Hepatitis and Liver disease Flashcards
What is the brand and drug class of sofosbuvir?
Sofosbuvir (Sovaldi®) is a direct acting antiviral agent (DAA) polymerase inhibitor indicated for treatment of HCV only. It is a nucleotide inhibitor of HCV NS5B polymerase and often combined with other DAA in many recommended HCV regimens.
Hepatitis B virus (HBV) is a vaccine preventable disease that causes acute illness. Which of the following statements about HBV is correct? (Select all that apply)
A. Transmission requires contact with blood, semen, or other body fluids by having sex with an infected person
B. Treatment duration is well defined
C. HBV can lead to liver cirrhosis, liver cancer, and liver failure
D. Ribavirin is often chosen as a first line agent
E. Viread® and Baraclude® are both considered good treatment options for HBV
A, C, E are true
What is the brand and drug class of the combination product sofosbuvir + ledipasvir?
Sofosbuvir + ledipasvir (Harvoni®) are both direct acting antiviral agents (DAA) with slightly different MOA used in the treatment of HCV. Sofosbuvir is a polymerase inhibitor inhibiting NS5B polymerase while ledipasvir is an NS5A replication complex inhibitor. It is one tablet taken once daily and is considered a complete HCV regimen.
Combining these 2 medications allows therapy to target HCV by different mechanisms.
What is the brand and drug class of lamivudine used for hepatitis B?
Lamivudine (Epivir HBV®) is a NRTIs used for the treatment of HBV and, at higher doses, HIV.
What is the brand and drug class of entecavir?
Entecavir (Baraclude®) is an NRTI and is a 1st line agent for the treatment of HBV.
Treatment for HCV usually lasts for how long? A.) 8 weeks B.) 6 weeks C.) 12 weeks D.) 24 weeks
12 weeks
A pharmacist will counsel a patient who is beginning Peg-Intron® self-injections. Counseling points should include all of the following EXCEPT:
A. This medication is given by SC injection, usually once weekly
B. Blood tests will be required to monitor SE. If detected, the dose may need to be reduced
C. if the pt is being treated with combo therapy, they will also take Ribavirin capsules or liquid by mouth everyday. Ribavirin should be taken on an empty stomach.
D. The most common SE include flu-like Sx, fatigue, appetite problems, skin reactions, and hair thinning
E. The flu-like Sx can last 24hr and generally appear 1-2 hrs after administration; pre-to with APAP and antihistamine.
Except C: Ribavirin is given with food in order to increase tolerability
Which of the following medications is Viekira Pak® contraindicated with: (Select all that apply)
A. Metoprolol B. Seasonique C. Tri-Sprintec D. Midazolam E. Viagra®
B, C, D, and E are all contraindicated with Viekira Pak®
Viekira Pak® is contraindicated with several medications including ethinyl estradiol-containing medications, like Seasonique and Tri-Sprintec. Viekira Pak® can cause increased LFTs, especially when combined with ethinyl estradiol meds. It is also CI with concomitant use of other medications highly dependent on CYP3A4 for elimination like midazolam (Versed®) and sildenafil (Viagra®).
One of the major SE and boxed warning for ribavirin is hemolytic anemia. What exactly is hemolytic anemia?
Hemolytic anemia is when RBC are destroyed before their normal lifespan is over. A normal healthy RBC lifespan is 120 days. Hemolytic anemia can be diagnosed by a few tests including bilirubin (which is a test that measures the level or RBCs your liver has broken down), hemoglobin, and LFTs
What is the brand and drug class of sofosbuvir?
Sofosbuvir (Sovaldi®) is a direct acting antiviral agent (DAA) polymerase inhibitor indicated for treatment of HCV only. It is a nucleotide inhibitor of HCV NS5B polymerase and often combined with other DAA in many recommended HCV regimens.
Why should NSAIDs (including ASA) be avoided in cirrhosis patients seeking OTC pain medication?
NSAIDs (including ASA) can precipitate a GI bleed, blunt the diuretic response, and exacerbate renal dysfunction in these patients. APAP is the preferred OTC pain medication at reduced doses. There are no recommendations listed in Lexicomp®, just to use with caution and use a limited, low-dose therapy.
Which of the following is appropriate management for ascites? (Select all that apply)
A. Spironolactone monotherapy B. Furosemide monotherapy C. Spironolactone and furosemide D. Salt restriction E. Fluid restriction
A, C, D
Tx:
1.) Sodium <2 g/day
2.) Avoid NSAIDs
3.) Spironolactone monotherapy
4.) Spironolactone + furosemide
Furosemide MONOTHERAPY is not recommended
3.) Liver transplant
What is the dose of spironolactone + furosemide for an ascites patient?
Ratio of Spironolactone + furosemide: 40 mg of furosemide and 100 mg spironolactone.
-This will mantain a balance of potassium.
Black box warnings for All HBV NRTIs (2)?
- Lactic acidosis and severe hepatomegaly with steatosis
- Exacerbations of HBV may occur upon discontinuation
NRTIs used in the treatment of HBV include: Lamivudine (Epivir HBV®) Adefovir (Hepsera®) Tenofovir (Viread®) Entecavir (Baraclude®) Telbivudine (Tyzeka®)
What are the toxicities associated with ribavirin (select all that apply)? A.) CrCl <50 ml/min B.) Hemolytic anemia C.) Pregnancy D.) Do not use as monotherapy E.) CNS toxicities
A, B, C, D RIBAvirin R-renal: CrCl<50 I-in combination only B-birth defects A-hemolytic anemia
What is the brand name of the combination product paritaprevir + ritonavir + ombitasvir?
Paritaprevir + ritonavir + ombitasvir (Technivie®) is a combination product of DAA agents for treatment of HCV.
Generic of Mavyret?
glecaprevir/pibrentasvir
What is the brand name of the combination product paritaprevir + ritonavir + ombitasvir + dasabuvir?
Paritaprevir + ritonavir + ombitasvir + dasabuvir (Viekira Pak®)
