Hepatitis & Liver Disease Flashcards
Hepatitis means…
inflammation of the liver
Causes of hepatitis include…
hepatitis viruses A, B, C, D, E (most common); alcohol, drugs, autoimmune conditions, drugs, other viruses/infections
There 6 different HCV genotypes (1-6) and various subtypes. Preferred HCV regiments consist of…
2-3 direct-acting antivirals (DAAs) with different mechanisms, usually for 8-12 weeks
NS3/4A protease inhibitors
end in -previr (take with food)
NS5A replication complex inhibitors
end in-Asvir
NS5B polymerase inhibitor
end in -Buvir
Which drug can be added to DAA therapy as an alternative?
ribavirin
For treatment-naive patients with cirrhosis, recommended pan-genotypic regimens are…
- glecaprevir/pibrentasvir (Mavyret)
- sofosbuvir/velpatasvir (Epclusa)
Before starting DAAs, test patients for…
HBV (BBW includes risk of reactivating HBV)
Serious symptomatic bradycardia has happened when combining sofosbuvir with…
amiodarone and another DAA. **Do not use amiodarone with sofosbuvir.
Which DAAs should be dispensed in their original containers?
Sovaldi, Epclusa, Harvoni, Vosevi
Which DAAs are approved for HCV/HIV co-infection?
Epclusa, Harvoni and Mavyret
Which DAAs are approved for children ≥ 12 years old with certain genotypes?
Sovaldi and Harvoni
Which DAAs include ritonavir as a PK booster?
- paritaprevir/ritonavir/ombitasvir (Technivie)
- paritaprevir/ritonavir/ombitasvir/dasabuvir (Viekira Pak)
PPIs cannot be used with…
Epclusa
Antacids should be avoided or separated from…
ledipasvir and velpatasvir-containing regimens (Epclusa, Harvoni, Vosevi)
All DAAs are contraindicated with…
strong CYP3A4 inducers
Ethinyl estradiol-containing products, lovastatin, and simvastatin are specifically contraindicated with…
Technivie and Viekira
Viekira Pak counseling
Take 2 tablets of paritaprevir/ritonavir/ombitasvir once daily in the AM and 1 dasabuvir tablet BID with meals
Ribavirin should not be used as monotherapy and is only approved for..
HCV
Ribavirin BBW
Teratogenic (Category X); hemolytic anemia (mostly occurring within 4 weeks of therapy).
C/I: CrCL <50 mL/min
Ribavirin counseling
Avoid pregnancy in females and female partners of male patients during therapy and 6 months after completion; at least 2 reliable forms of effective contraception are required during tx and in the 6-month post-treatment period
RIBA (ribavirin)
R- Renal (CI when CrCl <50 mL/min)
I- In combination only
B- Birth Defects
A- Anemia: hemolytic (primary toxicity)
Pegylated forms have polyethylene glycol, which is added…
to PEG-interferon-alpha (Pegasys, PegIntron) to prolong the half-life (weekly dosing)
Interferon is no longer recommended in HCV guidelines but may be used when other treatments are C/I or too expensive. BBW include…
Can cause or exacerbate neuropsychiatric, autoimmune, ischemic or infectious disorders
Interferon (C/Is and Side effects: Flu-like syndrome) Pre-treat with acetaminophen and an antihistamine.
C/I: autoimmune hepatitis, decompensated liver disease in cirrhotic patients, infants/neonates (Pegasys)
S/Es: CNS effects, fatigue, depression, anxiety, weakness, GI upset, increased LFTs, myelosuppression, mild alopecia
Interferon-alpha is approved as monotherapy, and is a preferred treatment, for…
HBV
Before starting HBV therapy, all patients should be tested for…
HIV
All HBV NRTIS should be renally dose-adjusted when CrCl is less than…
50 mL/min (except Vemlidy)