Hep C Flashcards
- Hep C is the most common ____
- Commonly associated w/ which 3 things?
- blood-borne pathogen
- IVDU
- Renal dialysis
- Body piercing, tattoos
- ___ nature of acute infections
- ___ to ___ year disease progression
- silent
- 20-30
What are the 2 most common genotypes of Hep C?
- Genotype 1a and 1b
Treatment regimens for Hep C are usually __ to ___ weeks
- 6 to 24 weeks
Hep C virus uses what to replicate?
Healthy cells
What drugs are these?
- BoceprEVIR
- GlecaprEVIR
- GrazoprEVIR
NS3/4A Protease Inhibitors
What drugs are these?
- DaclatASVIR
- ElbASVIR
- LedipASVIR
NS5A Inhibitors
What drugs are these?
- DasaBUVIR
- SofoBUVIR
NS5B Polymerase Inhibitors
What category?
- Sofosbuvir
NS5B Nucleoside Polymerase Inhibitor
Which category?
- Dasabuvir
- Beclabuvir
NS5B Non-Nucleoside Polymerase Inhibitors
Which category?
- Daclatasvir
- Ledipasvir
- Ombitasvir
- Elbasvir
- Velpatasvir
- Pibrentasvir
NS5A Inhibitors: replication complex inhibitor
NS3/4A Protease Inhibitors: inhibits ___ replication directly binding to the NS3/4A protease that cleaves HCV - encoded polyproteins
HCV
Which 2 HCV meds have been discontinued?
- Boceprevir
- Telaprevir
What 2 lab tests are recommended at any time prior to starting antiviral therapy?
- HCV genotype and subtype
- Quantitative HCV RNA (HCV viral load)
What 4 lab tests are recommended within 12 weeks prior to starting antiviral therapy?
- CBC - complete blood count
- INR - international normalized ratio
- Hepatic function panel (ALT & AST)
- Calculated glomerular filtration rate (eGFR)
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
- decompensated liver disease
- NS3
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
- HBV coinfection
- prior infection
What 3 tests are recommended after 4 weeks of tx and as clinically indicated?
- CBC
- Creatinine level
- calculated eGFR
- Hepatic function panel
Patients receiving _____/_____ should be monitored with a hepatic function panel at 8 weeks and again at 12 weeks if receiving 16 weeks of tx
Elbasvir / Grazoprevir
A 10-fold increase in ____ activity at any time during tx should prompt discontinuation of therapy
alanine aminotransferase (ALT)
An increase in ALT <10-fold that is accompanied by what 7 things should also prompt discontinution of therapy?
- weakness
- nausea
- vomiting
- jaundice
- significantly increased bilirubin
- increased alkaline phosphatatse
- increased INR
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
2
Which part of Hep C Virus Lifecycle?
-
NS5A inhibitors
- Ledipasvir
- Ombitasvir
- Daclatasvir
- Elbasvir
- Viral Assembly
- Transport & Release
Which part of the Hep C Virus Lifecycle?
-
NS5B Polymerase inhibitors
- Dasubuvir
- Sofosbuvir
RNA replication
Which part of the Hep C Virus Lifecycle?
-
NS3/4A protease inhibitors
- Telaprevir
- Boceprevir
- Simeprevir
Polyprotein processing
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
Ribavirin
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
Simprevir (Olysio)
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.
Epclusa
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.
Mavyret (glecaprevir & pibrentasvir)
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.
Vosevi (sofosbuvir/velpatasvir/voxilapresvir tablet)
What are the 3 “PAN-GENOTYPIC MEDICATIONS” which treat all genotypes?
- Epclusa
- Mavyret
- Vosevi
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*
Epclusa (Sofosbuvir / Velpatasvir)
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*
Epclusa (Sofosbuvir / Velpatasvir)
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
Mavyret (Glecaprevir & Pibrentasvir)
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.
Mavyret (Glecaprevir & Pibrentasvir)
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
Vosevi (Sofosbuvir / Velpastavir / Voxilaprevir)
What 6 medications are Genotype Specific for HCV Genotype 1?
- Daklinza w/ Sovaldi sometimes given w/ Ribavirin
- Harvoni sometimes given w/ Ribavirin
- Olysio plus Sovaldi sometimes given w/ Ribavirin
- Kiekira Pak
- Viekira XR
- Zepatier
Which drug for HCV Genotype 1?
ADE:
- fatigue
- HA
- Nausea
- anemia
Daklinza
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
- Harvoni
“The breakthrough drug”
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
Olysio plus Sovaldi
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
Viekira Pak
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
Viekira XR
ADEs of which HCV Genotype 1 drug?
- W/o Ribavirin: fatigue, HA, nausea
- W/ Ribavirin: anemia, HA, fatigue, SOB, rash, itching
Zepatier
Which medication is genotype specific for HCV Genotype 2?
Sovaldi (sofosbuvir + ribavirin)
What are the 2 ADEs of Sovaldi + Ribavirin (Genotype 2)?
- Fatigue & Headache
- What are the 2 medications genotype specific for HCV Genotype 3?
- What are their 2 side effects?
- Daklinza with Sovaldi
- Sovaldi + Ribavirin
- Fatigue and HA
What 4 medications are Genotype 4?
- Harvoni
- Sovaldi
- Technivie
- Zepatier
ADEs of which HCV Genotype 4?
- Fatigue & HA
- w/ Ribavirin: weakness, HA, cough
Harvoni
ADEs of which HCV Genotype 4?
- Fatigue & HA
Sovaldi + Ribavirin
ADEs of which HCV Genotype 4?
- w/ Ribavirin: fatigue, nausea, sleep problems, feeling weak, itching/redness/rash
Technivie
ADEs of which HCV Genotype 4?
- w/o Ribavirin: fatigue, HA, nausea
- w/ ribavirin: anemia, HA, fatigue, SOB, rash/itching
Zepatier
Genotype 5 drug
SE?
Harvoni
Fatigue & HA
Genotype 6 drug?
SE?
Harvoni
Fatigue & HA
Hep B Vaccine prior to tx
- New anti-viral therapies can ____ .
- Hep B vaccine prior to starting tx
- May also need ____ vaccine.
- re-activate past Hep B
- Hep A vaccine
Don’t give _____ for Hep C related pain
Tylenol
