Hepatitis C Medications Flashcards
What is the goal of treatment for Hepatitis C infection?
ERADICATION of the virus
What is the goal of treatment for Hepatitis C infection?
ERADICATION of the virus
What is the sustained viral response (SVR)?
Absence of detectable viremia 24 weeks after therapy
Is relapse possible in some patients?
Yes
Why may some practitioners wait to start therapy after the initial HCV infection?
20-25% of HCV will clear on its own
– delay therapy to see if it will do so
What are the agents and combos to treat HCV?
PEG Interferon Alfa-2b Elbasvir/Grazoprevir Ledipasvir/Sofosbuvir Velpatasvir/Sofosbuvir Ribivarin Boceprevir
What are the agents and combos to treat HCV?
PEG Interferon Alfa-2b Elbasvir/Grazoprevir Ledipasvir/Sofosbuvir Velpatasvir/Sofosbuvir Ribivarin Boceprevir
What are the agents and combos to treat HCV?
PEG Interferon Alfa-2b Elbasvir/Grazoprevir Ledipasvir/Sofosbuvir Velpatasvir/Sofosbuvir Ribivarin Boceprevir
Indications for PEG Interferon Alfa-2b?
- > 18
- Chronic HCV with history of blood exposure and (+) HCV antibody
Contraindications and adverse effects of PEG Interferon Alfa-2b?
- Autoimmune Hepatitis
- Hepatic Decompensation
= Flu-like effects
BB warning for PEG Interferon Alfa-2b?
May cause or worsen LIFE-THREATENING neuropsych, autoimmune, ischemic and infectious disorders
MOA for Elbasvir/Grazoprevir
Elbasvir - Ns5A (-)
Grazoprevir - Ns3/4 Protease (-)
Contraindications for Elbasvir/Grazoprevir?
- Hepatic impairment
- May also cause ALT increase
Adverse effects of Elbasvir/Grazoprevir?
Headache, fatigue, nausea
Do not give Elbasvir/Grazoprevir with?
CYP3A inducers = decrease the concentrations of these drugs!
MOA for Ledipasvir/Sofosbuvir?
Ledipasvir - Ns5A (-)
Sofosbuvir - Nucleotide analog Ns5B polymerase (-)
Contraindications for Ledipasvir/Sofosbuvir?
Do not give with other drugs that contain Sofosbuvir
Adverse effects of Ledipasvir/Sofosbuvir?
Headache, fatigue
Do not give Ledipasvir/Sofosbuvir with?
Polyglycoprotein inducers = alter concentrations of these drugs!
What are examples of polyglycoprotein inducers that should not be given with Ledipasvir/Sofosbuvir?
Rifampin
St. John’s Wort
MOA for Velpatasvir/Sofosbuvir?
Velpatasvir - Ns5A (-)
Sofosbuvir - Nucleotide analog Ns5B polymerase (-)
Indications for Velpatasvir/Sofosbuvir?
HCV infection w/o or w/ compensated cirrhosis
What can you add to Velpatasvir/Sofosbuvir to treat decompensated cirrhosis?
Ribavirin
Contraindications for Velpatasvir/Sofosbuvir?
- If ribavirin is contraindicated
- Can potentiate bradycardia with amiodarone
When should you use caution with Velpatasvir/Sofosbuvir?
Patients on beta blockers, or that have cardiac and liver disease
Adverse effects of Velpatasvir/Sofosbuvir?
Headache and fatigue
Do not give Velpatasvir/Sofosbuvir with?
Polyglycoprotein and CYP inducers = decreases concentrations of these drugs!
What are examples of polyglycoprotein inducers that should not be given with Velpatasvir/Sofosbuvir?
Rifampin
St. John’s wort
Nucleoside analog
Ribavirin
Ribavirin is used in combo with?
In combo with PEG Interferon Alfa-2a
Contraindications for Ribavirin?
Pregnant women and their male partners
Hemoglobinopathies
Adverse effects of Ribavirin?
Fatigue, weakness, fever, muscle aches
BB warning for Ribavirin?
Birth defects and fetal death
– Do not use in pregnancy
When should you not use Ribavirin?
During pregnancy or 6 months before coming pregnant
MOA for Boceprevir?
Ns3/4A protease (-)
Boceprevir is given with?
PEG Interferon Alfa and Ribavirin
Boceprevir is given with?
PEG Interferon Alfa and Ribavirin
Adverse effects of Boceprevir?
Altered taste (dysguesia) Fatigue, headache, nausea
Which drug is for those who have failed previous treatments?
Boceprevir
- + PEG interferon Alfa and Ribavirin
Which drug can cause altered taste (dysguesia)?
Boceprevir
