Hepatitis/Liver Disease Flashcards
1
Q
NS3/4A Protease Inhibitor
A
- previr (P for PI), type of DAA
- Glecaprevir (part of Mavyret)
- Grazoprevir
- Paritaprevir
- Voxilaprevir
2
Q
NS5A Replication Complex Inhibitors
A
- asvir (A for NS5A), type of DAA
- Elbasvir
- Ledipasvir
- Ombitasvir
- Pibrentasvir (part of Mavyret)
- Velpatasvir (part of Epclusa)
3
Q
NS5B Polymerase Inhibitors
A
- buvir (B for NS5B), type of DAA
- Dasabuvir
- Sofosbuvir (part of Epclusa)
4
Q
All DAAs
A
- Risk of reactivacting HBV, test ALL patients before starting DAA
- Sofosbuvir-regimens: don’t use with amiodarone (parcerone), serious bradycardia
- Well-tolerated medications overall
5
Q
Epclusa
A
- Sofosbuvir/velpatasvir - 1 tablet daily with or without food
- Monitor drug interactions, some potentially serious
- Sofosbuvir not recommended monotherapy
- Dispense in original container (protect from moisture)
- Avoid/minimize with acid-suppressive therapy (potentially less absorption/untreated hepatitis)
- Pan-genotypic for HCV treatment-naive patients
6
Q
Mavyret
A
- Glecaprevir/pibrentasvir - 3 tablets by mouth once daily with food
- Only 8 week course of treatment
- Pan-genotypic for HCV treatment-naive patients
7
Q
Regimens for Special HCV Situations
A
- Salvage therapy: Mavyret (select patients), Vosevi
- HCV/HIV co-infection: Mavyret, Epclusa, Harvoni
- Approved for children: Sovaldi/Harvoni (>3 years old), Epclusa (>6 yo), Mavyret (>12 yo)
8
Q
Viekira Pak
A
- 2 tablets of paritaprevir/ritonavir/ambitasvir once daily (morning) and 1 tablet of dasabuvir BID with meals
- CI: CYP3A4 inducers/substrates (increase levels and cause toxicities), ethinyl estradiol products (during and 2 weeks after stopping)
- Warning: Hepatic decompensation/failure in cirrhotic patients, increased LFTs (>5x ULN), significant DDI potential
9
Q
Zepatier
A
- Elbasvir/grazoprevir
- CI: strong inducers of CYP3A4
- Warnings: Increased LFTs (>5x ULN), significant DDI potential
10
Q
Ribavirin
A
- Used in combination with other agents, never monotherapy
- Aerosolized: used for respiratory syncytial virus (RSV)
- Warnings: hemolytic anemia, significantly teratogenic (child-bearing age women and male partners)
- CI: Pregnancy
- Avoid during therapy and 6 months after completion in child bearing population, use 2 reliable forms of birth control during this time
11
Q
Interferon alfa
A
- Injected SQ, 3x/week normally (Intron), once/week PEGylated (PegIntron)
- Alfa works on HCV, HBV (monotherapy), and some cancers
- Warning: Can cause neuropsychiatric, ischemic, or infectious disorders; ribavirin coadministration teratogenic/anemia risk
- SE: CNS effects (fatigue, depression), GI upset, increased LFTS (5-10x ULN) myelosuppressions, flu-like syndrome (fever, chills, malaise)
- Pretreat with APAP or antihistamine
12
Q
ALL HBV NRTIs
A
- Boxed Warning: Lactic acidosis and severe hepatomegaly with steatosis (can be fatal)
- Exacerbations of HBV can occur is discontinued abruptly
13
Q
Tenofovir-containing products
A
- TDF (Tenofovir disoproxil fumarate)/Viread or TAF (Tenofovir alafenamide)/Vemlidy
- Preferred therapies for HBV
- Warning: (NOF) Fanconi syndrome, osteomalacia, decreased bone mineral density from renal toxicity
- SE: renal impairment/decreased BMD for TDF, nausea for TAF (TAF has less renal tox. than TDF)
- Dispense both in original containers to protect from moisture
14
Q
Baraclude
A
- Entecavir
- Preferred HBV therapy
- Take on an empty stomach
15
Q
Hepsera
A
- Adefovir
- Caution in patient with renal impairment or at risk for renal toxicity (nephrotoxic drugs or NSAIDs)
- Don’t use with tenofovir containing regimens due to increased virological failure/side effect potential
