Hepatitis

Question 1

*Lamivudine, *tenovir. (+Entecavir)

Answer 1

Hepatitis
-Nucleoside/nucleotide analogs
-focused on Hep B
Lamivudine
-Therapeutic Indication
  -Chronic HBV
  -HIV
Tenofovir
-Therapeutic Indication
  -Chronic HBV
-Pharmacokinetics
  -Oral bioavailability 25% fasting – *39% high-fat meal
ADE
lamivudine -Headache, nausea, dizziness
tenofovir -HA and *asthma (caution in pts w/ renal dysfx), GI complaints

Question 2

*Pegylated interferon 2a; 2b

Answer 2

Hepatitis
-Interferon Alpha
-focused on Hep B
-*dose reduced for pts w/ renal insufficiency
Therapeutic indication
-Hepatitis C (and B apparently)
-HBV
MOA
-Stimulate Interferon receptors = degradation of host/viral RNA and protein synthesis
-Degradation of viral/host mRNA 
-Inhibit viral/host protein synthesis
ADE
-*flu-like sx, *neurotoxicity, *myopathy, neutropenia

Question 3

Ribavirin

Answer 3

Hepatitis
-focused on Hep C
Therapeutic
-HCV
-RSV
-*Not a monotherapy used with other antivirals (PEG INF, Sofosbuvir)
MOA
-*Interfere with GTP synthesis
-*Inhibit RNA dependent polymerase
-Inhibit capping of viral mRNA
-*Ribavirin Triphosphate (RTP) inhibits replication:
  -Influenza, RSV, HIV, HCV
ADE
-*hemolytic anemia
Contraindication
-*pregnancy due to teratogenoic effects

Question 4

*Simeprevir

Answer 4

Hepatitis
-focused on Hep C
Therapeutic
-HCV: used in combination of PEG INF + Ribavirin or Sofosbuvir
MOA
-Inhibitor of HCV NS3/4A serine protease, important for viral replication
ADE
-*rash, photosensitivity, pruritus, nausea
Contraindications
-Associated with other antivirals apply to Simeprevir

Question 5

*Sofobuvir

Answer 5

Hepatitis
*Polymerase inhibitor
-focused on Hep C
Therapeutic
-HCV used in *combination with (simeprevir, ribavirin, or ribavirin + PEG INF)
MOA
-Nucleotide analog HCV NSB5 
-RNA dependent RNA
ADE (depends on combo)
-+ ribavirin ( fatigue and headache)
-+ PEG INF (fatigue, headache, nausea, insomnia, and anemia) 
Contraindications
-Associated with other antivirals apply (*patients negative pregnancy test before initiation)

Question 6

*Harvoni, *Sofosbuvir+Ledipasvir

Answer 6

Hepatitis
-focused on Hep C
-\$\$$
Therapeutic
-HCV
MOA
-HCV NS5A inhibitor
ADE
-fatigue, HA

Question 7

Lactulose

Answer 7

Liver dysfx
-osmotic laxative
Therapeutic
-used in hepatic encephalopathy
-reduces blood ammonia levels
MOA
-Reduction of fecal pH, leading to reduced blood ammonia.  
-ammonia that diffuses into gut is "trapped" and excreted in poop (NH3-->NH4) *"ION TRAPPING"
-suppress urease producing organism
-causes an osmotic type of laxation with diminishes fecal stasis
ADE
-excessive sweet taste
-GI upset
-hypernatremia