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SG - Pharm 4 > Hep C > Flashcards

Hep C Flashcards

1
Q
  • Hep C is the most common ____
  • Commonly associated w/ which 3 things?
A
  • blood-borne pathogen
  • IVDU
  • Renal dialysis
  • Body piercing, tattoos
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2
Q
  • ___ nature of acute infections
  • ___ to ___ year disease progression
A
  • silent
  • 20-30
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3
Q

What are the 2 most common genotypes of Hep C?

A
  • Genotype 1a and 1b
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4
Q

Treatment regimens for Hep C are usually __ to ___ weeks

A
  • 6 to 24 weeks
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5
Q

Hep C virus uses what to replicate?

A

Healthy cells

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6
Q

What drugs are these?

  • BoceprEVIR
  • GlecaprEVIR
  • GrazoprEVIR
A

NS3/4A Protease Inhibitors

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7
Q

What drugs are these?

  • DaclatASVIR
  • ElbASVIR
  • LedipASVIR
A

NS5A Inhibitors

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8
Q

What drugs are these?

  • DasaBUVIR
  • SofoBUVIR
A

NS5B Polymerase Inhibitors

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9
Q

What category?

  • Sofosbuvir
A

NS5B Nucleoside Polymerase Inhibitor

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10
Q

Which category?

  • Dasabuvir
  • Beclabuvir
A

NS5B Non-Nucleoside Polymerase Inhibitors

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11
Q

Which category?

  • Daclatasvir
  • Ledipasvir
  • Ombitasvir
  • Elbasvir
  • Velpatasvir
  • Pibrentasvir
A

NS5A Inhibitors: replication complex inhibitor

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12
Q

NS3/4A Protease Inhibitors: inhibits ___ replication directly binding to the NS3/4A protease that cleaves HCV - encoded polyproteins

A

HCV

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13
Q

Which 2 HCV meds have been discontinued?

A
  • Boceprevir
  • Telaprevir
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14
Q

What 2 lab tests are recommended at any time prior to starting antiviral therapy?

A
  • HCV genotype and subtype
  • Quantitative HCV RNA (HCV viral load)
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15
Q

What 4 lab tests are recommended within 12 weeks prior to starting antiviral therapy?

A
  • CBC - complete blood count
  • INR - international normalized ratio
  • Hepatic function panel (ALT & AST)
  • Calculated glomerular filtration rate (eGFR)
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16
Q

Pts w/ current or prior hx of ____ or w/ a current CTP score of 7 or greater should NOT receive tx w/ regiments that contain ____ protease inhibitors due to increased blood levels / lack of safety data

A
  • decompensated liver disease
  • NS3
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17
Q

All patients initiating HCV direct acting antiviral (DAA) therapy should be assessed for ______ w/ HBsAg testing and for evidence of ____ w/ anti-HBs and anti-HBc testing

A
  • HBV coinfection
  • prior infection
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18
Q

What 3 tests are recommended after 4 weeks of tx and as clinically indicated?

A
  • CBC
  • Creatinine level
  • calculated eGFR
  • Hepatic function panel
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19
Q

Patients receiving _____/_____ should be monitored with a hepatic function panel at 8 weeks and again at 12 weeks if receiving 16 weeks of tx

A

Elbasvir / Grazoprevir

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20
Q

A 10-fold increase in ____ activity at any time during tx should prompt discontinuation of therapy

A

alanine aminotransferase (ALT)

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21
Q

An increase in ALT <10-fold that is accompanied by what 7 things should also prompt discontinution of therapy?

A
  • weakness
  • nausea
  • vomiting
  • jaundice
  • significantly increased bilirubin
  • increased alkaline phosphatatse
  • increased INR
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22
Q

Asymptomatic increases in ALT <10-fold should be closely monitored w/ repeat testing at ___ week intervals. If levels remain persistently elevated, consideration should be given to discontinue therapy

A

2

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23
Q

Which part of Hep C Virus Lifecycle?

  • NS5A inhibitors
    • Ledipasvir
    • Ombitasvir
    • Daclatasvir
    • Elbasvir
A
  • Viral Assembly
  • Transport & Release
24
Q

Which part of the Hep C Virus Lifecycle?

  • NS5B Polymerase inhibitors
    • Dasubuvir
    • Sofosbuvir
A

RNA replication

25
Q

Which part of the Hep C Virus Lifecycle?

  • NS3/4A protease inhibitors
    • Telaprevir
    • Boceprevir
    • Simeprevir
A

Polyprotein processing

26
Q

Which Box Warning?

  • Must not be taken by pregnant women or the male partners of pregnant women
    • Teatogenic / emryocidal effects
  • Extreme care must be taken to avoid pregnancy during treatment and for six months following treatment in both female patients and female partners of male patients who are taking ribavirin
  • Use two forms of birth control during this period

Example, a man could use a condom and a woman could use a diaphragm or birth control pills

A

Ribavirin

27
Q

Which box warning?

  • Protease inhibitors interfere with hormonal birth control
    • Birth control pills
    • Uterine implants
    • Depo-Provera injections
    • Vaginal rings
    • Use two non-hormonal forms of birth control
    • Example: a condom and diaphragm plus spermicidal jelly
A

Simprevir (Olysio)

28
Q

Which drug?

  • only given with ribavirin in cases of decompensated (advanced) cirrhosis.
  • Recommended dosage: One tablet (sofosbuvir 400 mg/velpatasvir 100 mg) taken orally once daily with or without food.
  • Length of treatment is 12 weeks.
  • The most common side effects are headache and fatigue.
  • When given with ribavirin, the most common side effects include headache, fatigue, nausea, diarrhea, insomnia and anemia.
A

Epclusa

29
Q

Which drug?

  • Recommended dosage: Three tablets (glecaprevir 100 mg/pibrentasvir 40 mg) taken orally once daily with food
  • Length of treatment is 8, 12 or 16 weeks depended on genotype, previous HCV treatment experience and having compensated cirrhosis.
  • The most common side effects are headache and fatigue.
A

Mavyret (glecaprevir & pibrentasvir)

30
Q

Which drug?

  • Recommended dosage: One tablet (400 mg of sofosbuvir, 100 mg of velpatasvir, and 100 mg of voxilapresvir) taken orally once daily with food.
  • Length of treatment is 12 weeks for patients without cirrhosis and patients with compensated cirrhosis.
  • The common side effects for Vosevi include headache, tiredness, diarrhea, and nausea.
A

Vosevi (sofosbuvir/velpatasvir/voxilapresvir tablet)

31
Q

What are the 3 “PAN-GENOTYPIC MEDICATIONS” which treat all genotypes?

A
  • Epclusa
  • Mavyret
  • Vosevi
32
Q

Drug interactions of which drug?

  • Increased levels of Amiodarone –> bradycardia*
  • Increased levels of statin medication (e.g., atorvastatin, rosuvastatin)
  • Decreased efficacy with concomitant rifampin ( Rifadin, Rifamate, Rifater, Rimactane), St. John’s wort*
A

Epclusa (Sofosbuvir / Velpatasvir)

33
Q

Drug interactions of what drug?

  • AED –> decrease level of sofosbuvir*
    • Carbamazepine, oxcarbazepine, phenobarbital, primidone
  • Proton pump inhibitors of H2 blockers decrease the level of Epclusa
  • Take antacids containing aluminum or magnesium hydroxide fours hours before or fours hours Epclusa.
  • Drug interaction issues with some of the medications used to treat HIV*
A

Epclusa (Sofosbuvir / Velpatasvir)

34
Q

Drug interactions of what drug?

  • Taking other drugs including with atazanavir or rifampin at the same time as Mavyret.
  • Taking these medications can reduce the success of the medication
  • Digoxin treat heartbeat irregularities, at the same time as Mavyret.
  • Increased levels of statin medication (e.g., atorvastatin, rosuvastatin)
  • Decreased efficacy with concomitant rifampin ( Rifadin, Rifamate, Rifater, Rimactane), St. John’s wort
A

Mavyret (Glecaprevir & Pibrentasvir)

35
Q

Drug interactions of what drug?

  • AED –> decrease level of sofosbuvir
    • Carbamazepine, oxcarbazepine, phenobarbital, primidone
  • Oral contraceptives at the same time as Mavyret can increase ALT levels and is not recommended
  • Drug interaction issues with some of the medications used to treat HIV
  • Not recommended for those taking immunosuppressants such as Cyclosporine on a daily basis.
A

Mavyret (Glecaprevir & Pibrentasvir)

36
Q

Which drug?

  • Increased levels of Amiodarone à bradycardia
  • Increased levels of statin medication (e.g., atorvastatin, rosuvastatin)
  • Decreased efficacy with concomitant rifampin ( Rifadin, Rifamate, Rifater, Rimactane), St. John’s wort
  • AED à decrease level of sofosbuvir
    • Carbamazepine, oxcarbazepine, phenobarbital, primidone
A

Vosevi (Sofosbuvir / Velpastavir / Voxilaprevir)

37
Q

What 6 medications are Genotype Specific for HCV Genotype 1?

A
  • Daklinza w/ Sovaldi sometimes given w/ Ribavirin
  • Harvoni sometimes given w/ Ribavirin
  • Olysio plus Sovaldi sometimes given w/ Ribavirin
  • Kiekira Pak
  • Viekira XR
  • Zepatier
38
Q

Which drug for HCV Genotype 1?

ADE:

  • fatigue
  • HA
  • Nausea
  • anemia
A

Daklinza

39
Q

Which drug for HCV Genotype 1?

ADE:

  • Tx for 8, 12, or 24 weeks: fatigue, HA, neuromuscular/skeletal weakness
  • When given w/ ribavirin: weakness, HA, cough
A
  • Harvoni

“The breakthrough drug”

40
Q

Which drug for HCV Genotype 1?

ADE:

  • Tx for 12 weeks w/ combo therapy: fatigue, HA, nausea, insomnia, itching, rash, photosensitivity
  • Tx for 24 weeks: all above + dizziness & diarrhea
A

Olysio plus Sovaldi

41
Q

ADEs of which HCV Genotype 1 drug?

  • w/o Ribavirin: nausea, itching, sleep problems
  • w/ Ribavirin: tiredness, nausea, itching, sleep problems, feeling weak, skin rxns such as redness or rash
A

Viekira Pak

42
Q

ADEs of which HCV Genotype 1 drug?

  • Length of tx is 12 weeks (w/ cirrhosis)
  • Lenght of tx if 24 weeks (w/ compensated cirrhosis)
  • W/o ribavirin: nausea, itching, sleep problems
  • W/ Ribavirin: tiredness, nausea, itching, sleep problems, feeling weak, skin rxns such as redness and rash
A

Viekira XR

43
Q

ADEs of which HCV Genotype 1 drug?

  • W/o Ribavirin: fatigue, HA, nausea
  • W/ Ribavirin: anemia, HA, fatigue, SOB, rash, itching
A

Zepatier

44
Q

Which medication is genotype specific for HCV Genotype 2?

A

Sovaldi (sofosbuvir + ribavirin)

45
Q

What are the 2 ADEs of Sovaldi + Ribavirin (Genotype 2)?

A
  • Fatigue & Headache
46
Q
  • What are the 2 medications genotype specific for HCV Genotype 3?
  • What are their 2 side effects?
A
  • Daklinza with Sovaldi
  • Sovaldi + Ribavirin
  • Fatigue and HA
47
Q

What 4 medications are Genotype 4?

A
  • Harvoni
  • Sovaldi
  • Technivie
  • Zepatier
48
Q

ADEs of which HCV Genotype 4?

  • Fatigue & HA
  • w/ Ribavirin: weakness, HA, cough
A

Harvoni

49
Q

ADEs of which HCV Genotype 4?

  • Fatigue & HA
A

Sovaldi + Ribavirin

50
Q

ADEs of which HCV Genotype 4?

  • w/ Ribavirin: fatigue, nausea, sleep problems, feeling weak, itching/redness/rash
A

Technivie

51
Q

ADEs of which HCV Genotype 4?

  • w/o Ribavirin: fatigue, HA, nausea
  • w/ ribavirin: anemia, HA, fatigue, SOB, rash/itching
A

Zepatier

52
Q

Genotype 5 drug

SE?

A

Harvoni

Fatigue & HA

53
Q

Genotype 6 drug?

SE?

A

Harvoni

Fatigue & HA

54
Q

Hep B Vaccine prior to tx

  • New anti-viral therapies can ____ .
  • Hep B vaccine prior to starting tx
  • May also need ____ vaccine.
A
  • re-activate past Hep B
  • Hep A vaccine
55
Q

Don’t give _____ for Hep C related pain

A

Tylenol

SG - Pharm 4 (16 decks)

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