Hepatitis Flashcards
This hepatitis virus is acute, fecal-oral transmission, has a vaccine and first line is supportive treatment
HEP A
This hepatitis virus is both acute & chronic, bodily fluid/blood transmission, has a vaccine and first line is PEG-INF or NRTI (tenofovir or entecavir)
HEP B
This hepatitis virus is both acute & chronic, bodily fluid/blood transmission, no vaccine and first line is (naive: DAA combo)
HEP C
preferred HCV regimens consist of 2-3 _____ with different mechanisms, usually for 8-12 weeks
direct-acting antivirals
some combos include ritonavir, which is NOT active for HCV, but to boost levels of HCV protease inhibitors
Mechanism: NS3/4A, protease inhibitor
glecaPREVIR
grazoPREVIR
paritaPREVIR
voxilaPREVIR
mechanism: NS5A replication complex inhibitor
ledipASVIR
ombitASVIR
pibrentASVIR
velpatASVIR
mechanism: NS5B polymerase inhibitor
dasaBUVIR
sofosBUVIR
What do the protease inhibitors used for HIV and HCV have in common?
they are taken with food
“Protease Inhibitor & Grub = PIG)
*except for fosamprenavir
for treatment naive patients - recommended regimens are?
- glecaprevir/pibrentasvir
- sofosbuvir/velpatasvir
ALL DAAs have a BBW for?
risk of reactivating HBV; test all patients for HBV before starting a DAA
What are warnings for sofosbuvir containing regimens?
serious symptomatic bradycardia when taken with AMIODARONE - do not use with each other
Brand: Epclusa
generic: sofosbuvir/velpatasvir
Brand: Mavyret
generic: glecaprevir/pibrentasvir
* with food
What HCV drugs do you dispense in original container?
Sovaldi, epclusa, harvoni, vosevi
Pan-genotypic - approved for all 6 HCV genotypes for treatment naive
epclusa and mavyret
approved for salvage therapy
vosevi, mavyret
approved for 8 week course of therapy
mavyret
approved for HCV/HIV co infection
epclusa, harvoni, mavyret
approved for children >12 with certain genotypes
Sovaldi and harvoni
What HCV drugs do you avoid or minimize with acid suppressive therapy?
epclusa
harvoni
vosevi
All DAAs are contraindicated with strong inducers of
CYP 3A4
carbamazepine/oxcarbamazpine
phenobarbital
phenytoin
rifampin
rifabutin
st johns wort
most DAAs increase concentration of
statins and increase myopathy risk
*monitor BG too
harvoni should not be used with
stribild
technivie and viekira are contraindicated with
strong inducers of 3A4, ethinyl estradiol containing products, lova, simva
What are the BBW for ribavirin
teratogenic effects, not monotherapy
hemolytic anemia
*AVOID IN PREGNANCY and male patients; even 6 months after completion
Interferon alpha is used for
HBV, HCV and some cancer
interferon beta is used for
MS
what are the BBW for interferon alpha
neuropsychiatric, autimmune, ischemic, or infectious disorders; if used with ribavirin, teratogenic/anemia risk
how often is interferon alpha dosed?
weekly (peg)
what are the side effects of interferon alpha?
extensive –
CNS - fatigue, depression
GI upset, inc LFTs, myelosuppresion
flu like syndrome - pre treat with APAP and antihistamine
_________ is approved as monotherapy and is a PREFERRED treatment for HBV
interferon alfa
these drugs inhibit HBV replication by inhibiting HBV polymerase resulting in DNA chain termination
NRTIs
ALL HBV NRTIs should decrease the dose or frequency when CrCl
50
What are the BBW for all HBV NRTIs?
lactic acidosis and severe hepatomegaly with steatosis (can be fatal)
exacerbations of HBV
What is the preferred therapy for hep B (NRTIs)
Vemlidy
Viread
Bacaclude (empty stomach)
Brand: Viread
generic: tenofovir disoproxil fumarate
Brand: Vemlidy
generic: tenofovir alafenamide
Brand: Baraclude
generic: entecavir
Brand: Epivir HBV
generic: lamivudine
Warnings:
renal tox
fanconi syndrome, osteomalacia and dec bone density
TDF
TAF (nausea)
Do not use ____ for treatment of HIV
Epivir HBV (resistance)
