Hepatitis C Medications

Question 1

What is the goal of treatment for Hepatitis C infection?

Answer 1

ERADICATION of the virus

Question 2

What is the goal of treatment for Hepatitis C infection?

Answer 2

ERADICATION of the virus

Question 3

What is the sustained viral response (SVR)?

Answer 3

Absence of detectable viremia 24 weeks after therapy

Question 4

Is relapse possible in some patients?

Answer 4

Yes

Question 5

Why may some practitioners wait to start therapy after the initial HCV infection?

Answer 5

20-25% of HCV will clear on its own

– delay therapy to see if it will do so

Question 6

What are the agents and combos to treat HCV?

Answer 6

PEG Interferon Alfa-2b
Elbasvir/Grazoprevir
Ledipasvir/Sofosbuvir
Velpatasvir/Sofosbuvir
Ribivarin
Boceprevir

Question 7

What are the agents and combos to treat HCV?

Answer 7

PEG Interferon Alfa-2b
Elbasvir/Grazoprevir
Ledipasvir/Sofosbuvir
Velpatasvir/Sofosbuvir
Ribivarin
Boceprevir

Question 8

What are the agents and combos to treat HCV?

Answer 8

PEG Interferon Alfa-2b
Elbasvir/Grazoprevir
Ledipasvir/Sofosbuvir
Velpatasvir/Sofosbuvir
Ribivarin
Boceprevir

Question 9

Indications for PEG Interferon Alfa-2b?

Answer 9

• • > 18

- Chronic HCV with history of blood exposure and (+) HCV antibody

Question 10

Contraindications and adverse effects of PEG Interferon Alfa-2b?

Answer 10

• Autoimmune Hepatitis
• Hepatic Decompensation
  = Flu-like effects

Question 11

BB warning for PEG Interferon Alfa-2b?

Answer 11

May cause or worsen LIFE-THREATENING neuropsych, autoimmune, ischemic and infectious disorders

Question 12

MOA for Elbasvir/Grazoprevir

Answer 12

Elbasvir - Ns5A (-)

Grazoprevir - Ns3/4 Protease (-)

Question 13

Contraindications for Elbasvir/Grazoprevir?

Answer 13

• Hepatic impairment

- May also cause ALT increase

Question 14

Adverse effects of Elbasvir/Grazoprevir?

Answer 14

Headache, fatigue, nausea

Question 15

Do not give Elbasvir/Grazoprevir with?

Answer 15

CYP3A inducers = decrease the concentrations of these drugs!

Question 16

MOA for Ledipasvir/Sofosbuvir?

Answer 16

Ledipasvir - Ns5A (-)

Sofosbuvir - Nucleotide analog Ns5B polymerase (-)

Question 17

Contraindications for Ledipasvir/Sofosbuvir?

Answer 17

Do not give with other drugs that contain Sofosbuvir

Question 18

Adverse effects of Ledipasvir/Sofosbuvir?

Answer 18

Headache, fatigue

Question 19

Do not give Ledipasvir/Sofosbuvir with?

Answer 19

Polyglycoprotein inducers = alter concentrations of these drugs!

Question 20

What are examples of polyglycoprotein inducers that should not be given with Ledipasvir/Sofosbuvir?

Answer 20

Rifampin

St. John’s Wort

Question 21

MOA for Velpatasvir/Sofosbuvir?

Answer 21

Velpatasvir - Ns5A (-)

Sofosbuvir - Nucleotide analog Ns5B polymerase (-)

Question 22

Indications for Velpatasvir/Sofosbuvir?

Answer 22

HCV infection w/o or w/ compensated cirrhosis

Question 23

What can you add to Velpatasvir/Sofosbuvir to treat decompensated cirrhosis?

Answer 23

Ribavirin

Question 24

Contraindications for Velpatasvir/Sofosbuvir?

Answer 24

• If ribavirin is contraindicated

- Can potentiate bradycardia with amiodarone

Question 25

When should you use caution with Velpatasvir/Sofosbuvir?

Answer 25

Patients on beta blockers, or that have cardiac and liver disease

Question 26

Adverse effects of Velpatasvir/Sofosbuvir?

Answer 26

Headache and fatigue

Question 27

Do not give Velpatasvir/Sofosbuvir with?

Answer 27

Polyglycoprotein and CYP inducers = decreases concentrations of these drugs!

Question 28

What are examples of polyglycoprotein inducers that should not be given with Velpatasvir/Sofosbuvir?

Answer 28

Rifampin | St. John's wort

Question 29

Nucleoside analog

Answer 29

Ribavirin

Question 30

Ribavirin is used in combo with?

Answer 30

In combo with PEG Interferon Alfa-2a

Question 31

Contraindications for Ribavirin?

Answer 31

Pregnant women and their male partners | Hemoglobinopathies

Question 32

Adverse effects of Ribavirin?

Answer 32

Fatigue, weakness, fever, muscle aches

Question 33

BB warning for Ribavirin?

Answer 33

Birth defects and fetal death | -- Do not use in pregnancy

Question 34

When should you not use Ribavirin?

Answer 34

During pregnancy or 6 months before coming pregnant

Question 35

MOA for Boceprevir?

Answer 35

Ns3/4A protease (-)

Question 36

Boceprevir is given with?

Answer 36

PEG Interferon Alfa and Ribavirin

Question 37

Boceprevir is given with?

Answer 37

PEG Interferon Alfa and Ribavirin

Question 38

Adverse effects of Boceprevir?

Answer 38

``` Altered taste (dysguesia) Fatigue, headache, nausea ```

Question 39

Which drug is for those who have failed previous treatments?

Answer 39

Boceprevir | - + PEG interferon Alfa and Ribavirin

Question 40

Which drug can cause altered taste (dysguesia)?

Answer 40

Boceprevir