevated lipase, CPK, T.bili

Monitoring- Majot DDI, do not use if eGFR < 30ml

41
Q

Mavyret (Glecaprevir/ Pibrentasvir)- side effects and monitoring

A

side effects- fatigue, GI effects, Elevated t.bili

Monitoring- No renal dose adjustment, C/I patient with hepatic impairment, atazanavir or rifampin

42
Q

Interferon

Peginterferon alfa-2a

Peginterferon alfa-2b

A

MOA- induces innate antiviral immune respnse

Side effects- injection site reaction, flu-like aymptoms, alopecia, thrombocytopenia, leukopenia, photosensitivity

BBB warning- fatal neuropsychiatric, autoimmune, ischemic and infectious disorders (CNS psychosis & arrhythmia)

43
Q

Ribavirin

A

MOA- inhibits HCV viral polymerase activity

ADR- Anemia, injection site reaction, weight loss, diarrhea, insomnia, weakness, flu-like symptoms, hepatotoxicity (in combo with interferon)

BBB Warning- Hemolytic Anemia, Teratogenic

44
Q

Hep C medication monitoring

A

Prior to therapy

  • CBC, INR, LFT, eGRF

During therapy

  • HCV viral load (week 4 and end of therapy)
  • routine labs
  • monitor DDI

After therapy

  • Check HCV viral load 12 weeks after end of therapy
    • must be undetectable for SVR
45
Q

DDI with Amiodarone and Digoxin

  • Which HCV agents
  • Interactions
  • Recommendations
A

HCV Agents- Harvoni, Epclusa, Zepatier, Mavyret

Interactions- Symptomatic bradycardia

Recommendation- reduce digoxin by 50%, monitor EKG during therpy

46
Q

DDI with Antacids (H2 antagonist, PPI)

  • Which HCV agents
  • Interactions
  • Recommendations
A

Which HCV agents- Epclusa, Vosevi, Harvoni

Interactions- decreasde antiviral concentration

Recommendations- seperate by 4 hours or select different HCV agent

47
Q

DDI with Phenytoin

  • Which HCV agents
  • Interactions
  • Recommendations
A

Which HCV agents- Harvoni, Epclusa, Zepatier, Mavyret

Interactions- Decreased antiviral concentration (P-gp activation and CYP inhibition)

Recommendations- contraindicated use another anti-epileptic (Keppra, Lamictal, Depakote)

48
Q

DDI with Rifampin

  • Which HCV agents
  • Interactions
  • Recommendations
A

Which HCV agents- Harvoni, Epclusa, Zepatier, Mavyret

Interactions- Decreased antiviral concentration (P-gp activation and CYP inhibition)

Recommendations- contraindicated

49
Q

How to diagnose Hep C?

A

LFT, imagining, liver biopsy

First serologic test of antibody to HCV (anti-HCV)

  • non reactive= no Hep C
  • Reactive= further Hep C testing

Further Hep C testing

  • Molecular assay for HCV RNA- tests for viral load

Pharm (9 decks)

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