Hepatitis B Medications Flashcards
Is there treatment for an ACUTE HBV infection?
NO - resolves on its own
What are 3 goals for treatment of CHRONIC HBV infection?
- Decrease HBV DNA
- Convert HbeAg from (+) to (-)
- Decrease ALT/AST
If the goals for treatment of Chronic HBV infection are achieved, what will that do?
Lower the patient’s risk for cirrhosis, hepatocellular carcinoma and liver transplant
Is it possible to cure HBV?
RARE - do not usually eradicate the virus
Why is it rare to cure HBV?
The covalently closed circular viral DNA always exists in cell and is a reservoir that gives HBV the ability to reactivate
Relapse is more common in those co-infected with?
HDV
What are 6 drugs that can treat Chronic HBV?
Entecavir Tenofovir Disoproxil Adefovir Lamivudine Telbivudine PEG Interferon Alfa-2a
What are 6 drugs that can treat Chronic HBV?
Entecavir Tenofovir Disoproxil Adefovir Lamivudine Telbivudine PEG Interferon Alfa-2a
What are 6 drugs that can treat Chronic HBV?
Entecavir Tenofovir Disoproxil Adefovir Lamivudine Telbivudine PEG Interferon Alfa-2a
Nucleoside Analogue Reverse Transcriptase
Entecavir
Indications for Entecavir?
** > 2 years old:
Chronic HBV infection with active viral replication
- with elevated AST/ALT OR
- histologically active disease
Adverse effects of Entecavir?
Headache
Fatigue
Dizziness
Nausea
Nucleotide Analog HIV-1 and HBV Reverse Transcriptase (-)
Tenofovir Disoproxil
Indications for Tenofovir Disoproxil?
** > 12 years old:
Chronic HBV infection
HIV-1 infection
Contraindications and adverse effects for Tenofovir Disoproxil?
Do not take if new onset or worsening renal impairment
= NEPHROTOXIC, nausea
Nucleotide Analog
Adefovir
Indications for Adefovir?
** > 12 years old:
Chronic HBV infection
Contraindications of Adefovir?
- If patients have hypersensitivity reaction
- May cause NEPHROTOXICITY or worsen hepatitis
Due to Adefovir’s ability to be nephrotoxic, what should you monitor during therapy?
Renal function
Adverse effects of Adefovir?
NEPHROTOXICITY
asthenia (weakness)
Increased creatinine
Adefovir has drug interactions. What drugs will it react with and what happens?
Drugs that decrease renal function
= increases serum concentrations of Adefovir or other agent
Which drugs are potentially nephrotoxic?
Tenofovir Disoproxil
Adefovir
Nucleoside Analogue Reverse Transcriptase (-)’s?
Lamivudine
Telbivudine
Nucleoside Analogue Reverse Transcriptase (-)’s?
Lamivudine
Telbivudine
Lamivudine can also treat?
HIV-1
What are the contraindications for Lamivudine?
- patients with hypersensitivity to iamivudine
- Pancreatitis
- In pts with HIV-1 and HBV using ART that includes iamivudine = iamivudine resistant HBV
Adverse effects of Lamivudine?
Headache, nausea, fatigue, cough, diarrrhea
Indications for Telbivudine?
Chronic HBV infection with viral replication and
- elevated AST/ALT OR
- histologically active disease
Telbivudine + PEG Interferon Alfa-2a may cause?
Peripheral neuropathy
Telbivudine + PEG Interferon Alfa-2a may cause?
Peripheral neuropathy
Adverse effects of Telbivudine?
Fatigue
Elevated Creatinine Kinase
Headache and cough
PEG Interferon Alpha-2a can treat?
HBV and HCV chronic infections
What are 3 contraindications for PEG Interferon Alfa-2a?
- Autoimmune hepatitis
- Hepatic decompensation
- neonates/infants
Adverse effects of PEG Interferon Alfa-2a?
Flu like - fatigue, fever, muscle aches
BB warning with PEG Interferon Alfa-2a?
Serious disorders and Ribavirin-associated effects
Which drugs have similar BB warnings?
Entecavir
Tenofovir Disoproxil
Lamivudine
Telbivudine
Which drugs have similar BB warnings?
Entecavir
Tenofovir Disoproxil
Lamivudine
Telbivudine
What is the most common BB warnings?
Exacerbations of Hepatitis B
Lactic Acidosis
Hepatomegaly (+/- steatosis)
What is the most common BB warnings?
Exacerbations of Hepatitis B
Lactic Acidosis
Hepatomegaly (+/- steatosis)
Entecavir includes a BB warning with the usual items +?
Patient’s co-infected with HIV and HBV
