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06. GI > Hepatitis Drugs > Flashcards

Hepatitis Drugs Flashcards

1
Q

Goals for hepatitis B treatment

A
  • virus will not be fully eradicated and relapse is possible even if therapy is successful
  • goal is to slow cirrhosis and hepatocellular carcinoma development
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2
Q

MOA interferons

A
  • activate JAK1 and TYK2
  • phosphorylated receptor leads to activation of STAT 1/2
  • these go to the nucleus and transcribe interferon stimulated genes
  • these inhibit viral protein synthesis
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3
Q

Indications for interferons

A

used in well compensated liver disease, don’t want long term treatment (may be want to get pregnant in 2-3 years)

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4
Q

interferon with short half life (+frequency of administration)

A

interferon alpha-2b (must be given every 36 hours)

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5
Q

interferons with longer half life

A

1) PEGylated interferon α-2b

2) PEGylated interferon α-2a

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6
Q

adverse effects of interferons

A

80% of patients have flu-like syndromes, bone marrow suppression, and neurotoxicity. Improve with continued therapy

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7
Q

Initial reaction to interferons

A

leads to a flare of hepatitis (good sign)

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8
Q

Contraindications interferons

A
  • dangerous in decompensated cirrhosis (flare will make liver disease much worse)
  • don’t use with patients wanting to be pregnant soon
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9
Q

nucleoside drugs (3)

A
  • Lamivudine
  • telbivudine
  • Entecavir
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10
Q

Nucleotide drugs (2)

A
  • Tenofivir

- Adefovir

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11
Q

MOA Nucleoside and Nucleotides

A

incorportated into viral DNA to block transcription of hepatitis B virus (HBV DNA reverse transciptase/DNA polymerase inhibitors)

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12
Q

First line nucleoside/nucleotide for HBV infection

A

Entecavir (guanosine analog)

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13
Q

First line nucleoside/nucleotide for HBV infection if resistant to nucleosides

A

Tenofovir

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14
Q

Suffix Nucleotides

A

-fovir

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15
Q

Adverse effects tenofovir

A

nephrotoxicity (proximal renal tubule)

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16
Q

Highlights nucleoside/nucleotide drugs (3)

A
  • oral agents that suppress HBV
  • better tolerated and higher response rate than interferon Tx
  • can be used in patients with decompensated cirrhosis
17
Q

What HBV drug (nucleoside/nucleotide) is better for renal insufficiency patients?

A

nucleosides (entecavir)

18
Q

Factors influencing selection for nucleotide/sides for HBV treatment

A
  • resistance profile
  • efficacy (clearance of HBV DNA)
  • usefulness with HIV co-infection
19
Q

Do therapies for HBV fully eradicate the virus?

A

NO, relapse is always possible, even with therapy

20
Q

nucleoside for HCV used in concert with PEG interferons to potentiate their action

A

Ribavirin (guanosine analog)

21
Q

Suffix NS3/4A inhibitors

A

-previr

22
Q

Suffix NS5B inhibitors

A

-buvir

23
Q

Suffix NS5A inhibitors

A

-asvir

24
Q

Treatment for patients with both HBV and HCV

A

treatment directed at predominant virus

25
Q

Contraindications Ribavirin

A

anemia and pregnancy (specific regimen listed out months tests and 2 forms of birth control)

26
Q

MOA grazoprevir, paritaprevir, simeprevir

A

inhibit NS3/4A serine protease

27
Q

Adverse interactions paritaprevir

A

CYP3A, drug-drug interaction

28
Q

Special instructions for Simeprevir use

A

must be taken with food to maximize absorption

29
Q

MOA dasabuvir, sofobuvir

A

inhibit NS5B RNA polymerase (polymerase is highly conserved so it is effective against all 6 HCV genotypes)

30
Q

interactions dasabuvir

A

CYP3A, drug-drug interactions

31
Q

Interactions elbasvir, ombitasvir

A

CYP3A

32
Q

First once-daily single-tablet regimen with pangenotypic activity

A

Velpatasvir + sofosbuvir

33
Q

nucleoside vs nucleotide

A

nucleoside: -OH group
nucleotide: phosphate group

34
Q

Can HCV be cured?

A

Yes, because it is RNA and not incorporated into the host DNA

06. GI (7 decks)

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